Endometrioid endometrial carcinoma of no-specific-molecular-profile with multiple bone metastases and muscle involvement: Case report and review of the literature

Abstract

Bone metastasis and muscular involvement in endometrial carcinoma are rare, and information on molecular profiles of endometrial carcinoma with bone metastasis is scarce. We present a case of an 83-year old woman with a poorly differentiated endometrioid adenocarcinoma of no-specific-molecular-profile with para-aortic lymph node involvement, who underwent surgery, received adjuvant chemotherapy and vaginal brachytherapy but declined external beam radiotherapy. Fifteen months after the initial diagnosis she presented with pain in her right leg. Imaging showed an osteolytic lesion in the right femur with soft-tissue involvement. She underwent an open biopsy and protective osteosynthesis. Histologically, infiltrates of both bone and muscle were consistent with metastasis derived from endometrioid endometrial carcinoma. She received concomitant palliative chemotherapy and external beam radiotherapy to the right femur. Eleven months later, she presented with an acute hemiparesis caused by a right-sided subacute, superior frontal gyrus infarct, which also showed aggressive bone metastasis of the left sphenoid bone. She subsequently died 2 weeks later. This is a rare case of multiple bone metastases and muscle involvement in endometrial carcinoma. To our knowledge, this is the first reported such case in endometrial carcinoma showing no-specific-molecular-profile.

Keywords: Bone metastasis; Cancer genomics; Case report; Endometrial carcinoma; Muscle metastasis; Tumor biomarkers.

Fig. 1

Histological findings of primary and secondary endometrial carcinoma. Primary histology revealed a poorly differentiated endometrioid adenocarcinoma of the endometrium (asterisk) with deep myometrial invasion as shown in H&E staining (A). Serosa penetration, bilateral parametrial as well as cervical stroma tumor-infiltration was identified. Vessel invasion (arrow-heads) (B) and perineural tumor-infiltration were present. Two para-aortic lymph nodes were found to be involved (dagger) (C). In samples obtained during open biopsy on the right femur 15 months after the initial diagnosis, histological workup of femur bone samples confirmed infiltrates of a poorly differentiated carcinoma with partial squamous differentiation (double dagger) (D), consistent with metastasis derived from poorly differentiated endometrioid adenocarcinoma. Furthermore, muscular tumor-invasion was present (arrows) (E), which is depicted with Pan-Cytokeratin staining (F).

Fig. 2

Imaging of femoral bone and soft-tissue involvement. X-ray of the right leg (anteroposterior view, standing) showing a 55 × 25,5 mm lesion (asterisk) in the mid-shaft of the right femur, suspicious of bone metastasis (A), showing an osteolytic lesion and cortical destruction (arrow) in the lateral view (B) in February, 2020. Clinical and imaging information resulted in a Mirel score of 11 points. A consecutive computed tomography (CT) scan of the lower extremities shows the right-sided femur with a thinned-out cortical bone, which in the anterior aspect shows complete destruction on axial imaging (double dagger) (C), as well as increased tracer-uptake (arrow-heads) and signs of extraosseus extension (dagger) on axial positron emission tomography – computed tomography (PET-CT) (D).

Fig. 3

Imaging of cranial bone involvement. Top-row showing an axial non-enhanced computed tomography (NECT) cranium (A) as well as an axial positron emission tomography – computed tomography (PET-CT) of the cranium (B) in January, 2020 without signs of metastasis. Images in the bottom-row display cortical destruction of the left sphenoidal bone in the bone window of an axial NECT cranium (arrow-heads) (C), a 28 mm lesion in diameter infiltrating the left orbital region as well as the neurocranium via cortical destruction of the left sphenoidal bone in the soft-tissue window of the same NECT (asterisk) (D) in November, 2020.

Fig. 4

Timeline of episode of care. AUC – Area under the curve; CT – Computed tomography; MRI Magnetic resonance imaging; PET-CT – Positron emission tomography-CT; BM – Bone metastasis