Contributed by Lisa Radkay, MD and R. Marshall Austin, MD
A 57 year old postmenopausal woman presented with spotting and underwent a routine Papanicolaou test. The patient had no previous medical history or pertinent family history.
The Thin Prep Pap test consisted of squamous cells, inflammatory cells, endocervical cells and endometrial cells with a clean background (Images 1, 2, 3, 4, 5, 6, 7, and 8). Some of the glandular cells were notably enlarged.
GROSS, HISTOLOGIC AND IMMUNOPHENOTYPIC FINDINGS
Due to the findings on the Pap test, the patient subsequently had an endometrial biopsy. Microscopically the biopsy consisted of fragments of tumor cells growing in a solid pattern (Images 9 and 10). The cytoplasm was pink and the nuclei were hyperchromatic and pleomorphic. There were areas with glandular formation (Images 11 and 12). The lesion stained diffusely strong for vimentin (Image 13), estrogen receptor (ER) (Image 14), progesterone receptor (PR) (Image 15), and p16 (Image 16) immunohistochemical stains. The lesion was negative for CK5 and CEA (carcinoembryonic antigen) immunohistochemical stains.
Due to the findings on the endometrial biopsy, the patient had a hysterectomy which revealed a 5.0 x 4.3 x 2.0 cm tan-pink, exophytic, friable mass located on the fundus and anterior endometrial cavity. This mass occupied approximately 75% of the anterior endometrial cavity, came to within 2.2 cm of the anterior serosa and 5.7 cm of the anterior cervix. There was also a 1.3 x 0.9 x 0.2 cm tan- pink friable area on the posterior endometrial cavity that occupied approximately 10% of the surface area. That area came to within 1.8 cm of the posterior serosa and 6.5 cm of the posterior cervix. The myometrium was tan-pink and grossly uninvolved by the mass. Microscopically, the mass consisted of more differentiated gland areas (Image 17) and solid less differentiated areas (Image 18). There was pleomorphism and mitoses present (Images 19 and 20). There was superficial invasion into the myometrium (Image 21).