An unusual case of aggressive endometrial adenocarcinoma metastasis to the clivus: illustrative case

Abstract

Background: Though endometrial carcinomas are a relatively common cancer of the female genitourinary tract, they rarely metastasize. Similarly, clival metastases make up a tiny fraction of all brain metastases. To the authors' knowledge, an endometrial carcinoma clival metastasis has never been described in the literature; therefore, the authors present the following unusual case of a 69-year-old female with a history of an initially grade 2 endometrial adenocarcinoma that metastasized to her clivus.

Observations: Endometrial carcinoma has the potential to metastasize to the clivus.

Lessons: Endometrial carcinoma, even when initially low grade, can metastasize intracranially. Prompt diagnosis with tissue biopsy and radiation is the mainstay of treatment, although the prognosis remains poor. https://thejns.org/doi/10.3171/CASE24392.

Keywords: clivus tumor; endometrial carcinoma; malignant epithelial neoplasms; neoplasm metastases; skull base neoplasm.

FIG. 1.

Preoperative sagittal (A) and axial (B) head computed tomography demonstrates an erosive clival lesion with superior extension to the dorsum sellae as well as to the right, eroding the bone around the lacerum segment of the right internal carotid artery. The posterior table of the clivus has been eroded. Sagittal (C) and coronal (D) postcontrast T1-weighted MRI demonstrates an enhancing lesion with encroachment upon the lacerum segment of the right internal carotid artery. Posteriorly, there is mild effacement of the basilar artery and ventral pons.

FIG. 2.

Endoscopic endonasal view of the sphenoid sinus and clivus with the resection cavity outlined in white, revealing the tumor tissue. Skeletonized lacerum segment (proximal paraclival) of the right internal carotid artery (asterisk). C = clivus dura; S = sella; SF = sphenoid sinus floor.

FIG. 3.

Postoperative sagittal (A), coronal (B), and axial (C) postcontrast T1-weighted MRI demonstrating near-total resection of an invasive clival metastatic mass. A small amount of residual tumor is seen around the lacerum and paraclival right internal carotid artery as well as adjacent to the right Dorello’s canal. The tumor was densely adherent to the clival dura. Two weeks postoperatively, a new right temporal lobe metastasis was seen, demonstrating the aggressive nature of the tumor (D).

FIG. 4.

A: Microscopic hematoxylin and eosin evaluation showed a poorly differentiated neoplasm composed of sheets and nests of cells with ample, eosinophilic cytoplasm and large, pleomorphic nuclei, with frequent mitoses present. B: The Ki-67 proliferation rate is approximately 80% within the malignant cells. C: Expression of MLH-1, a protein in mismatch repair, is lost in malignant cells. D: Expression of PMS-2, a protein in mismatch repair, is lost in malignant cells. Original magnification ×400 (A, C, and D); ×100 (B).