Transitional Cell Carcinoma of the Endometrium

Primary Transitional Cell Carcinoma of the Endometrium: A Case Report and Review of Literature

Transitional cell carcinoma of the endometrium is a rare cancer. We present a 58-year-old Caucasian female was diagnosed with high-grade polyploid transitional cell carcinoma of the endometrium. The pathological findings included a dense serosal adhesion over the fundus and the posterior wall, necrotic and polyploid papillary mass in the endometrial cavity, serosal adhesions and unremarkable parenchyma in the fallopian tubes. Others were the presence of cancer antigen 125 and cytokeratin 7 and absence of cytokeratin 20, actin, estrogen receptor, soluble protein 100, vimentin, and cytokeratin high molecular weight.

The case is relevant to practice as it identifies the histological patterns for primary transitional cell carcinoma of the endometrium, including expressing cytokeratin 7 instead of cytokeratin 20. The tumor showed a papillary and solid architecture and composed of undifferentiated to poorly differentiated cells with no defined glandular nor squamous differentiation.

Transitional cell carcinoma of endometrium: a case report of rare pure form

Transitional cell carcinoma is a very rare histological subtype of endometrial cancer, with only 18 cases described in literature. Ovary represents the most common site where it accounts for 2% of all ovarian cancers. Due to the rarity of this disease, current management is controversial and includes various approaches, mostly described in the adjuvant setting, both radiotherapy and chemotherapy alone or in combination. Here, we report a case of a 65-year-old patient who underwent adjuvant vaginal brachytherapy for an endometrial transitional cell carcinoma. The patient was treated with radical total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAH-BSO), without lymph-node sampling, and adjuvant endocavitary brachytherapy delivering 30 Gy in 5 fractions in consecutive days. Treatment tolerance was excellent, with only G1 genitourinary acute toxicity and no other adverse events reported. In this experience, the choice of brachytherapy alone resulted in excellent local control outcomes. However, the patient developed a distant recurrence after 43 months and chemotherapy was applied. More research is required to determine the most effective treatment for this rare histological subtype, and in particular, the role of chemotherapy and radiotherapy combinations.

Pathology of uterine malignancies

This overview covers epithelial, stromal and mesenchymal malignancies of the body of the uterus, excluding the cervix. The distinction of type I and type II endometrial adenocarcinoma with the morphological variants of this tumour is discussed and some molecular aspects are explored. The concept of carcinosarcoma representing a metaplastic adenocarcinoma of the endometrium that behaves more like a carcinoma than a sarcoma is explained. Some types of mixed epithelial and stromal neoplasm are described and contrasted with carcinosarcoma. The concept of stromal sarcoma and high-grade uterine sarcoma is described and an outline of malignant smooth muscle tumours of the uterus includes a description of smooth muscle tumours of uncertain malignant potential and worrying benign smooth muscle lesions.

Histopathology of endometrial hyperplasia and endometrial carcinoma: an update

Endometrial cancer (EC) is the most common malignancy of the female genital tract in the western world. Conceptually, a dualistic model of endometrial carcinogenesis exists for sporadic EC, based on molecular findings with a good correlation to the morphologic phenotype and clinical behavior. Type 1 endometrial carcinoma represents an estrogen-related tumor, which usually arises in the setting of endometrial hyperplasia, has endometrioid histology with low grade, and tends to be biologically indolent. Grade 3 endometrioid cancers, which constitute a minority of EC, also behave aggressively. The type 2 cancers are not estrogen-driven and have a higher grade, various histologies, particularly serous carcinomas and clear-cell carcinomas, and a poorer prognosis. The diagnostic criteria of endometrial hyperplasia, endometrial in situ carcinoma, and of the different histologic types of EC, according to the most recent World Health Organization classification, are given in detail. In addition, the risk of progression of endometrial hyperplasia into endometrioid type EC and their treatment modalities are discussed. Endometrial pathologies in patients with breast cancer, receiving tamoxifen, and women affected by hereditary nonpolyposis colorectal cancer syndrome are described, including their pathogenetic aspects. Finally, a short practical description for the handling of surgical specimens from fractional curetting and hysterctomies is given.