Primary squamous cell carcinoma of endometrium: case report and literature review

Application of CT and MRI combined with VEGF-C and EGFR in the identification of endometrial cancer stages

OBJECTIVE

To explore the application of computed tomography (CT) and magnetic resonance imaging (MRI) in combination with vascular endothelial growth factor-C (VEGF-C) and epidermal growth factor receptor (EGFR) in the identification of endometrial cancer stages.

METHODS

Clinical data of 84 patients with endometrial cancer who underwent surgery in our hospital were retrospectively analyzed. Before surgery, they were received inspection by CT and MRI and examination by VEGF-C and EGFR measurement. The pathological results after surgery were used as the gold standard, which was applied to compare the diagnostic accuracy of endometrial cancer stages by CT, MRI, and CT+MRI and to analyze how VEGF-C and EGFR expression and CT+MRI diagnosis correlated with relevant pathological parameters.

RESULTS

Using pathological results as the gold standard, the diagnostic accuracy of endometrial cancer stages via CT+MRI combined with VEGF-C+EGFR immunostaining was significantly higher (96.43%) compared with CT+MRI, CT, and MRI (91.67%, 70.24%, and 77.38%, respectively) (P<0.05). The positive rates of VEGF-C and EGFR expression in patients with different endometrial cancer stages identified by CT+MRI were significantly different (P<0.05). Spearman's rank correlation coefficient showed that the positive rates of VEGF-C and EGFR expression were both positively correlated with CT+MRI identified stages (r>0, P<0.05). The accuracy of CT+MRI diagnosed lymph node metastasis, myometrial infiltration, and interstitial infiltration was 90.48%, 92.86%, and 84.52%, respectively. The positive rates of VEGF-C and EGFR expression were significantly higher by lymph node metastasis compared with non-metastasis; the positive rates of VEGF-C and EGFR expression were significantly higher by deep myometrial infiltration compared with superficial infiltration; the positive rates of VEGF-C and EGFR expression were significantly higher by interstitial infiltration compared with no interstitial infiltration (P<0.05).

CONCLUSION

CT and MRI combined with VEGF-C and EGFR can effectively identify endometrial cancer stages.

Two primary cancers: Primary squamous cell carcinoma with extensive ichthyosis uteri and cervical endometrioid carcinoma: A case report

Squamous cell carcinoma of the endometrium is extremely rare, accounting for approximately 1% of uterine body malignancies. The present report describes a case of squamous cell carcinoma of the uterine body arising from ichthyosis due to persistent pyometra. A 68-year-old Japanese woman, gravida 1 para 1, was referred to the Gynecological Department of Tokyo Women's Medical University, due to watery brown vaginal discharge which had persisted for 10 days. Pelvic magnetic resonance (MRI) imaging revealed a tumorous lesion occupying the cervical uteri, measuring 3 cm in diameter, and pyometra. The endometrial biopsy specimen obtained after drainage of the purulent fluid in the uterus was insufficient for obtaining a definitive pathological diagnosis. Under a clinical diagnosis of cervical tumor and pyometra, total transabdominal hysterectomy with bilateral salpingo-oophorectomy was performed. Histopathologically, two primary cancers were diagnosed, i.e., cervical endometrioid carcinoma and squamous cell carcinoma of the endometrium. The patient was treated with additional chemotherapy with carboplatin (area under the curve, 6) and paclitaxel (175 mg/m²). The patient has remained alive, without recurrence, for 1 year to date. In this case, preexisting cervical endometrioid carcinoma caused stenosis of the uterine orifice and also resulted in pyometra. The uterine body squamous cell carcinoma appeared to have been caused by persistent inflammatory stimuli to the endometrium. One must be cautious regarding cancer in elderly postmenopausal females presenting with pyometra. The findings in this case report suggest that chronic inflammation of the endometrium may be associated with primary squamous cell carcinoma of the endometrium.

Non-HPV-related verrucous carcinoma of the endometrium: report of one case and review of literature

The clinicopathologic diagnosis and treatment of a case of endometrial verrucous carcinoma were analyzed, combined with the relevant literature for review and discussion. The patient was a 67-year-old postmenopausal woman who had recurrent vaginal bleeding with increased secretion. The gross morphology and histopathology of the uterine cavity tumor had typical characteristic changes of verrucous carcinoma. There was obvious inflammation in the tumor background and squamous differentiation in the residual endometrial gland basal reserve cells. Tumor cell immunohistochemistry showed wild-type P53, P16 negative expression and HPV molecular test was negative. The expression of p63 was positive in squamous differentiated reserve cells, and Ki67 showed high proliferative activity. Verrucous carcinoma of endometrium is a rare tumor with low malignancy, that belongs to a special subtype of squamous cell carcinoma. It is easily missed or misdiagnosed and has a long diagnosis cycle. The diagnosis should be combined with clinical data, imaging and pathology. The pathogenesis of the disease is not clear. Surgical treatment is the first treatment, and the clinical prognosis is good.