- Email: [email protected]
Glassy cell carcinoma of the endometrium: A case report and review of the literature
ARTICLE IN PRESS
Pathology – Research and Practice 203 (2007) 217–220 www.elsevier.de/prp
TEACHING CASES
Glassy cell carcinoma of the endometrium: A case report and review of the literature Gabriella Ferrandinaa,c,, Gian Franco Zannonib, Marco Petrilloa, Valerio Velloneb, Enrica Martinellia, Giovanni Scambiac a
Gynecologic Oncology Unit, Catholic University, L.go A. Gemelli 8, 00168 Rome, Italy Institute of Human Pathology, Catholic University, Rome, Italy c Department of Oncology, Catholic University, Campobasso, Italy b
Received 20 November 2006; accepted 5 February 2007
Abstract Glassy cell carcinomas are composed of malignant cells showing a ‘‘ground glass’’ cytoplasm, distinct cell membranes, and large nuclei with prominent nucleoli. To our knowledge, only 12 cases of glassy cell endometrial carcinomas (EGCC) have been reported until now. A 63-year-old patient complaining of irregular vaginal bleeding underwent hysteroscopy-guided biopsy revealing a well-differentiated endometrial endometrioid adenocarcinoma. The patient underwent left salpingo-oophorectomy, total abdominal hysterectomy, and pelvic lymphadenectomy. The final diagnosis was FIGO stage IB poorly differentiated endometrial adenosquamous carcinoma with 490% of glassy tumor cells. The patient is alive, with no evidence of disease for 69 months after diagnosis. We describe an additional case of EGCC and review the data of the literature, emphasizing the need to strictly define the criteria for the diagnosis and the potential usefulness of assessing biologic parameters for the prognostic characterization of this rare entity. r 2007 Elsevier GmbH. All rights reserved. Keywords: Glassy cell tumor; Endometrial cancer
Introduction Glu¨cksmann and Cherry [3] were the first to describe glassy cell carcinomas in the uterine cervix. They reported that these were typically composed of malignant cells showing a moderate amount of cytoplasm with ‘‘ground glass’’ appearance, distinct cell membranes stained with eosin or periodic acid-Schiff, and large nuclei with prominent nucleoli. These tumors often Corresponding author. Gynecologic Oncology Unit, Catholic University, L.go A. Gemelli 8, 00168 Rome, Italy. Tel./fax: +39 06 35508736. E-mail address: [email protected] (G. Ferrandina).
0344-0338/$ - see front matter r 2007 Elsevier GmbH. All rights reserved. doi:10.1016/j.prp.2007.02.001
contain a heavy inflammatory infiltrate consisting of eosinophilic leukocytes. Since the beginning, they have been regarded as an uncommon variant of poorly differentiated adenosquamous carcinoma [3]. Within cervical cancer histotypes, glassy cell carcinoma had been considered a highly aggressive tumor endowed with resistance to radiation therapy and unfavorable prognosis [3,14,15], until more recent reports suggested that the use of multimodal strategies, including adjuvant chemoradiation after surgery, may dramatically improve the patients’ clinical outcome [7,10]. Glassy cell carcinomas of the endometrium are very rare neoplasms, accounting for approximately 0.5% of
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G. Ferrandina et al. / Pathology – Research and Practice 203 (2007) 217–220
all endometrial carcinomas [4]. To our knowledge, only 12 cases of glassy cell endometrial carcinomas have been reported until now [1,4–6,8,11]. Here, we report an additional case of endometrial glassy cell carcinoma and review the literature.
Case report In November 2000, a 63-year-old patient was admitted to the Gynecologic Oncology Unit of the Catholic University of Rome for irregular vaginal bleeding. Her family history was unremarkable, while her past history included hypertension. Her gynecologic history included right adnexectomy (15 years before) due to the presence of a simple ovarian cyst. Spontaneous menopause occurred at the age of 53 years. Hysteroscopy-guided biopsy was performed, revealing a well-differentiated endometrial endometrioid adenocarcinoma. Gynecologic examination documented a uterus of normal size, no adnexal masses, and unremarkable cervix. Colposcopy was also negative. Transabdominal and transvaginal ultrasound examination documented the presence of a normally sized uterus showing a heterogeneously echogenic nodule (maximum diameter ¼ 2.5 cm) in the uterine fundus. Staging work-up included chest X-ray and pelvic Magnetic Resonance Imaging (MRI). MRI documented a tumor mass (2.8 cm in maximum diameter) located in the uterine corpus and invading less than 50% of the myometrium. There was found a nodule of 1.2 cm at the level of right external iliac lymph nodes. Ca-125 levels were 44.1 U/ml. At laparotomy, several firm and dense adhesions between the uterus and sigmoid colon were detected. After lysis of the adhesions, peritoneal washing was performed, and the patient underwent left salpingooophorectomy, total abdominal hysterectomy, pelvic lymphadenectomy, and peritoneal as well as omental biopsies. At pathologic examination, the uterus appeared to be enlarged because of the presence of a nodular lesion (3 cm in maximum diameter) located in the uterine fundus and protruding 0.6 cm out of the myometrium (1.8 cm). Lymphovascular space invasion was not documented. The uterine cervix and the left ovary were unremarkable. All biopsies and pelvic lymph nodes (n ¼ 19) were negative. The final diagnosis was FIGO stage IB poorly differentiated endometrial adenosquamous carcinoma, with 490% of the tumor being neoplastic cells with glassy cell features (Fig. 1). The diagnosis was confirmed by a second gynecologic pathologist who was unaware of the first diagnosis. Tumor cells were found to be estrogen- and progesterone receptor-negative, while positivity for ki67 and
Fig. 1. Glassy cell carcinoma of the endometrium: the undifferentiated glassy cells display large nuclei with prominent nucleoli and granular cytoplasm. Areas of abundant eosinophilic infiltration are present (Hematoxylin & Eosin, magnification: 200 ).
p53 was found in 80% and 5% of tumor cells, respectively. Moreover, a positive immunoreaction for Vascular Endothelial Growth Factor was detected in 90% of tumor cells. On the other hand, Her-2/neu protein showed 1+ positivity, while bcl-2 protein immunoreaction was barely detectable. Adjuvant radiation was considered contra-indicated due to the presence of diffuse intraabdominal adhesions, and the patient had to undergo routine follow-up procedures. The patient is alive with no evidence of disease for 69 months after diagnosis.
Discussion Glassy cell carcinomas most frequently occur in the uterine cervix, although some cases of glassy cell carcinoma of the uterus, colon, and fallopian tube have also been reported [4,9,11]. As far as endometrial glassy cell carcinomas are concerned, the histogenesis and site of origin are still debated. Indeed, the peculiar characteristics of glassy cell carcinomas (absence/paucity of squamous or glandular differentiation, PASpositive cell wall, prominent nucleoli in vesicular nuclei) are not sufficient to recapitulate the histogenesis of this tumor, which has been originally regarded as a poorly differentiated variant of adenosquamous carcinoma [3]. This assumption was questioned by Arendt et al. [1], based on the absence of keratin and prekeratin in glassy cell carcinoma of the endometrium. Moreover, also the documentation of the presence of lysozyme, the expression of which is limited to the endocervical and isthmic normal uterine mucosa, led the same authors [1] to favor
ARTICLE IN PRESS G. Ferrandina et al. / Pathology – Research and Practice 203 (2007) 217–220
the endocervical or isthmic origin of endometrial glassy cell carcinoma. However, as summarized in Table 1, after exclusion of cases with advanced stage of disease, all endometrial glassy cell carcinomas were reported to be located in the uterine corpus, with the exception of a FIGO stage IIIA case [1], in which the tumor also involved the uterine isthmus and parametrium. The fraction of glassy cells, considered necessary for the diagnosis of a glassy cell carcinoma, showed a very wide range (from 30% to 100%) [2,11]. Moreover, in most of the cases summarized in Table 1, the percentage of glassy cells in the tumor is not given, and sometimes, the description of sheets or nests of malignant cells with glassy cell features is provided [1,4–6,8]. In our case, the diagnosis of glassy cell carcinoma was made, given the presence of 490% of malignant cells with glassy cell features, according to Scully et al. [12]. The issue of strictly defining and widely sharing the criteria for the diagnosis of glassy cell carcinomas becomes clinically relevant under consideration of the fact that glassy cell carcinomas are usually very aggressive. Regarding glassy cell carcinomas of the uterine cervix, earlier studies reported overall survival rates of 0–60% in stage IB tumors [13–15]. Nonetheless, recent studies employing multimodal treatment strategies, including surgery and radiation with or without chemotherapy, documented a significantly improved prognosis with survival rates closely resembling those reported for squamous cervical cancer at a similar stage of disease [7,10]. Table 1.
219
Regarding endometrial glassy cell carcinoma, earlier studies documented a very dismal prognosis even in stage I tumors. From the data summarized in Table 1, 5 of 9 cases with stage I tumors experienced recurrence/ death of disease within 5 years after diagnosis, suggesting that glassy cell carcinomas arising in the uterus may behave aggressively. However, it has to be considered that the small size of the cases reported in the literature does not allow any definitive conclusion to be reliably drawn. Although adjuvant treatment was not performed because of the documentation of several and dense adhesions, regarded as a contraindication to radiotherapy, our case had a favorable prognosis, since the patient has been free of disease for more than 5 years after surgery. Other than glassy cell carcinomas of the uterine cervix, in which pathologic factors have been identified that allow for the definition of patients at higher risk of relapse [7], to our knowledge, no specific pathologic or molecular factors are known to play a prognostic role in this neoplasia. Estrogen and progesterone receptors were absent in the case reported by Mhawech et al. [1], while the complete response to progestins, described in the case by Dawson et al. [5], is an indirect evidence of the presence of progesterone receptors. In our case, estrogen and progesterone receptors were negative, and p53 positivity was found in only 5% of tumor cells. On the other hand, the expression of ki67, a marker of cell proliferation, was found in the vast majority of the tumor cells.
Characteristics of patients with glassy cell adenocarcinoma of the endometrium, as reported in the literature
Author
Age (years)
Stage
Location in the uterus
Treatment
Clinical outcome
Christopherson [4]
56 70 71
I I I
— — —
RT, H RT, H RT, H
78 78 59
I III IIIA
— — Isthmus
58 52
IB IB
Fundus Fundus
58
IB
Fundus
Dawson [5]
96
IVB
Fundus
RT RT TAH, BSO, RT, progestins TAH, BSO TAH, BSO, pelvic node dissection TAH, BSO, pelvic node dissection Megestrol 80 md bid
DOD at 5 months DOD at 32 months Death of pneumonia after 6 years Suicide at 7 months DOD after 5 months NED after 24 months
Hachisuga [8]
62
IIIC
Fundus
Mhawech [11]
60
IB
Fundus
Current case
63
IB
Fundus
Arends [1] De Rosa [6]
TAH, BSO, pelvic node dissection,RT TAH, BSO, pelvic node dissection, RT TAH, BSO, pelvic node dissection
DOD after 12 months DOD after 16 monhs ED at 36 months Persisting complete response after 16 months NED after 66 months NED after 60 months NED after 69 months
RT ¼ radiotherapy, H ¼ hysterectomy, DOD ¼ death of disease; ED ¼ alive with evidence of disease; NED ¼ no evidence of disease.
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In conclusion, we described an additional case of endometrial glassy cell carcinoma and reviewed the literature. We emphasized the need to more strictly define the criteria required for the diagnosis and stressed the potential usefulness of assessing biologic parameters for the prognostic characterization of this rare entity.
Acknowledgments This work was financially supported by grants from Associazione Italiana per la Ricerca sul Cancro (A.I.R.C) and I.R.I.S-PCR-OG-ONLUS (www.iris-og.com).
References [1] J.W. Arends, D. Willebrand, H.J. Dekoning Gans, G.J.V. Swaen, F.T. Bosman, Adenocarcinoma of the endometrium with glassy cell features – immunohistochemical observations, Histopathology 8 (1984) 873–879. [2] A. Aru, L.A. Rasmussen, B. Federspiel, T. Horn, Glassy cell carcinoma of the colon with human chorionic gonadotropin-production, Am J Surg Pathol 20 (1996) 187–192. [3] C. Cherry, A. Glucksmann, Incidence, histology, and response to radiation of mixed carcinomas (adenoacanthomas) of the uterine cervix, Cancer 9 (1956) 971–979. [4] W.M. Cristopherson, R.C. Alberhaski, P.J. Connelly, Glassy cell carcinoma of the endometrium, Hum Pathol 13 (1982) 418–421.
[5] E.C. Dawson, J.L. Belinson, K. Lee, Glassy cell carcinoma of the endometrium responsive to megestrol acetate, Gynecol Oncol 33 (1989) 121–124. [6] G. De Rosa, E. Barra, L. Palombini, C. Nappi, Glassy cell carcinoma dell’endometrio, Pathologica 79 (1987) 339–345. [7] H.J. Gray, R. Garcia, H.K. Tamimi, et al., Glassy cell carcinoma of the cervix revisited, Gynecol Oncol 85 (2002) 274–277. [8] T. Hachisuga, H. Sugimori, T. Kaku, K. Matsukuma, N. Tsukamoto, H. Nakano, Glassy cell carcinoma of the endometrium, Gynecol Oncol 36 (1990) 134–138. [9] D.R. Herbold, J.H. Axelrod, S.J. Bodowski, J.H. Freel, Glassy cell carcinoma of the fallopian tube: a case report, Int J Gynecol Pathol 7 (1988) 384–390. [10] R.J. Lotocki, G.V. Krepart, M. Paraskevas, G. Vadas, M. Heywood, M. Fung Kee Fung, Glassy cell carcinoma of the cervix, Gynecol Oncol 44 (1992) 254–259. [11] P. Mhawech, A. Dellas, A.M. Terracciano, Glassy cell carcinoma of the endometrium, Arch Pathol Lab Med 125 (2001) 816–819. [12] R.B. Scully, R.H. Young, P.B. Clement, Atlas of tumor pathology. Tumors of the ovary, maldeveloped gonads, fallopian tube and broad ligament, AFIP 8 (1998) 165–168. [13] H. Pak, S. Yokota, R. Paladugu, C.M. Agliozzon, Glassy cell carcinoma of the cervix, Cancer 52 (1983) 307–312. [14] V. Seltzer, S. Sanford, M.U. Castadot, M. MuradianDavidian, A. Sedlis, Glassy cell cervical carcinoma, Gynecol Oncol 8 (1979) 141–151. [15] H.K. Tamimi, J. Hesla, J.M. Cain, D.C. Figge, B.E. Greer, Glassy cell carcinoma of the cervix redefined, Obstet Gynecol 71 (1988) 837–841.
Pathology – Research and Practice 203 (2007) 217–220 www.elsevier.de/prp
TEACHING CASES
Glassy cell carcinoma of the endometrium: A case report and review of the literature Gabriella Ferrandinaa,c,, Gian Franco Zannonib, Marco Petrilloa, Valerio Velloneb, Enrica Martinellia, Giovanni Scambiac a
Gynecologic Oncology Unit, Catholic University, L.go A. Gemelli 8, 00168 Rome, Italy Institute of Human Pathology, Catholic University, Rome, Italy c Department of Oncology, Catholic University, Campobasso, Italy b
Received 20 November 2006; accepted 5 February 2007
Abstract Glassy cell carcinomas are composed of malignant cells showing a ‘‘ground glass’’ cytoplasm, distinct cell membranes, and large nuclei with prominent nucleoli. To our knowledge, only 12 cases of glassy cell endometrial carcinomas (EGCC) have been reported until now. A 63-year-old patient complaining of irregular vaginal bleeding underwent hysteroscopy-guided biopsy revealing a well-differentiated endometrial endometrioid adenocarcinoma. The patient underwent left salpingo-oophorectomy, total abdominal hysterectomy, and pelvic lymphadenectomy. The final diagnosis was FIGO stage IB poorly differentiated endometrial adenosquamous carcinoma with 490% of glassy tumor cells. The patient is alive, with no evidence of disease for 69 months after diagnosis. We describe an additional case of EGCC and review the data of the literature, emphasizing the need to strictly define the criteria for the diagnosis and the potential usefulness of assessing biologic parameters for the prognostic characterization of this rare entity. r 2007 Elsevier GmbH. All rights reserved. Keywords: Glassy cell tumor; Endometrial cancer
Introduction Glu¨cksmann and Cherry [3] were the first to describe glassy cell carcinomas in the uterine cervix. They reported that these were typically composed of malignant cells showing a moderate amount of cytoplasm with ‘‘ground glass’’ appearance, distinct cell membranes stained with eosin or periodic acid-Schiff, and large nuclei with prominent nucleoli. These tumors often Corresponding author. Gynecologic Oncology Unit, Catholic University, L.go A. Gemelli 8, 00168 Rome, Italy. Tel./fax: +39 06 35508736. E-mail address: [email protected] (G. Ferrandina).
0344-0338/$ - see front matter r 2007 Elsevier GmbH. All rights reserved. doi:10.1016/j.prp.2007.02.001
contain a heavy inflammatory infiltrate consisting of eosinophilic leukocytes. Since the beginning, they have been regarded as an uncommon variant of poorly differentiated adenosquamous carcinoma [3]. Within cervical cancer histotypes, glassy cell carcinoma had been considered a highly aggressive tumor endowed with resistance to radiation therapy and unfavorable prognosis [3,14,15], until more recent reports suggested that the use of multimodal strategies, including adjuvant chemoradiation after surgery, may dramatically improve the patients’ clinical outcome [7,10]. Glassy cell carcinomas of the endometrium are very rare neoplasms, accounting for approximately 0.5% of
ARTICLE IN PRESS 218
G. Ferrandina et al. / Pathology – Research and Practice 203 (2007) 217–220
all endometrial carcinomas [4]. To our knowledge, only 12 cases of glassy cell endometrial carcinomas have been reported until now [1,4–6,8,11]. Here, we report an additional case of endometrial glassy cell carcinoma and review the literature.
Case report In November 2000, a 63-year-old patient was admitted to the Gynecologic Oncology Unit of the Catholic University of Rome for irregular vaginal bleeding. Her family history was unremarkable, while her past history included hypertension. Her gynecologic history included right adnexectomy (15 years before) due to the presence of a simple ovarian cyst. Spontaneous menopause occurred at the age of 53 years. Hysteroscopy-guided biopsy was performed, revealing a well-differentiated endometrial endometrioid adenocarcinoma. Gynecologic examination documented a uterus of normal size, no adnexal masses, and unremarkable cervix. Colposcopy was also negative. Transabdominal and transvaginal ultrasound examination documented the presence of a normally sized uterus showing a heterogeneously echogenic nodule (maximum diameter ¼ 2.5 cm) in the uterine fundus. Staging work-up included chest X-ray and pelvic Magnetic Resonance Imaging (MRI). MRI documented a tumor mass (2.8 cm in maximum diameter) located in the uterine corpus and invading less than 50% of the myometrium. There was found a nodule of 1.2 cm at the level of right external iliac lymph nodes. Ca-125 levels were 44.1 U/ml. At laparotomy, several firm and dense adhesions between the uterus and sigmoid colon were detected. After lysis of the adhesions, peritoneal washing was performed, and the patient underwent left salpingooophorectomy, total abdominal hysterectomy, pelvic lymphadenectomy, and peritoneal as well as omental biopsies. At pathologic examination, the uterus appeared to be enlarged because of the presence of a nodular lesion (3 cm in maximum diameter) located in the uterine fundus and protruding 0.6 cm out of the myometrium (1.8 cm). Lymphovascular space invasion was not documented. The uterine cervix and the left ovary were unremarkable. All biopsies and pelvic lymph nodes (n ¼ 19) were negative. The final diagnosis was FIGO stage IB poorly differentiated endometrial adenosquamous carcinoma, with 490% of the tumor being neoplastic cells with glassy cell features (Fig. 1). The diagnosis was confirmed by a second gynecologic pathologist who was unaware of the first diagnosis. Tumor cells were found to be estrogen- and progesterone receptor-negative, while positivity for ki67 and
Fig. 1. Glassy cell carcinoma of the endometrium: the undifferentiated glassy cells display large nuclei with prominent nucleoli and granular cytoplasm. Areas of abundant eosinophilic infiltration are present (Hematoxylin & Eosin, magnification: 200 ).
p53 was found in 80% and 5% of tumor cells, respectively. Moreover, a positive immunoreaction for Vascular Endothelial Growth Factor was detected in 90% of tumor cells. On the other hand, Her-2/neu protein showed 1+ positivity, while bcl-2 protein immunoreaction was barely detectable. Adjuvant radiation was considered contra-indicated due to the presence of diffuse intraabdominal adhesions, and the patient had to undergo routine follow-up procedures. The patient is alive with no evidence of disease for 69 months after diagnosis.
Discussion Glassy cell carcinomas most frequently occur in the uterine cervix, although some cases of glassy cell carcinoma of the uterus, colon, and fallopian tube have also been reported [4,9,11]. As far as endometrial glassy cell carcinomas are concerned, the histogenesis and site of origin are still debated. Indeed, the peculiar characteristics of glassy cell carcinomas (absence/paucity of squamous or glandular differentiation, PASpositive cell wall, prominent nucleoli in vesicular nuclei) are not sufficient to recapitulate the histogenesis of this tumor, which has been originally regarded as a poorly differentiated variant of adenosquamous carcinoma [3]. This assumption was questioned by Arendt et al. [1], based on the absence of keratin and prekeratin in glassy cell carcinoma of the endometrium. Moreover, also the documentation of the presence of lysozyme, the expression of which is limited to the endocervical and isthmic normal uterine mucosa, led the same authors [1] to favor
ARTICLE IN PRESS G. Ferrandina et al. / Pathology – Research and Practice 203 (2007) 217–220
the endocervical or isthmic origin of endometrial glassy cell carcinoma. However, as summarized in Table 1, after exclusion of cases with advanced stage of disease, all endometrial glassy cell carcinomas were reported to be located in the uterine corpus, with the exception of a FIGO stage IIIA case [1], in which the tumor also involved the uterine isthmus and parametrium. The fraction of glassy cells, considered necessary for the diagnosis of a glassy cell carcinoma, showed a very wide range (from 30% to 100%) [2,11]. Moreover, in most of the cases summarized in Table 1, the percentage of glassy cells in the tumor is not given, and sometimes, the description of sheets or nests of malignant cells with glassy cell features is provided [1,4–6,8]. In our case, the diagnosis of glassy cell carcinoma was made, given the presence of 490% of malignant cells with glassy cell features, according to Scully et al. [12]. The issue of strictly defining and widely sharing the criteria for the diagnosis of glassy cell carcinomas becomes clinically relevant under consideration of the fact that glassy cell carcinomas are usually very aggressive. Regarding glassy cell carcinomas of the uterine cervix, earlier studies reported overall survival rates of 0–60% in stage IB tumors [13–15]. Nonetheless, recent studies employing multimodal treatment strategies, including surgery and radiation with or without chemotherapy, documented a significantly improved prognosis with survival rates closely resembling those reported for squamous cervical cancer at a similar stage of disease [7,10]. Table 1.
219
Regarding endometrial glassy cell carcinoma, earlier studies documented a very dismal prognosis even in stage I tumors. From the data summarized in Table 1, 5 of 9 cases with stage I tumors experienced recurrence/ death of disease within 5 years after diagnosis, suggesting that glassy cell carcinomas arising in the uterus may behave aggressively. However, it has to be considered that the small size of the cases reported in the literature does not allow any definitive conclusion to be reliably drawn. Although adjuvant treatment was not performed because of the documentation of several and dense adhesions, regarded as a contraindication to radiotherapy, our case had a favorable prognosis, since the patient has been free of disease for more than 5 years after surgery. Other than glassy cell carcinomas of the uterine cervix, in which pathologic factors have been identified that allow for the definition of patients at higher risk of relapse [7], to our knowledge, no specific pathologic or molecular factors are known to play a prognostic role in this neoplasia. Estrogen and progesterone receptors were absent in the case reported by Mhawech et al. [1], while the complete response to progestins, described in the case by Dawson et al. [5], is an indirect evidence of the presence of progesterone receptors. In our case, estrogen and progesterone receptors were negative, and p53 positivity was found in only 5% of tumor cells. On the other hand, the expression of ki67, a marker of cell proliferation, was found in the vast majority of the tumor cells.
Characteristics of patients with glassy cell adenocarcinoma of the endometrium, as reported in the literature
Author
Age (years)
Stage
Location in the uterus
Treatment
Clinical outcome
Christopherson [4]
56 70 71
I I I
— — —
RT, H RT, H RT, H
78 78 59
I III IIIA
— — Isthmus
58 52
IB IB
Fundus Fundus
58
IB
Fundus
Dawson [5]
96
IVB
Fundus
RT RT TAH, BSO, RT, progestins TAH, BSO TAH, BSO, pelvic node dissection TAH, BSO, pelvic node dissection Megestrol 80 md bid
DOD at 5 months DOD at 32 months Death of pneumonia after 6 years Suicide at 7 months DOD after 5 months NED after 24 months
Hachisuga [8]
62
IIIC
Fundus
Mhawech [11]
60
IB
Fundus
Current case
63
IB
Fundus
Arends [1] De Rosa [6]
TAH, BSO, pelvic node dissection,RT TAH, BSO, pelvic node dissection, RT TAH, BSO, pelvic node dissection
DOD after 12 months DOD after 16 monhs ED at 36 months Persisting complete response after 16 months NED after 66 months NED after 60 months NED after 69 months
RT ¼ radiotherapy, H ¼ hysterectomy, DOD ¼ death of disease; ED ¼ alive with evidence of disease; NED ¼ no evidence of disease.
ARTICLE IN PRESS 220
G. Ferrandina et al. / Pathology – Research and Practice 203 (2007) 217–220
In conclusion, we described an additional case of endometrial glassy cell carcinoma and reviewed the literature. We emphasized the need to more strictly define the criteria required for the diagnosis and stressed the potential usefulness of assessing biologic parameters for the prognostic characterization of this rare entity.
Acknowledgments This work was financially supported by grants from Associazione Italiana per la Ricerca sul Cancro (A.I.R.C) and I.R.I.S-PCR-OG-ONLUS (www.iris-og.com).
References [1] J.W. Arends, D. Willebrand, H.J. Dekoning Gans, G.J.V. Swaen, F.T. Bosman, Adenocarcinoma of the endometrium with glassy cell features – immunohistochemical observations, Histopathology 8 (1984) 873–879. [2] A. Aru, L.A. Rasmussen, B. Federspiel, T. Horn, Glassy cell carcinoma of the colon with human chorionic gonadotropin-production, Am J Surg Pathol 20 (1996) 187–192. [3] C. Cherry, A. Glucksmann, Incidence, histology, and response to radiation of mixed carcinomas (adenoacanthomas) of the uterine cervix, Cancer 9 (1956) 971–979. [4] W.M. Cristopherson, R.C. Alberhaski, P.J. Connelly, Glassy cell carcinoma of the endometrium, Hum Pathol 13 (1982) 418–421.
[5] E.C. Dawson, J.L. Belinson, K. Lee, Glassy cell carcinoma of the endometrium responsive to megestrol acetate, Gynecol Oncol 33 (1989) 121–124. [6] G. De Rosa, E. Barra, L. Palombini, C. Nappi, Glassy cell carcinoma dell’endometrio, Pathologica 79 (1987) 339–345. [7] H.J. Gray, R. Garcia, H.K. Tamimi, et al., Glassy cell carcinoma of the cervix revisited, Gynecol Oncol 85 (2002) 274–277. [8] T. Hachisuga, H. Sugimori, T. Kaku, K. Matsukuma, N. Tsukamoto, H. Nakano, Glassy cell carcinoma of the endometrium, Gynecol Oncol 36 (1990) 134–138. [9] D.R. Herbold, J.H. Axelrod, S.J. Bodowski, J.H. Freel, Glassy cell carcinoma of the fallopian tube: a case report, Int J Gynecol Pathol 7 (1988) 384–390. [10] R.J. Lotocki, G.V. Krepart, M. Paraskevas, G. Vadas, M. Heywood, M. Fung Kee Fung, Glassy cell carcinoma of the cervix, Gynecol Oncol 44 (1992) 254–259. [11] P. Mhawech, A. Dellas, A.M. Terracciano, Glassy cell carcinoma of the endometrium, Arch Pathol Lab Med 125 (2001) 816–819. [12] R.B. Scully, R.H. Young, P.B. Clement, Atlas of tumor pathology. Tumors of the ovary, maldeveloped gonads, fallopian tube and broad ligament, AFIP 8 (1998) 165–168. [13] H. Pak, S. Yokota, R. Paladugu, C.M. Agliozzon, Glassy cell carcinoma of the cervix, Cancer 52 (1983) 307–312. [14] V. Seltzer, S. Sanford, M.U. Castadot, M. MuradianDavidian, A. Sedlis, Glassy cell cervical carcinoma, Gynecol Oncol 8 (1979) 141–151. [15] H.K. Tamimi, J. Hesla, J.M. Cain, D.C. Figge, B.E. Greer, Glassy cell carcinoma of the cervix redefined, Obstet Gynecol 71 (1988) 837–841.