Dedifferentiated endometrioid adenocarcinoma of the uterus: a case report

Background: Dedifferentiated endometrioid adenocarcinoma (DEAC) of the uterus was first described by Silva et al. in 2006. The tumor has high-grade endometrial carcinoma component which abruptly emerged from low-grade areas. DEAC showed more aggressive phenotype than FIGO grade 3 endometrioid adenocarcinoma. However, there have been a few studies evaluating effectiveness of adjuvant therapy for the patients with DEC. Case Report: A 41-year-old case with Stage IVB DEAC that clinically showed resistance to several regimens of chemotherapy is reported. The uterine corpus tumor with size of 120 x 100 mm, and the metastases were found in lung, liver, and pelvic lymph nodes. She underwent supra-vaginal hysterectomy, left salpingo-oophorectomy, and partial resection of ileum. Pathologically, the tumor had both well differentiated and undifferentiated carcinoma components, and it was diagnosed as DEAC. After primary surgery, the patient received four regimens of adjuvant chemotherapy, however all regimens were judged as progressive disease. Subsequently, the patient died of disease seven months after surgery. Conclusion: The present case of DEAC had an exceedingly poor prognosis, as was suggested in the several previous reports. The review of adjuvant therapeutic modalities revealed that there has been no effective therapy in the response-evaluable patients with DEAC. Further investigations for new strategy to treat the cases with DEAC are needed.

Uterine corpus; Endometrioid adenocarcinoma; Dedifferentiated endometrioid adenocarcinoma.

[1] Dahlin D.C., Beabout J.W.: “Dedifferentiation of low-grade chondrosarcomas”. Cancer, 1971, 28, 461.

[2] Delahunt B.: “Sarcomatoid renal carcinoma: the final common dedifferentiation of renal epithelial malignancies”. Pathology, 1999, 31, 185.

[3] Saliva E.G., Deavers M.T., Bodurka D.C., Malpica A.: “Association of low-grade endometrioid carcinoma of the uterus and ovary with undifferentiated carcinoma: a new type of dedifferentiated carcinoma?” Int. J. Gynecol. Pathol., 2006, 25, 52.

[4] World Health Organization: “Classification of tumours of the uterine corpus”. IRAC Press, 2014, 122. Available at: http://www.iarc.fr/en/publications/pdfs-online/pat-gen/bb4/bb4-chap4.pdf

[5] Murali R., Soslow R.A., Weigelt B.: “Classification of endometrial carcinoma: more than two types”. Lancet Oncol., 2014, 15, 268.

[6] Bokhman J.V.: “Two pathogenetic types of endometrial carcinoma.” Gynecol. Oncol. 1983, 15, 10.

[7] Vita G., Borgia L., Giovannantonio L.D., Bisceglia M.: “Dedifferentiated endometrioid adenocarcinoma of the uterus: A clinicopathologic study of a case”. Int. J. Surgical. Pathology., 2011, 19, 649.

[8] Soslow R.A.: “Mixed mullerian tumors of the female genital tract”. Surgical. Pathology Clinics., 2009, 2, 707.

[9] Wu E.S., Shih I.M., Teresa P.D.M.: “Dedifferentiated endometrioid adenocarcinoma: an under-recognized but aggressive tumor?” Gynecol. Oncol. Reports, 2013, 5, 25.

[10] Shen Y., Wang Y., Shi Y., Liu J., Liu Y.: “Clinicopathologic study of endometrial dedifferentiated endometrioid adenocarcinoma: a case report”. Int. J. Clin. Exp. Pathol., 2012, 5, 77.

[11] Berretta R., Patrelli T.S., Faioli R., Mautone D., Gizzo S., Mezzogiorno A., et al.: “Dedifferentiated endometrial cancer: an atypical case diagnosed from cerebellar and adrenal metastasis: case presentation and review of literature”. Int. J. Clin. Exp. Pathol., 2013, 6, 1652.

[12] Chen L., Pang S., Shen Y., Liu Z., Luan J., Shi Y., Liu Y.: “Lowgrade endometrioid carcinoma of the ovary associated with undifferentiated carcinoma: case report and review of the literature”. Int. J. Clin. Exp. Pathol., 2014, 7, 4422.