Table 1 Clinical and pathologic features of four patients with dedifferentiated endometrioid adenocarcinoma (DEAC) of uterus
Case 1 | Case 2 | Case 3 | Case 4 | |
|---|---|---|---|---|
Clinical features | ||||
Age at diagnosis, years | 77 | 54 | 60 | 52 |
Age at menopause, years | 60 | 51 | 52 | Not applicable |
Presentation | Postmenopausal bleeding | Postmenopausal bleeding | Postmenopausal spotting | Perimenopausal bleeding |
Initial diagnosis | Poorly differentiated carcinoma | Endometrioid adenocarcinoma, FIGO grade 3 | Pap smear: adenocarcinoma vaginal biopsy: poorly differentiated carcinoma | Leiomyoma |
Imaging findings | MRI: 8.6 × 3.7 cm sized heterogeneously enhanced mass on CET1WI with involvement of the cervical stroma | MRI: 5.0 × 3.6 cm sized lobulated mass filling endometrial cavity with slightly high SI in T2WI and poor enhancement than adjacent myometrium | MRI: 7.2 × 3.5 cm sized lobulated mass which showed high SI on T2WI and low SI on T1WI with heterogeneous enhancement | CT: 10 cm sized low density mass in the endometrial cavity and cervical canal |
Surgical management | TH/BSO/PLND | TH/BSO/PLND/PALND | Wide cuff TH/BSO | TH/BSO/PLND/PALND |
Operative findings | Cancer extension to cervix | Invasion to superficial myometrium | Cancer extension to cervix and vaginal wall extension | Necrotic mass filling endometrial cavity with protruding through cervical canal |
Postoperative management | Refused | Not needed | Chemotherapy (CDDP + ADR + CTX) and EBRT(50 Gy) + ICR(20 Gy/4fx) | EBRT(50 Gy) + ICR(20 Gy/4fx) |
First postoperative recurrence or progression | 1 month | None | 1 month | None |
FIGO surgical stage | II | IA | IIIB | II |
Clinical history | Hypertension | Hypertension | Hypertension | None |
Family history | None | None | Gastric cancer (mother) | None |
Status at last follow-up | DOD (7 weeks) | NED (19 months) | DOD (10 months) | NED (39 months) |
Pathologic features | ||||
Tumor location | Fundus, body, lower uterine segment, cervix | Body | Body, lower uterine segments | Body, lower uterine segment |
Tumor grade | G2 (80%) + UC (20%) | G1 (70%) + UC (30%) | G1 (10%) + UC (90%) | G2 (40%) + UC (60%) |
Myometrial invasion | Full thickness of myometrium | <1/2 of myometrium | <1/2 of myometrium | >1/2 of myometrium |
Lymphovascular space invasion (LSI) | Present | Present | Present | Present |
Cervical stromal invasion | Present | Absent | Present | Present |
Ovaries and fallopian tubes | Unremarkable | Unremarkable | Unremarkable | Unremarkable |