A case of adenocarcinoma of the endometrial type mixed with a clear cell component that metastasized to the vagina

We present a patient with adenocarcinoma of the endometrial type mixed with a clear cell component (AMC) that metastasized to the vagina and one of the pelvic lymph nodes. She underwent a radical hysterectomy and pelvic and paraaortic lymphadenectomy, and then received postoperative adjuvant chemotherapy. Histologic features of the endometrial tumor included clear cell adenocarcinoma with an approximate 10% extent to endometrioid adenocarcinoma. On the other hand, histologic examination on the vaginal tumor predominatly showed clear cell adenocarcinoma and also revealed endometrioid adenocarcinoma to a very small extent, suggesting metastasis to the vagina from AMC. On immunohistochemical examination, expression of vascular endothelial growth factor (VEGF)-A, VEGF-C and VEGF-D was apparently stronger in the component of clear cell adenocarcinoma than in that of endometrioid adenocarcinoma. She has been a disease-free survivor for 26 months. Interestingly, locations of endometrial and vaginal lesions were consistent with the sites of an intrauterine device and ring pessary insertion, respectively.

Adenocarcinoma of the endometrial type mixed with a clear cell component; Vaginal metastasis; Intrauterine device; Ring pessary; VEGF

[1] Nicklin J. L., Petersen R. W.: "Stage 3B adenocarcinoma of the endometrium: a clinicopathologic study". Gynecol. Oneal., 2000, 78, 203.

[2] MacKillop W. J., Pringle J. F.: "Stage III endometrial carcinoma". Cancer, 1985, 56, 2519.

[3] Yamawaki T., Teshima H., Takeshima N., Yamauchi K., Hasumi K.: "A clinicopathological study in clear cell adenocarcinoma of the endometrium". Acta. Obstet. Gynaec. Jpn., 1996, 48, 328.

[4] Yokoyama Y., Sato S., Futagami M., Fukushi Y., Sakamoto T., Umemoto M., Saito Y.: "Prognostic significance of vascular endothelial growth factor and its receptors in endometrial carcinoma". Gynecol. Oneal., 2000, 77, 413.

[5] Yokoyama Y., Charnock-Jones D. S., Licence D., Yanaihara A., Hastings J.M., Holland C. M. et al.: "Vascular endothelial growth factor-D is an independent prognostic factor in epithelial ovarian carcinoma". Br. J. Cancer, 2003, 88, 237.

[6] Yokoyama Y., Charnock-Jones D. S., Licence D., Yanaihara A., Hastings J.M., Holland C. M. et al.: "Expression of vascular endothelial growth factor (VEGF)-D and its receptor, VEGFR-3 as a prognostic factor in endometrial carcinoma". Clin. Cancer Res., 2003, 9, 1361.

[7] Umemoto M., Yokoyama Y., Sato S., Tsuchida S., Al-Mulla F., Saito Y.: "Carbonyl reductase as a significant predictor of survival and lymph node metastasis in epithelial ovarian cancer". Br. J. Cancer, 2001, 85, 1032.

[8] Tsukahara Y., Fukamatsu Y., Hirabayashi T., Iinuma H., Fukuta T.: "Adenocarcinoma of the endometrium following prolonged use of an intrauterine device". Acta Obstet. Gynaec. Jpn., 1983, 35, 339.

[9] Castadot M., Robinowitz M., Chervenak F., Sedlis A., Boria M. C.: "Recognizing malignancy in intrauterine contraceptive device users". Am. J. Obstet. Gynecol., 1980, 136, 966.

[10] Benshushan A., Paltiel 0., Rojansky N., Brzezinski A., Laufer N.: "IUD use and the risk of endometrial cancer". Eur. J. Obstet. Gynecol. Reprod. Biol., 2002, 105, 166.

[11] Parazzini F., La Vecchia C.,M oroni S.: "Intrauterine device use and the risk of endometrial cancer". Br. J. Cancer, 1994, 70, 672.

[12] Hill D., Weiss N. S., Voigt L. F., Beresford S. A.: "Endometrial cancer in relation to intra-uterine device use". Int. J. Cancer, 1997, 70, 278.

[13] Kay T. A., Keay S. D.,M iller P., Renninson J. N.: "Stage Ia endometrial carcinoma diagnosed on removal of an IUD". J. Fam. Plann. Reprod. Health Care, 2001, 27, 99.

[14] Schraub S., Sun X. S.,M aingon P., Horiot J. C.,D aly N., Keiling R. et al.: "Cervical and vaginal cancer associated with pessary use". Cancer, 1992, 69, 2505.