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OJHAS Vol. 9, Issue 4:
(Oct-Dec, 2010) |
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| Squamous
Cell Carcinoma of Endometrium with Extensive Icthyosis Uteri |
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Amita K, Assistant Professor,
Padmini J, Professor & Head,
Department of Pathology, MVJ Medical College & Research Hospital, Hosakote, Bangalore,
Karnataka, India |
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Address For Correspondence |
Assistant Professor,
Department of Pathology,
MVJ Medical College & Research Hospital,
Hosakote, Bangalore,
Karnataka, India
E-mail:
dramitay@rediffmail.com |
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Amita K, Padmini J. Squamous
Cell Carcinoma of Endometrium with Extensive Icthyosis Uteri. Online J Health Allied Scs.
2010;9(4):25 |
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Submitted: Dec 12,
2010; Accepted Dec 31, 2010; Published: Jan 20, 2011 |
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| Abstract: |
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We report a rare case of squamous cell carcinoma
of endometrium arising in icthyosis uteri in a 60 years old lady presenting with vaginal bleeding.
Key Words: Squamous cell carcinoma; Endometrium; Icthyosis uteri; Vaginal bleeding
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Icthyosis uteri is a rare condition in which
the entire surface of endometrium
is replaced by stratified squamous epithelium. Squamous cell carcinoma
of endometrium (SCC E) arising in icthyosis uteri is still rare, with
only few cases reported in literature.
A 60 year female presented with history of bleeding per vaginum since
6 to 8 months duration. She was para 3, live 3 and had attained menopause
15 years back. There was no history of tuberculosis or itrogenically
introduced substance in the uterus in past.
Per speculum examination
showed an atrophic cervix which was flushed with vagina.
Per vaginal examination
revealed an enlarged uterus of 14 weeks gestation. Adnexa was not palpable
through the cervix. Cervix appeared unremarkable.
Ultrasonography revealed
large fluid collection in the uterine cavity along with small soft tissue
projections over the margins of cavity.
Hence a presumptive
diagnosis of pyometra was made. Endometrial cavity was drained by cervical
dilatation. Endometrial curettage was done, histopathologic examination
of which revealed strips of stratified squamous epithelium with high
grade dysplasia. No endometrial glands or stroma was identified.
At surgery radical
hysterectomy with adnexectomy was done.
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Figure 1(Left): Widened endometrial
cavity and an irregular mass in the myometrium.
Figure 2(Above): Section from endo myometrium
shows squamous metaplasia with high grade dysplasia. (H& E X 400)
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Figure 3: Section shows foci of microinvasion.
(H & E X 100) |
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Figure 4: Section shows invasive squamous
cell carcinoma of endometrium invading the myometrium. (H & E X 400)
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Gross specimen
consisted of uterus with cervix measuring 12 x 11 x 7 cm. Cut surface
showed widened endometrial cavity lined by irregular shaggy, membrane
like material. Also seen were grey white irregular nodules in the myometrium.
Cervix was unremarkable.
Multiple sections from endometrium showed replacement of the entire
endometrium by stratified squamous epithelium which showed transition
from dysplasia through carcinoma in situ, area of micro invasion and
frankly invasive squamous cell carcinoma in the myometrium. Cervix was
unremarkable. Final diagnosis of primary
SCC-E with extensive icthyosis uteri was made.
Zeller in 1985 first coined the term icthyosis uteri in which the entire
surface of endometrium is replaced by stratified squamous epithelium
following iatrogenically introduced substances like formalin or iodine.1
It usually occur secondary
to chronic inflammation, irritation, foreign bodies or following iatrogenically
introduced substances in to the uterine cavity. According to some authors
icthyosis lack malignant potential.
2 However, dysplastic & anaplastic changes have been reported,
with few exceptional case reports describing the occurrence of primary
SCC-E in the background of icthyosis uteri. 3,4 Till date
only 64 cases of SCC-E have been reported in the literature.5Among
1182 cases of uterine corpus tumor, Goodman found only six cases of
SCC-E.6 Various studies have put forth two plausible explanations
for the occurrence of SCC-E. One theory being the direct extension of
squamous cell carcinoma of cervix to the endometrium, other being its
development from reserve cells.
In the present case,
since cervix did not show any gross or microscopic abnormality, the
possibility of direct extension from squamous cell carcinoma cervix
was ruled out.
Also the presence of
spectrum of changes from squamous metaplasia through dysplasia, carcinoma
in situ, microinvasion & frankly invasive squamous cell carcinoma
favoured a primary SCC-E rather than extension from cervix which in
turn will not show such changes.7
Chronic irritation
due to long standing pyometra might have lead to the malignant change
in icthyosis uteri.
Fluhmann and Kay had
put forth following criteria for the diagnosis of primary SCC-E. 1)
there should be no endometrial carcinoma, 2) no primary squamous cell
carcinoma of cervix and 3) if there is in situ change in cervix there
should be no association with the endometrial neoplasm.5Our
case satisfied all the above criteria.
Therapy consists of total abdominal hysterectomy with adnexectomy followed
by radiotherapy in selected cases. Chemotherapy can be considered in
addition to radiotherapy in these pateints. Prognosis is stage dependent,
one forth die within two years of diagnosis. Survival rate for patients
with stage I disease is 80% and for stage III it is 20%. Hence early
diagnosis and prompt treatment is imperative to improve the survival
rate. 7
In summary, though rare, primary squamous cell carcinoma of endometrium
can arise in icthyosis uteri. Hence the possibility of squamous cell
carcinoma of endometrium should be considered when strips of stratified
squamous epithelium are found in endometrial curettage specimen especially
in a postmenopausal women with pyometra.
- Patton WT, Squares GV. Ichthyosis uteri. A case report.
Am J Obstet Gynecol. 1962; 84:858-860.
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Zaino RJ. Metaplasia.
In Interpretation of endometrial biopsies and curettings. Edited by:
Silverberg SG. Philadelphia: Lippincott-Raven; 1996:241-261.
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Heckeroth V, Ziegler
HK. Ichthyosis uteri. Case report on a rate clinical entity. Geburtshilfe
Frauenheilkd. 1986;46:248-249.
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Kanchan M, Urmila
M, Sridevi V, Rajkumar T. Does "ichthyosis uteri" have malignant
potential? : A case report of squamous cell carcinoma of endometrium
associated with extensive ichthyosis uteri. Diagnostic Pathology. 2008;3:4.
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Bagga PK, Jaswal
TS, Datta U, Mahajan NC. Primary endometrial squamous cell carcinoma
with extensive squamous metaplasia and dysplasia. Indian J Pathol Microbiol.
2008 ;51:267-268.
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Goodman A, Zukerberg
LR, Rice LW, Fuller AF, Young RH, Scully RE. Squamous cell carcinoma
of endometrium: A report of eight cases and a review of the literature.
Gynecol Oncol. 1996;61:54-60
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Kennedy
AS, Demars LR, Flannegan LM, Varia MA. Primary squamous cell carcinoma
of the endometrium: a first report of adjuvant chemoradiation. Gynecol
Oncol. 1995;59:117-123.
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