PMC6459065_01
Axial T2 (a and b) images showing multifocal urinary bladder thickening (red arrows), axial (c) and coronal (d) T2 images showing nodular growth along the posterior wall of the myometrium (red arrows)
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F1
To confirm the diagnosis, magnetic resonance imaging of pelvis was performed, suggestive of carcinoma endometrium [Figure 1], with normal endocervical canal and cervical stroma along with carcinoma bladder [Figure 1] with no extravesical involvement.
(a) Endometrial aspirate shows back-to-back tubular glands with the absence of intervening stroma, increased nuclear hyperchromasia, and nuclear stratification. Other areas showed squamous differentiation, (b) section from hysterectomy specimen showed an endometrioid adenocarcinoma with infiltration into myometrium (focal micropapillary architecture is seen), (c) P40 staining in the squamous areas of endometrial aspirate shows strong nuclear staining, (d) strong nuclear staining with estrogen receptor antibody is also seen in tumor (endometrial aspirate)
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F2
HPE report of EA was suggestive of nonkeratinizing squamous cell carcinoma positive for P40, whereas ECC reported as well-differentiated adenocarcinoma positive for estrogen receptor (ER) progesterone receptor [Figure 2].
A papillary fragment of low-grade papillary urothelial carcinoma with a prominent fibrovascular core, the tumor cells still have maintained polarity, occasional mitoses, and mild nuclear pleomorphism can be seen (H and E, x40)
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F3
HPE reported as endometrioid adenocarcinoma with focal micropapillary pattern of the endometrium with less than half of the myometrial invasion [Figure 3].
PMC6459065_02
(a) Cut section of uterus shows a 4 cm x 3 cm growth present over endometrium, (b) left ovarian-lobulated solid cystic mass (15 cm x 10 cm)
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F4
Intraoperatively, ascites (1.5 L) was present, uterus was of 6-8 weeks in size with a 4x3 cm endometrial growth, 15x10 cm lobulated solid cystic mass arising from left ovary [Figure 4].
(a) (H&E; 100x) shows representative images of the uterine grade 3 endometrioid carcinoma with pleomorphic cells in sheets and focal squamoid areas. These tumor cells are immunopositive for ER (b; 100x) and Vimentin (c; 400x) while are negative for CD10 (d; 100x) and SMA (e; 100x). (f) shows representative images from the grade 1 endometrioid carcinoma in the ovary, which was immunopositive for ER (g; 400x) and Vimentin (h; 400x) while being negative for p53 (i; 400x)
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F5
The final HPE [Figure 5] revealed a diagnosis of synchronous independent primary malignancies arising from endometrium and ovary.