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Thanks to Dr. Ankur Sangoi, El Camino Hospital (California), for contributing this case. This case was reviewed in May 2020 by Dr. Jennifer Bennett, University of Chicago and Dr. Carlos Parra-Herran, University of Toronto. To contribute a Case of the Week, follow the guidelines on our Case of the Week page.
A 43 year old woman presented with uterine bleeding, leading to an endometrial biopsy. She subsequently underwent a total abdominal hysterectomy.
Total abdominal hysterectomy
What is your diagnosis?
Endometrioid adenocarcinoma, corded and hyalinizing pattern
In 2005, Young et. al. described uterine endometrioid carcinomas with epithelial cords, spindle cells and a hyalinized stroma that sometimes formed osteoid, mixed with classic endometrial carcinoma, which they termed "corded and hyalinized endometrioid carcinoma" (Am J Surg Pathol 2005;29:157). The mean patient age was 52 years, and 65% were stage I, despite the appearance of a sarcoma. In addition, 70% exhibited squamous differentiation, and 50% had background endometrial hyperplasia. Unusual features included cords of cells with a hyalinized of loose fibromyxoid stroma, and areas of diffuse spindle cells resembling endometrial stroma or even smooth muscle. Two thirds of the tumors were grade 1, and the remainder were grade 2. The classic endometrial carcinoma component was keratin positive, with weaker / variable staining in the epithelial cords. The cords were negative for muscle markers (desmin, actin), CD10, inhibin and p53. A subsequent study showed nuclear beta-catenin expression and complete loss of membranous E-cadherin expression in all cases, due to mutation of exon 3 of the beta-catenin gene in spindled or corded areas (Histol Histopathol 2009;24:149). These patients have a good prognosis after hysterectomy, with 83% alive with no evidence of disease at follow-up in the original study.