PMC5835282_01
(a) Diffusion weighted magnetic resonance imaging. The abnormal signal with a diameter of approximately 2 cm on the left sidewall of the uterine corpus (at indicated by arrow). (b) FDG-PET. Abnormal uptake in the tumor had a maximal standardized uptake value (SUV (max)) of 7.79.
CRIPA2018-5848629.001.jpg
PMC5835282_01_CRIPA2018-5848629.001.jpg
fig1
Diffusion weighted magnetic resonance imaging revealed an abnormal mass with a diameter of approximately 2 cm on the left sidewall of the uterine corpus without any lymph node enlargement (Figure 1(a)). Fluorodeoxyglucose-positron emission tomography showed abnormal uptake in the mass with a maximal standardized uptake value (SUV, max) of 7.79 (Figure 1(b)).
The specimen from the operation. There was a 1.5 cm brownish mass with an unclear border with the stroma on the uterine corpus side of the cervix.
CRIPA2018-5848629.002.jpg
PMC5835282_01_CRIPA2018-5848629.002.jpg
fig2
There were no abnormal findings in the bilateral adnexa (Figure 2).
Endocervical tumor. (a) H-E stain. Fascicular and interlacing proliferation of spindle cells with hemorrhage. (b) H-E stain. Spindle cells had high-grade atypia and active mitosis. (c) H-E stain. Atypical cells were infiltrating just beneath the mucosa. (d) Immunohistochemical stain of H-caldesmon. Tumor cells were diffuse positive.
CRIPA2018-5848629.003.jpg
PMC5835282_01_CRIPA2018-5848629.003.jpg
fig3
It infiltrated beneath the mucosa (Figures 3(a) and 3(c)). High mitotic activity and focal necrosis with hemorrhage were also noted in the mass (Figure 3(b)). Immunohistochemically, the spindle and oval cells were positive for vimentin, SMA, and H-caldesmon (Figure 3(d)) and were negative for epithelial markers and ALK (Table 1).
Intraepithelial lesions. (a) H-E stain. Endocervical lesions. Neoplastic epithelium replaces normal epithelium on the cervical surface and glands. (b) Neoplastic epithelium with atypical epithelial and glandular cells with nuclear irregularity, variable sizes, mitosis, and apoptosis. Some glands have abundant pale eosinophilic cytoplasm, and partial glands have intestinal differentiation with goblet cells. AIS. (c) H-E stain. Endometrial lesions. Similar lesions in the endocervical mucosa. Cytological atypia was less than Figures 4(a) and 4(b); however they have mild nuclear atypia and pseudostratification. (d) H-E stain. The left tube mucosa is abnormal with mild nuclear pseudostratification, hyperchromasia, and enlargement, and tumor cells had mitosis. However, dysplasia was less than AIS. (e) H-E stain. Endometrium without lobular architecture and with the characteristic "pale pink" cytoplasm that was next to AIS. Simple gastric metaplasia (as indicated by arrow). (f) H-E stain. The endometrium showed lesions of stratified mucin-producing intraepithelial lesion (SMILE) focally. The stratified epithelium contains cells with mucin vacuoles in all cell layers. Nuclear atypia and hyperchromasia figures are present.
CRIPA2018-5848629.004.jpg
PMC5835282_01_CRIPA2018-5848629.004.jpg
fig4
Part of the glands had abundant pale eosinophilic cytoplasm, and part of the glands had intestinal differentiation with goblet cells (Figures 4(a) and 4(b)). Stromal invasion was noted in all lesions (Figures 4(c) and 4(d)). In the cervix and endometrium, mucinous metaplasia and stratified mucinous-producing intraepithelial lesion (SMILE) was admixed with intraepithelial carcinoma lesions (Figures 4(e) and 4(f)).
Immunohistochemical results. (a) MUC6 stain. Tumor cells were partially positive. (b) HIK1083 stain. Tumor cells were focally positive.
CRIPA2018-5848629.005.jpg
PMC5835282_01_CRIPA2018-5848629.005.jpg
fig5
The carcinoma cells consisted mostly of gastric-type cells and partly of intestinal type cells from the histological features and immunohistochemical findings (Figures 5(a) and 5(b), Table 2).