PMC10445650_01
Coexistence of uterine endometrioid adenocarcinoma along with PEComa and leiomyoma. (A) Uterine endometrioid carcinoma (blue asterisk) associated with PEComa (yellow asterisk) (H&E x40). (B) The endometrioid carcinoma, displays mainly tubular and cribriform and in a lesser degree (estimated at 10%) solid architecture (solid architecture not shown). (H&E x 100). (C-E). Endometrioid carcinoma: diffuse and intense CKAE1/AE3 (C, x200), ER (D, x200), and PR (E, x200) immunostaining. (F-H). PEComa: epithelioid component (F, neoplastic cells with epithelioid morphology and clear cell cytoplasm, H&E x200) exhibiting strong HMB45 (G, x200) and MiTF (H, x200) immunostaining. (I-K). PEComa: spindle cell component (I, neoplastic cells with spindle cell morphology and clear cell cytoplasm, H&E, x200) exhibiting strong Desmin (J, x200) and SMA (K, x200) immunostaining. (L). Uterine leiomyoma (green asterisk) associated with endometrioid carcinoma (blue asterisk) (H&E, x100).
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Microscopic examination of the lesion revealed a FIGO grade 2 endometrioid adenocarcinoma ( Figures 1A, B ) invading the left parametrium. The carcinomatous cells exhibited strong diffuse immunopositivity for CKAE1/AE3 ( Figure 1C ), Estrogen receptor (ER,  Figure 1D ), and Progesterone receptor (PR,  Figure 1E ). Immediately abutting the carcinoma was a mesenchymal neoplasm consisting mainly (around 90% of the tumor volume) of epithelioid ( Figures 1A, F ) and focally (an estimated 10% of the tumor volume) spindle ( Figures 1A, I ) cells arranged in sheets or nests, with a clear or eosinophilic cytoplasm, lacking significant cytological atypia or nuclear pleomorphism; thin, delicate vessels were found in between the tumor cells. The epithelioid cells were immunostained for melanocytic glycoprotein 100 [Human Melanoma Black-45 (HMB-45),  Figure 1G ] and Microphthalmia Transcription Factor (MiTF,  Figure 1H ), as well as focally for Melan-A, whereas Desmin decorated spindle cells ( Figure 1J ). SMA ( Figure 1K ), h-caldesmon, ER, and PR stains were positive in both epithelioid and spindle cells. Both smaller nodules were consistent with leiomyomas ( Figure 1L ).
Timeline of postoperative management. TAH, total abdominal hysterectomy; BSO, bilateral salpingo-oophorectomy; MDT, multidisciplinary team board; EBRT, external beam radiotherapy.
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The timeline with relevant data from the episode of care is displayed in  Figure 2 .