Category: Pituitary Disorders/Neuroendocrinology
To present an interesting case with low incidence of endometrial neuroendocrine carcinoma.
Methods : The clinical and paraclinical characteristics of the patient are described
Results : Woman, 65 yO. HTA and Obesity grade II. Two years ago, she presented with vaginal bleeding, so she underwent an endometrial biopsy that was reported as: moderately differentiated endometrioid adenocarcinoma. Being subjected to radical surgery whose pathology reported: Mixed carcinoma composed of neuroendocrine carcinoma of high grade of small cells, grade 3, index of proliferation Ki 67: 90%, compromises 90% and carcinoma endometrioid FIGO 2, comprises 10%. Vascular embolism (+). Infiltra myometrium to serous surface. Right pelvic nodes 1/6. IHQ Endometrioid / Neuroendocrine. Estrogen receptors: +/-; Progesterone receptors: +/-; p53: - / -; Ki67: 50% / 90%; CD10: - / -; Pankeratin: + / +; Desmin: - / -; Synaptophysin: - / +; Chromogranin A: - / +. CT: multiple retrocrural lymph node metastasis, retroperitoneum, intercaval-aortic, para-aortic, mesenteric, hypogastric chain. Receiving chemotherapy: Etoposide + Carboplatin (6 cycles). CT in 2018 without evidence of significant nodes. Bone scintigraphy: Does not show suggestive lesions of secondary extension. The patient is currently performing multidisciplinary follow-up with Oncological Gynecology, Medical Oncology and Endocrinology, for evaluation of disease recurrence.
Discussion : The primary sites of extrapulmonary NETs are the gastrointestinal tract or the genitourinary tract, the endometrium is the least common site. Small cell NEC of the endometrium is a very rare and aggressive tumor. The reported cases present genital hemorrhage and abdominal pain. It has a tendency to associate with other endometrial cancer histotypes that can make it difficult to recognize. The diagnosis of NET is based mainly on markers of neuroendocrine differentiation by IHC. The standard modality of treatment consists of surgical resection, radiotherapy, chemotherapy and hormonal treatment. In case of recurrence, none of these treatments has a significant impact on survival. It may represent a diagnostic challenge, the low recognition of the neuroendocrine component is probably due to its association with a conventional endometrioid carcinoma.
Conclusion : Endometrial carcinoma is infrequent and its recognition may have an impact on the treatment of the patients affected by this disease. Although NEC has usually an aggressive behavior, a 28% survival after 5 years of follow-up has been described
HOSPITAL NACIONAL EDGARDO REBAGLIATI - UNIVERSIDAD NACIONAL MAYOR DE SAN MARCOS. LIMA - PERU
Lima, Lima, Peru
PERUVIAN ENDOCRINOLOGIST, UNIVERSITY TEACHER, ACTIVE MEMBER OF AACE, AREAS OF INTEREST NEUROENDOCRINOLOGY, THYROID, ENDOCRINOLOGY OF REPRODUCTION AND BONE MINERAL METABOLISM