20 July 2008 – Case of the Week #125


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We thank Dr. Mowafak Hamodat, Eastern Health of Newfoundland and Labrador, St. John’s, Canada for contributing this case.  To contribute a Case of the Week, email NatPernick@Hotmail.com with the clinical history, your diagnosis and diagnostic microscopic images in JPG, GIF or TIFF format (send as attachments, we will shrink if necessary).  Please include any other images (gross, immunostains, etc.) that may be helpful or interesting.  We will write the discussion (unless you want to), list you as the contributor, and send you $35 (US dollars) by check or PayPal for your time after we send out the case.  Please only send cases with high quality images and a diagnosis that is somewhat unusual (or a case with unusual features).


Case of the Week #125


Clinical History


A 62 year old woman presented to her gynecologist with postmenauposal bleeding.  Seven endometrial biopsies were taken, all showing negative results, although one was suggestive of an endometrial polyp.  Physical examination showed uterine prolapse with cystocele, for which the patient requested a hysterectomy.  Past medical history included well controlled hypertension, DVT and a mastectomy 12 years previous, for which she received Tamoxifen for a few years.  A hysterectomy was performed.  These sections are from an endometrial polyp.


Micro images:  #1;  #2#3


What is your diagnosis?




























Metastatic lobular carcinoma in an endometrial polyp.




Immunostains were confirmatory for a breast metastasis (ER, PR, GCDFP-15).  Metastases to the cervix (image #1#2) were also identified, with a similar morphology and staining pattern.  The mastectomy was apparently performed for lobular breast carcinoma, although no reports or slides were available.


Tamoxifen is an estrogen antagonist widely used for treatment or prevention of breast carcinoma.  It may cause endometrial proliferative abnormalities, including endometrial polyps (Obstet Gynecol 1992;79:111).  Since metastatic breast carcinoma to tamoxifen-associated polyps has been reported, usually involving lobular carcinoma (Ann Diagn Pathol 2005;9:166, Mod Path 2003;16:395, Gynecol Oncol 2005;97:946, Obstet Gynecol 2003;102:1149, Acta Obstet Gynecol Scand 1993;72:585), careful histologic evaluation of the endometrium is crucial in these patients.




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