Discovery of an endometrioid cancer lymph node metastasis without primary tumor in a context of Lynch syndrome

Abstract

Introduction: Lynch syndrome is a hereditary predisposition to cancers, including colo-rectal and endometrial cancers in women. Prophylactic surgery including hysterectomy and bilateral salpingo-oophorectomy is recommended once the parental project is completed in case of identified mutation.

Case presentation: We describe the case of a 50-year-old patient with Lynch syndrome and identified MSH6 mutation who underwent a prophylactic hysterectomy with bilateral salpingo-oophorectomy. A left large broad ligament lesion suggestive of a fibroma was intraoperatively discovered and removed. Pathological examination and immunohistochemical study showed a lymph node macro-metastasis of an endometrioid adenocarcinoma, without primary tumor.

Discussion/conclusion: Lymph node metastasis can occur before endometrial cancer but the link with Lynch syndrome remains to be proved. Lymph node assessment by imaging before prophylactic surgery in Lynch syndrome could be considered.

Keywords: Hysterectomy; Lynch syndrome; Pelvic nodes; Prophylactic surgery.