We report this rare case of carcinoma of the endometrium in a 62-year-old woman who presented with recurrent postmenopausal bleeding. Her medical condition was unremarkable. She underwent a diagnostic hysteroscopy which showed a large polyp on the posterior uterine wall. Polypectomy was performed and the histological report of the polyp showed a complex adenomatous lesion of uncertain malignant potential, therefore she had a standard pelvic MRI staging scan which revealed no evidence of pelvic lymphadenopathy, cystic changes in the cervix and a lesion on the left side of the fundus which appeared to be associated with some thinning of the endometrium which could represent invasion, however, it was not full thickness and the MRI excluded extra-uterine spread.
The patient underwent a total abdominal hysterectomy and bilateral oophorectomy. The pelvis looked clear; both ovaries looked healthy with no lymphadenopathy, and peritoneal washings were taken and sent for cytology.
Macroscopically the uterus showed a large soft peach coloured polyp in the endometrial cavity 20 × 9 × 20 mm and a small yellow deposit in the myometrium 3 mm in size 2 mm adjacent to the polyp. Microscopically, the polyp was composed of cord, nests, trabecular and occasional glandular structure that were formed by small tumour cells that resembled the granulosa cells of ovarian granulosa cell tumours (see Figure ). Occasional luteinized like cells with abundant foamy cytoplasm were seen only focally, thought to reflect leydig cell differentiation. The tumour immunostained with antibodies that recognize sex cord elements(inhibin, calretinin and CD99), epithelial differentiation (AE1/3 and MNF1165, but not EMA) and myoid (a mesenchymal marker) and WT1, but not CD10, a marker of endometrial stromal cells. All tumour cells expressed oestrogen and progesterone strongly.
Microscopic image of the polyp found in the endometrial cavity.
At the present, the patient is asymptomatic and is undergoing a yearly check up with pelvic examination and ultrasound scanning which have been normal so far.