Endometrioid adenocarcinoma presenting in a patient 18 years after hysterectomy: a potential hazard of unopposed oestrogen therapy

Abstract

We present a case of endometrioid adenocarcinoma arising from extragonadal endometriosis 18 years after total abdominal hysterectomy with bilateral salpingo-oophorectomy. After the primary surgery the patient received 11 years of unopposed oestrogen hormone replacement therapy. She presented with symptoms of urinary retention and pelvic mass. Following resection, histopathology identified the mass as an endometrioid adenocarcinoma. The association between persistent endometriosis and the development of endometrial cancer are discussed here together with the risks of unopposed oestrogen in the development of such lesions.

Figure 1

(A) Images taken at laparoscopy demonstrating endometriotic deposits in the pelvic side wall (closed arrows). (B) Macroscopic pathological specimen showing an endometriotic cyst, nodular deposits of endometrioid carcinoma and normal descending colon. (C) Low power view of specimen stained with haematoxylin and eosin (H&E) demonstrating normal colonic mucosa (CM) (top left) and endometrioid carcinoma (EC) (bottom right). (D) High power view of endometriotic cyst stained with H&E demonstrating fibrosis surrounding the cyst containing haemosiderin laden macrophages (open arrows). (E) High power view of H&E stained endometrioid carcinoma demonstrating histological features of glandular endometrium. Immunostaining with (F) anti cytokeratin-7 demonstrating patchy staining through endometrioid tissue, (G) carcino-embryonic antigen (CEA) showing no evidence of immunostaining, and (H) vimentin showing strong staining throughout the glandular tissue.