Case Report:

Squamous Cell Carcinoma of Endometrium with Extensive Icthyosis Uteri

Amita K, Assistant Professor,
Padmini J, Professor & Head,
e!artment of Patholo"y, #$J #edical Colle"e % &esearch 'os!ital, 'osa(ote, )an"alore, Karnata(a, India
Address *or Corres!ondence+
r, Amita K,
Assistant Professor,
Department of Pathology,
MVJ Medical College & Research Hospital,
Hosakote, Bangalore,
arnataka, !ndia
E-mail+ dramitay"rediffmail#com
Citation+ Amita , Padmini J# $%&amo&s Cell Carcinoma of 'ndometri&m (ith ')tensi*e !cthyosis +teri# Online J Health Allied
Scs. ,-.-/01234,5
U&.+ http466(((#o7has#org6iss&e896,-.-:2:,5#htm
/!en Access Archives+ http466cogprints#org6*ie(6s&;7ects6<JHA$#html and http466openmed#nic#in6*ie(6s&;7ects6o7has#html
$&;mitted4 Dec .,, ,-.-/ Accepted Dec 8., ,-.-/ P&;lished4 Jan ,-, ,-..
A0stract+
=e report a rare case of s%&amo&s cell carcinoma of
endometri&m arising in icthyosis &teri in a 9- years old lady
presenting (ith *aginal ;leeding#
Key 1ords+ $%&amo&s cell carcinoma/ 'ndometri&m/
!cthyosis &teri/ Vaginal ;leeding
Introduction+
!cthyosis &teri is a rare condition in (hich the entire s&rface of
endometri&m is replaced ;y stratified s%&amo&s epitheli&m#
$%&amo&s cell carcinoma of endometri&m 1$CC '3 arising in
icthyosis &teri is still rare, (ith only fe( cases reported in
literat&re#
Case &e!ort+
A 9- year female presented (ith history of ;leeding per *agin:
&m since 9 to > months d&ration# $he (as para 8, li*e 8 and had
attained menopa&se .5 years ;ack# ?here (as no history of
t&;erc&losis or itrogenically introd&ced s&;stance in the &ter&s
in past#
Per spec&l&m e)amination sho(ed an atrophic cer*i) (hich
(as fl&shed (ith *agina#
Per *aginal e)amination re*ealed an enlarged &ter&s of .2
(eeks gestation# Adne)a (as not palpa;le thro&gh the cer*i)#
Cer*i) appeared &nremarka;le#
+ltrasonography re*ealed large fl&id collection in the &terine
ca*ity along (ith small soft tiss&e pro7ections o*er the margins
of ca*ity#
Hence a pres&mpti*e diagnosis of pyometra (as made# 'ndo:
metrial ca*ity (as drained ;y cer*ical dilatation# 'ndometrial
c&rettage (as done, histopathologic e)amination of (hich re:
*ealed strips of stratified s%&amo&s epitheli&m (ith high grade
dysplasia# @o endometrial glands or stroma (as identified#
At s&rgery radical hysterectomy (ith adne)ectomy (as done#
Aross specimen consisted of &ter&s (ith cer*i) meas&ring ., )
.. ) B cm# C&t s&rface sho(ed (idened endometrial ca*ity
lined ;y irreg&lar shaggy, mem;rane like material# Also seen
(ere grey (hite irreg&lar nod&les in the myometri&m# Cer*i)
(as &nremarka;le#
*i"ure 2+ 1idened endometrial cavity and an irre"ular
mass in the myometrium,
M&ltiple sections from endometri&m sho(ed replacement of
the entire endometri&m ;y stratified s%&amo&s epitheli&m
(hich sho(ed transition from dysplasia thro&gh carcinoma in
sit&, area of micro in*asion and frankly in*asi*e s%&amo&s cell
carcinoma in the myometri&m# Cer*i) (as &nremarka;le# Cinal
diagnosis of primary $CC:' (ith e)tensi*e icthyosis &teri (as
made#
.
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Online Journal of Health and Allied Sciences
Peer Re*ie(ed, <pen Access, Cree <nline Jo&rnal
P&;lished E&arterly 4 Mangalore, $o&th !ndia 4 !$$@ -0B,:500B
Vol&me 0, !ss&e 2/ <ct:Dec ,-.-
*i"ure 3+ Section from endo myometrium shows squamous
meta!lasia with hi"h "rade dys!lasia, 4'% E 5 6778
*i"ure 9+ Section shows foci of microinvasion, 4' % E 5
2778
*i"ure 6+ Section shows invasive squamous cell carcinoma
of endometrium invadin" the myometrium, 4' % E 5 6778
iscussion+
Feller in .0>5 first coined the term icthyosis &teri in (hich the
entire s&rface of endometri&m is replaced ;y stratified s%&am:
o&s epitheli&m follo(ing iatrogenically introd&ced s&;stances
like formalin or iodine#
.
!t &s&ally occ&r secondary to chronic inflammation, irritation,
foreign ;odies or follo(ing iatrogenically introd&ced s&;:
stances in to the &terine ca*ity# According to some a&thors
icthyosis lack malignant potential#
,
Ho(e*er, dysplastic & ana:
plastic changes ha*e ;een reported, (ith fe( e)ceptional case
reports descri;ing the occ&rrence of primary $CC:' in the
;ackgro&nd of icthyosis &teri#
8,2
?ill date only 92 cases of
$CC:' ha*e ;een reported in the literat&re#
5
Among ..>, cases
of &terine corp&s t&mor, Aoodman fo&nd only si) cases of
$CC:'#
9
Vario&s st&dies ha*e p&t forth t(o pla&si;le e)plana:
tions for the occ&rrence of $CC:'# <ne theory ;eing the direct
e)tension of s%&amo&s cell carcinoma of cer*i) to the endomet:
ri&m, other ;eing its de*elopment from reser*e cells#
!n the present case, since cer*i) did not sho( any gross or mi :
croscopic a;normality, the possi;ility of direct e)tension from
s%&amo&s cell carcinoma cer*i) (as r&led o&t#
Also the presence of spectr&m of changes from s%&amo&s meta:
plasia thro&gh dysplasia, carcinoma in sit&, microin*asion &
frankly in*asi*e s%&amo&s cell carcinoma fa*o&red a primary
$CC:' rather than e)tension from cer*i) (hich in t&rn (ill not
sho( s&ch changes#
B
Chronic irritation d&e to long standing pyometra might ha*e
lead to the malignant change in icthyosis &teri#
Cl&hmann and ay had p&t forth follo(ing criteria for the dia:
gnosis of primary $CC:'# .3 there sho&ld ;e no endometrial
carcinoma, ,3 no primary s%&amo&s cell carcinoma of cer*i)
and 83 if there is in sit& change in cer*i) there sho&ld ;e no as:
sociation (ith the endometrial neoplasm#
5
<&r case satisfied all
the a;o*e criteria#
?herapy consists of total a;dominal hysterectomy (ith adne):
ectomy follo(ed ;y radiotherapy in selected cases# Chemother:
apy can ;e considered in addition to radiotherapy in these
pateints# Prognosis is stage dependent, one forth die (ithin t(o
years of diagnosis# $&r*i*al rate for patients (ith stage ! dis:
ease is >-G and for stage !!! it is ,-G# Hence early diagnosis
and prompt treatment is imperati*e to impro*e the s&r*i*al rate#
B
!n s&mmary, tho&gh rare, primary s%&amo&s cell carcinoma of
endometri&m can arise in icthyosis &teri# Hence the possi;ility
of s%&amo&s cell carcinoma of endometri&m sho&ld ;e con:
sidered (hen strips of stratified s%&amo&s epitheli&m are fo&nd
in endometrial c&rettage specimen especially in a postmeno:
pa&sal (omen (ith pyometra#
&eferences+
1. Patton =?, $%&ares AV# !chthyosis &teri# A case re:
port# Am J Obstet Gynecol. .09,/ >24>5>:>9-#
2. Faino RJ# Metaplasia# !n !nterpretation of endo:
metrial ;iopsies and c&rettings# 'dited ;y4 $il*er:
;erg $A# Philadelphia4 Dippincott:Ra*en/ .0094,2.:
,9.#
3. Heckeroth V, Fiegler H# !chthyosis &teri# Case re:
port on a rate clinical entity# Ae;&rtshilfe Cra&en:
heilkd# .0>9/294,2>:,20#
4. anchan M, +rmila M, $ride*i V, Ra7k&mar ?#
Does Hichthyosis &teriH ha*e malignant potentialI 4
A case report of s%&amo&s cell carcinoma of endo:
metri&m associated (ith e)tensi*e ichthyosis &teri#
Diagnostic Pathology# ,-->/842#
5. Bagga P, Jas(al ?$, Datta +, Maha7an @C#
Primary endometrial s%&amo&s cell carcinoma (ith
e)tensi*e s%&amo&s metaplasia and dysplasia# Indi-
an J Pathol Microbiol. ,--> /5.4,9B:,9>#
6. Aoodman A, F&ker;erg DR, Rice D=, C&ller AC,
Jo&ng RH, $c&lly R'# $%&amo&s cell carcinoma of
endometri&m4 A report of eight cases and a re*ie(
of the literat&re# Gynecol Oncol. .009/9.452:9-
7. ennedy A$, Demars DR, Clannegan DM, Varia
MA# Primary s%&amo&s cell carcinoma of the endo:
metri&m4 a first report of ad7&*ant chemoradiation#
Gynecol Oncol. .005/504..B:.,8#
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