The presence of signet-ring cells in an endometrial adenocarcinoma is extremely uncommon and it is always necessary to rule out a metastatic neoplasm. We report a FIGO grade 2 endometrial carcinoma with a signet-ring cell component found in the curettage performed to a 53-year-old woman. The neoplastic proliferation was also found in the endometrium of the radical hysterectomy with bilateral salpingo-oophorectomy and pelvic and para-aortic lymphadenectomy. The uterine neoplasm invaded less than one-half of the myometrium (FIGO stage I B). Alcian blue showed the presence of mucin in the signet-ring cells. The patient was alive and without evidence of recurrence 14 months after surgery. Polymerase chain reaction method from paraffin-embedded tissue revealed the presence of human papilloma virus type 11. We have discussed the differential diagnosis of this kind of neoplasm and we have reviewed the literature on signet-ring cell carcinoma of the endometrium. 1. Introduction Signet-ring cell (SRC) carcinoma is defined as a tumor composed predominantly or exclusively of SRCs, characterized by a central, optically clear, globoid droplet of cytoplasmic mucin with an eccentrically placed nucleus. SRCs are generally rare in primary adenocarcinomas of the female genital tract. To the best of our knowledge primary carcinoma of the endometrium with SRCs has only been observed in four previous cases [1–3] (Table 1). In fact primary pure endometrial SRCs adenocarcinomas of the genital tract are extremely rare, while more often they may be seen admixed with other more conventional types. In this paper we report a new case of endometrial adenocarcinoma (EA) with SRCs component. We have reviewed the literature in order to emphasize the histological criteria in the diagnosis of this very unusual malignancy. Table 1: Endometrial adenocarcinoma with signet-ring cells: review of the literature. 2. Materials and Methods A 53-year-old multiparous (gravida 4, para 4) woman was referred to the Department of Obstetrics and Gynecology for persistent abnormal vaginal bleeding of three-month duration. An endometrial curettage was performed. An extensive search for an extrapelvic primary cancer was undertaken, but abdominopelvic computed tomography (CT), mammography, cystoscopy, esophagogastroduodenoscopy, and colonoscopy revealed no evidence of malignancy. The patient underwent a radical hysterectomy with bilateral salpingo-oophorectomy and pelvic and para-aortic lymph node dissection. The patient provided written informed consent to perform the study. Tissue specimens were fixed in
References
[1]
E. E. Mooney, S. J. Robboy, C. B. Hammond, A. Berchuck, and R. C. Bentley, “Signet-ring cell carcinoma of the endometrium: a primary tumor masquerading as a metastasis,” International Journal of Gynecological Pathology, vol. 16, no. 2, pp. 169–172, 1997.
[2]
I. Chebib, P. Chu, M. A. Duggan, and L. M. Difrancesco, “Primary signet-ring cell adenocarcinoma of the endometrium: case report and review of the literature,” International Journal of Gynecological Pathology, vol. 29, no. 3, pp. 269–272, 2010.
[3]
C. Boyd, I. Cameron, and W. G. McCluggage, “Endometrial adenocarcinoma with signet ring cells: report of two cases of an extremely rare phenomenon,” International Journal of Gynecological Pathology, vol. 29, no. 6, pp. 579–582, 2010.
[4]
M. Wells, A. G. Ostor, C. P. Crum, et al., “Epithelial tumours,” in Pathology & Genetics of Tumours of the Breast and Female Genital Organs, A. Fattaneh, Tavassoli, and P. Devilee, Eds., World Health Organization Classification of Tumours, pp. 272–276, IARC Press, Lyon, France, 2003.
[5]
S. G. Silverberg, R. J. Kurman, F. Nogales, G. L. Mutter, R. A. Kubik-Huch, and F. A. Tavassoli, “Epithelial tumours and related lesions,” in Pathology & Genetics of Tumours of the Breast and Female Genital Organs, A. Fattaneh, Tavassoli, and P. Devilee, Eds., World Health Organization Classification of Tumours, pp. 221–228, IARC Press, Lyon, France, 2003.
[6]
C. P. Crum, L. R. Duska, and M. R. Nucci, “Adenocarcinoma, carcinosarcoma, and other epithelial tumors of the endometrium,” in Diagnostic Gynecologic and Obstetric Pathology, C. P. Crum, L. R. Duska, and M. R. Nucci, Eds., pp. 517–574, Elsevier Saunders, Philadelphia, Pa, USA, 2th edition, 2006.
[7]
A. Kumar and V. Schneider, “Metastases to the uterus from extrapelvic primary tumors,” International Journal of Gynecological Pathology, vol. 2, no. 2, pp. 134–140, 1983.
[8]
N. B. Kumar and W. R. Hart, “Metastases to the uterine corpus from extragenital cancers. A clinicopathologic study of 63 cases,” Cancer, vol. 50, no. 10, pp. 2163–2169, 1982.
[9]
R. T. Javier and J. S. Butel, “The history of tumor virology,” Cancer Research, vol. 68, no. 19, pp. 7693–7706, 2008.
[10]
D. Yavuzer, N. Karadayi, T. Salepci, H. Baloglu, R. Dabak, and O. U. Bayramicli, “Investigation of human papillomavirus DNA in colorectal carcinomas and adenomas,” Medical Oncology, vol. 28, no. 1, pp. 127–132, 2011.
[11]
T. Hoory, A. Monie, P. Gravitt, and T.-C. Wu, “Molecular epidemiology of human papillomavirus,” Journal of the Formosan Medical Association, vol. 107, no. 3, pp. 198–217, 2008.
[12]
A. Giatromanolaki, E. Sivridis, D. Papazoglou, M. I. Koukourakis, and E. Maltezos, “Human papillomavirus in endometrial adenocarcinomas: infectious agent or a mere “passenger”?” Infectious Diseases in Obstetrics and Gynecology, vol. 2007, Article ID 60549, 4 pages, 2007.
[13]
L. Jiang, A. Malpica, M. T. Deavers et al., “Endometrial endometrioid adenocarcinoma of the uterine corpus involving the cervix: some cases probably represent independent primaries,” International Journal of Gynecological Pathology, vol. 29, no. 2, pp. 146–156, 2010.
[14]
M. A. Ansari-Lari, A. Staebler, R. J. Zaino, K. V. Shah, and B. M. Ronnett, “Distinction of endocervical and endometrial adenocarcinomas: immunohistochemical p16 expression correlated with human papillomavirus (HPV) DNA detection,” American Journal of Surgical Pathology, vol. 28, no. 2, pp. 160–167, 2004.
[15]
K. Chinen, K. Kamiyama, T. Kinjo et al., “Morules in endometrial carcinoma and benign andometrial lesions differ from squamous differentiation tissue and are not infected with human papillomavirus DNA in malignant lesions from Chinese women with carcinomas of the upper genital tract,” Gynecologic Oncology, vol. 87, no. 1, pp. 104–111, 2008.
[16]
M. W. Jones, A. Onisko, D. J. Dabbs, E. Elishaev, S. Chiosea, and R. Bhargava, “Immunohistochemistry and HPV in situ hybridization in pathologic distinction between andocervical and endometrial adenocarcinoma. A comparative tissue microarray study of 76 tumors,” International Journal of Gynecological Cancer, vol. 23, no. 2, pp. 380–384, 2013.
[17]
N. Karadayi, M. Gecer, S. Kayahan et al., “Association between human papillomavirus and endometrial adenocarcinoma,” Medical Oncology, vol. 30, no. 3, article 597, 2013.
[18]
W. G. McCluggage and D. Jenkins, “p16 immunoreactivity may assist in the distinction between endometrial and endocervical adenocarcinoma,” International Journal of Gynecological Pathology, vol. 22, no. 3, pp. 231–235, 2003.
[19]
T. Sano, T. Oyama, K. Kashiwabara, T. Fukuda, and T. Nakajima, “Expression status of p16 protein is associated with human papillomavirus oncogenic potential in cervical and genital lesions,” American Journal of Pathology, vol. 153, no. 6, pp. 1741–1748, 1998.
[20]
E. E. Doxtader and A.-L. A. Katzenstein, “The relationship between p16 expression and high-risk human papillomavirus infection in squamous cell carcinomas from sites other than uterine cervix: a study of 137 cases,” Human Pathology, vol. 43, no. 3, pp. 327–332, 2012.
[21]
R. E. Alexander, Y. Hu, J. B. Kum et al., “p16 expression is not associated with human papillomavirus in urinary bladder squamous cell carcinoma,” Modern Pathology, vol. 25, no. 11, pp. 1526–1533, 2012.
