PMC7434505_01
Surgical pathology report (4/23/14).
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September 2014, she underwent robotic-assisted total laparoscopic hysterectomy, bilateral salpingo-oophorectomy and pelvic and para-aortic lymph node dissection. Surgical pathology was consistent with a stage IA (23% myometrial invasion), grade 3, mixed endometrioid and serous endometrial adenocarcinoma (Figure 1).
Large sellar/suprasellar mass on MRI. Views of the tumour (red arrows) on coronal T2 (A), coronal T1 with gadolinium (B) and sagittal T1 with gadolinium (C). As pointed out in (A), the tumour invades the right cavernous sinus and extends into the sphenoid sinus. The tumour also compresses the optic chiasm and both optic nerves appear oedematous.
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Further inpatient work up included a brain MRI, showing a sellar/suprasellar mass with invasion into the sphenoid and cavernous sinuses, and mass effect on the optic chiasm and hypothalamus (Figure 2).
Right hilar mass/opacity with atypical right upper lung zone opacity representing mass or atelectasis. There are multiple smaller nodules in the left chest. Findings suspicious for neoplasia. CT scan of the chest with IV contrast is recommended for further evaluation.
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CT (Figures 3 and 4) showed extensive tumour in the right upper and right middle lobes with obliteration of the right upper lobe bronchus as well as hilar, mediastinal and left supraclavicular node involvement. CT abdomen pelvis demonstrated multiple bilobar hepatic metastases measuring up to 3.2 cm and bilateral adrenal metastases (Figure 5).
Extensive tumour in the right upper and right middle lobes. Obliteration of the right upper lobe bronchus. There may be some superimposed atelectasis and/or pneumonia. Tumour is contiguous with the right hilum and there is significant adenopathy in the mediastinum and left supraclavicular region. Numerous subcentimetre pulmonary nodules bilaterally, compatible with metastatic disease. T1 sclerotic lesion, worrisome for metastatic disease.
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CT (Figures 3 and 4) showed extensive tumour in the right upper and right middle lobes with obliteration of the right upper lobe bronchus as well as hilar, mediastinal and left supraclavicular node involvement. CT abdomen pelvis demonstrated multiple bilobar hepatic metastases measuring up to 3.2 cm and bilateral adrenal metastases (Figure 5).
Multiple bilobar hepatic metastases measuring up to 3.2 cm. Bilateral adrenal metastases.
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CT (Figures 3 and 4) showed extensive tumour in the right upper and right middle lobes with obliteration of the right upper lobe bronchus as well as hilar, mediastinal and left supraclavicular node involvement. CT abdomen pelvis demonstrated multiple bilobar hepatic metastases measuring up to 3.2 cm and bilateral adrenal metastases (Figure 5).
Visual field and radiographic response to radiotherapy. (A) Comparison of Humphreys visual fields for the right (OD) and left (OS) eye at presentation and 3 months after stereotactic radiotherapy. (B) and (C) MRI images obtained 3 months after stereotactic radiotherapy show dramatic regression of the sellar/suprasellar tumour.
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Indeed, while on this regimen, the patient's right ophthalmoplegia, diplopia and visual field deficits (Figure 6A) totally resolved. Consistent with the clinical improvement, repeat MRI demonstrated a dramatic response of the suprasellar metastasis to the radiotherapy within a few months (Figure 6B and C).
Foundation Medicine molecular analysis. Microsatellite stable. No targetable mutations discovered.
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The tumour was found to be microsatellite stable and no other targetable mutations than HER2 were found (Figure 7).