Case 1 -
Metastatic Colorectal Adenocarcinoma Involving the Endometrium
The University of Texas, M.D. Anderson Cancer Center
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The patient is a 64 year old woman who presented with vaginal bleeding. On abdominal/pelvic CT scan,
there was a large area of ill defined hypodensity centered over the endometrial cavity in the mid and
lower uterine body, suspicious for endometrial carcinoma. An endometrial biopsy was obtained.
Case 1 - Slide 1
- Endometrioid Endometrial Adenocarcinoma
- Endocervical Adenocarcinoma
- Serous Carcinoma
- Metastatic Adenocarcinoma
- Not all adenocarcinomas identified in an EMB are from the
endometrium. Cervical primaries and metastases may also be encountered in these specimens.
- Most patients with metastases involving the uterus have a prior
history of cancer, but some metastases may mimic a primary gynecologic tumor. Approximately 1% of
patients referred to a gynecologic oncologist actually have gastrointestinal primaries, and in 20-30% of
those cases the metastasis is the initial presentation of their disease.
- While the ovary and the vagina are the most common sites of
metastasis to the gynecologic tract (80% of metastases involve at least one of those two sites), the
endometrium and cervix are involved in 8-9% of cases (intragenital and extragenital primaries).
- The ovary is the most common intragenital primary to involve the
uterus. The gastrointestinal tract (stomach, colon, pancreas) and breast are the most common
- While it is important to consider the possibility of a metastasis in
women who have a history of colorectal cancer and subsequently are found to have an adenocarcinoma
involving the uterus, they are more likely to have a new endometrial primary (74%) than metastatic
colonic adenocarcinoma involving the endometrium.
- Histologic clues for metastatic colorectal carcinoma:
Immunohistochemistry (CK7, CK20) can be useful.
- Tumor distinctly separate from normal endometrium.
- Scattered focal cytologic atypia, inappropriate for the architectural grade.
- Dirty necrosis.
- Goblet cells.
- Fibrotic background.
Metastatic Colorectal Adenocarcinoma involving the endometrium
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