PMC5591980_01
Histopathological findings of ascites and autopsy. (a) Cytomorphological evaluation of ascites revealed large abnormal cells mimicking lymphoma. (b, c) Autopsy showed an enlarged uterus. There was no apparent invasion in both kidneys. Small nodules were scattered throughout omentum. (d-i) Hematoxylin and eosin (HE) staining of the uterus showed two types of malignant cells (d, g) characterized by coexisting endometrial carcinoma and undifferentiated immature malignant cells. These endometrial malignant cells were positive for epithelial membrane antigen (EMA) (e) and negative for vimentin (f). Undifferentiated immature malignant cells were negative for EMA (h) and positive for vimentin (i). (j) HE staining of the kidney showed no malignant invasion and many small stones were seen in microtubules.
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These cells were scattered with loose adhesion mimicking malignant lymphoma (Figure 1(a)). Pathological evaluation for uterus showed differentiated endometrioid adenocarcinoma component with squamous differentiation (Figures 1(d), 1(e), and 1(f)) and undifferentiated carcinoma component (Figures 1(g), 1(h), and 1(i)). Epithelial membrane antigen (EMA) expression was diffusely positive in differentiated endometrioid adenocarcinoma lesion (Figure 1(e), arrowhead) but negative for undifferentiated carcinoma lesion (Figure 1(h)). On the other hand, vimentin staining was negative in differentiated adenocarcinoma lesion (Figure 1(f), arrowhead) and positive in undifferentiated carcinoma lesion (Figure 1(i)). MIB-1 (proliferative) index was approximately 60%. Microcalcification was seen in proximal tubules to collecting ducts of bilateral kidneys (Figure 1(j)).