Mismatch repair protein deficient endometrioid adenocarcinomas, metastasizing to adrenal gland and lymph nodes: Unusual cases with diagnostic implications.
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Date
2015-10
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Abstract
Recently, certain endometrial carcinomas have been found to be associated
with mismatch repair (MMR) protein defects/deficiency. A 39-year-old female
presented with cough, decreased appetite and significant weight loss since
2 months. Earlier, she had undergone total abdominal hysterectomy with
bilateral salpingo-oophorectomy (TAH-BSO) for endometrioid adenocarcinoma.
Imaging disclosed an 8 cm-sized adrenal mass that was surgically excised.
Histopathology of the adrenal tumor, endocervical tumor, and endometrial
biopsy revealed Federation of Gynecology and Obstetrics (FIGO) Grade II
to III endometrioid adenocarcinoma. By immunohistochemistry, tumor cells
were positive for cytokeratin 7, epithelial membrane antigen, PAX8, MLH1 and
PMS2 while negative for estrogen receptor (ER), progesterone receptor (PR),
MSH2 and MSH6. She underwent adjuvant radiotherapy and chemotherapy. A
34-year-old lady presented with vaginal bleeding since 9 months. She underwent
TAH-BSO, reported as FIGO Grade III endometrioid adenocarcinoma. By
immunohistochemistry, tumor cells were negative for ER, PR, MLH1, and PMS2
while positive for MSH2 and MSH6. She underwent adjuvant radiotherapy
and chemotherapy. However, she developed multiple nodal and pericardial
metastases and succumbed to the disease within a year post-diagnosis. Certain
high-grade endometrioid adenocarcinomas occurring in younger women are
MMR protein deficient and display an aggressive clinical course. Adrenal
metastasis in endometrial carcinomas is rare.
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Keywords
Endometrial adenocarcinoma, MLH1, mismatch repair deficient, MSH2, MSH6, PMS2
Citation
Rekhi Bharat. Mismatch repair protein deficient endometrioid adenocarcinomas, metastasizing to adrenal gland and lymph nodes: Unusual cases with diagnostic implications. Indian Journal of Pathology & Microbiology. 2015 Oct-Dec 58(4): 491-495.