General Oncology and Mammology - Clinical case No. 1

25 january 2018

Clinical review

Patient A. 66 years old, came to the clinic on 13.01.17 with an established diagnosis: clear cell endometrial cancer.

Subserous uterine myoma in postmenopausal women.


Medical history

  • Menses from 13 years old, established immediately, regular after 28 to 5 days, moderate. Painless. Postmenopausal from 53 years old.
  • Within 2 years, periodically I consulted a gynecologist at the place of residence with complaints of a single scanty vaginal discharge.

Medical history

  • In her words, according to the ultrasound examination, the endometrium corresponded to the period of menopause and no additional examination was carried out.
  • Since November 2016, he has noted the appearance of moderate bleeding from the vagina, in connection with which hysteroscopy, separate scraping of the uterine cavity and cervical canal, was performed in the clinic at the place of residence. According to the histological examination, the diagnosis was made: squamous cell carcinoma of the endometrium.
  • From the past diseases: hypertension stage 2, risk of 3 NK stage 1. Atherosclerosis of the aorta, aortic valve, small liver cysts, kidney cysts, superficial gastritis, duodenitis, catarrhal colitis, dolichosigma, chronic hemorrhoids.

Inspection

  • On examination, the diagnosis was confirmed. Histological response: clear cell adenocarcinoma (high grade) with full-thickness extension of endometrial fragments against the background of endometrial atrophy.
  • According to the ultrasound examination of the pelvic organs, the endometrium is 1.7 mm, linear, the basal layer is indistinct, signs of subserous uterine fibroids and evolutive changes in the pelvic organs.
  • According to PET / CT, there were no signs of a pathological metabolic active process, including in the uterus. Myomatous node in the body of the uterus.
  • After the oncological consultation, surgical treatment was performed in volume - extirpation of the uterus with appendages with pelvic lymphadenectomy.

Diagnosis

  • On examination, the diagnosis was confirmed. Histological response: clear cell adenocarcinoma (high grade) with full-thickness extension of endometrial fragments against the background of endometrial atrophy.
  • According to the ultrasound examination of the pelvic organs, the endometrium is 1.7 mm, linear, the basal layer is indistinct, signs of subserous uterine fibroids and evolutive changes in the pelvic organs.
  • According to PET / CT, there were no signs of a pathological metabolic active process, including in the uterus. Myomatous node in the body of the uterus.
  • After the oncological consultation, surgical treatment was performed in volume - extirpation of the uterus with appendages with pelvic lymphadenectomy.

Final diagnosis

Clear cell endometrial cancer 1A st (T1 N0 M0).

  • In the postoperative period, laboratory signs of hypercoagulability were observed, despite the prescribed prophylaxis of thromboembolic complications in the early postoperative period, which is typical for this tumor. The postoperative period was uneventful. The patient was discharged from the clinic on the 6th day with full recovery.
  • It is recommended to see an oncologist 2 times a year.