Endometrium-limited endometrioid adenocarcinoma and lung metastasis with unusual hyaline globules

Background: Endometrium-limited endometrial cancer that metastasizes is rare, as is endometrioid adenocarcinoma that contains hyaline globules. Case: A 33-year-old woman was referred after lung cancer was detected upon a routine health screening. Video-assisted thoracic surgery was performed, and subsequent pathologic examination revealed a metastatic lung cancer that was positive for both estrogen receptor (ER) and progesterone receptor (PgR). A follow-up Papanicolaou (Pap) test indicated endometrial carcinoma. Grade 1 (G1) endometrioid adenocarcinoma was diagnosed upon endometrial biopsy. There was no muscular invasion and CT and positron emission tomography-CT (PET-CT) showed no other metastases. Hysterectomy and bilateral adnectomy were performed and the final diagnosis was endometrial carcinoma, pT1aNXM1. In both the lung and uterine specimens, especially in areas showing squamous differentiation, there were numerous unusual hyaline globules. The hyaline globules stained weakly with Mallory Azan but not with alcian blue or von Kossa, and the periodic acid-Schiff reaction was negative. Immunohistochemically, the hyaline globules were negative for cytokeratins, vimentin, desmin, muscle actin, α-fetoprotein, transthyretin, α-antitrypsin, α1-chymotrypsin, fibrinogen, laminin, and β-catenin. Conclusion: We conclude that the unique hyaline globules had some metastatic potential or that previous dilatation and curettage, thrice performed, might have been responsible for the metastasis of the endometrium-limited cancer to the lung.

Endometrium-limited endometrial cancer; G1 endometrioid adenocarcinoma; Lung metastasis; Hyaline globule.

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