Document Type : Case report
Authors
1
Professor, Department of Pathology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
2
Resident, Department of Pathology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
3
Associate professor, Department of Obstetrics and Gynecology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
4
Associate professor, Department of Obstetrics and Gynecology, Fellowship of Gynecology Oncology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
10.22038/ijogi.2025.83502.6240
Abstract
Introduction: Endometriosis is defined as the presence of endometrial glands and stroma outside endometrium and myometrium. Peak age of endometriosis incidence is 30-45 years. Risk of development to malignant neoplasm is estimated at 1-2.5% (mostly endometrioid carcinoma). Corded and hyalinized endometrioid carcinoma is one of the rare variants of endometrioid carcinoma and its mean age is 49 years and characterized by cords of atypical epithelial cells within a hyalinized stroma, that merge with conventional low-grade EC. Most cases showed low grade, and a favorable outcome, with no specific molecular profile. In this study, a rare case of corded and hyalinized endometrioid carcinoma was reported in the context of endometriosis in a 45-year-old woman.
Case presentation: The patient was a 45 years old woman presented with abdominal pain and flatus to the obstetrics and gynecology clinic of Mehr hospital. In the tests, CA19-9 and CA125 were high and in ultrasound, the echo mixed solid-cystic mass was reported in the right adenex adjacent to the uterus fundus. CT scan show heterogeneous enhancer mass containing solid cystic segments in the right adenex attached to the right side of the uterus. The patient underwent uterine serous surface mass resection, hysterectomy and bilateral salpingo-oophorectomy. In the microscopic examination of the uterine mass in the context of endometriosis, atypical epithelioid cells were observed as chords and cells aggregations in the context of hyalineized stroma. In the immunohistochemistry study, PAX8, ER, and CK were positive, which is generally in favor of corded and hyalinized endometrioid carcinoma (CHEC).
Conclusion: Given the rarity of CHEC, there is possibility of misdiagnosis, and due to their “biphasic” morphology, these tumors are often misdiagnosed as other biphasic endometrial malignancies especially carcinosarcoma. Therefore, CHEC should be considered in endometrioid carcinoma and also biphasic tumors such as carcinosarcoma.
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