Endocrine Abstracts

A 69-year-old patient with a history of hysterectomy 18 years ago due to apparent uterine myomatosis, who presents with a clinical picture of 6 months of evolution of a solid suprapubic mass without any other associated symptomatology. Normal vaginal cytology 3 years ago; Menarche at 16 years of age and obstetric history: G1P2V2(Twin).

Physical examination: Indurated mass in the suprapubic region, mobile, not painful External atrophic genitalia; Vaginal examination: mass in suprapubic region, solid, mobile, without clarity regarding intrapelvic location; vaulted vagina and uncovered dome. Abdominal-pelvic CT-SCAN: Solid mass that makes body with the abdominal wall located on the midline of suprapubic region reaching diameters of length 6.5 cmx6 cmx10 cm, richly vascularized, with adequate cleavage planes with the surrounding structures and located above of the vesical dome. Tranvaginal-Echography: Absence of uterus due to surgical history, free vaginal dome without masses or collections, right adnexal mass of 55×52×61 mm for a volume of 93 cc, left ovaryof 17×10×15 mm, volume of 1.5 cc, free sac fundus. Tumor markers: Alphaphetoprotein (AFP): 3.6 ng/ml (normal value(NV)<10 ng/ml (−); CARCINEMBERIONAIRE ANTIGEN(CEA): 4.0 mcg/L(NV<5 mcg/L)(−); CA-125:58.5(NV<35 U/ml)(+) and human chorionic gonadotropin: Negative. 05/31/2017 the patient underwent an exploratory laparotomy and resection of mass: Surgical description Extensive abdominal wall fibrosis, preperitoneal midline mass of firm lobulated consistency of approximately 7×10 cm, adhered to muscle and posterior in relation to dome / anterior bladder wall. Free pelvic cavity. there are no masses, atrophic left ovary, right not visualized. no adenomegalies are evident. Anatomopathological study: Macroscopic: Nodular lesion of violaceous tissue that weighs 136 grams and measures 10×6×5 cm, smooth large surface; internal surface with hard consistency, and areas of necrosis. Microscopic: Fibroadiposous tissue committed by moderately differentiated endometrioid adenocarcinoma, figo2, nuclear degree 2 with focal squamous differentiation. Immunohistochemistry study: Positivity in tumor cells for CX7, PAX 8, RE, RP, VIMENTIN. Negative for CK20, CEA, AE1/AE3, TTF-1, THYLOGLOBULINE AND WT-1. Cell proliferation index measured by KI67 30%. Pathology conclusion: primary origin in endometrium. 08/17/2017. Chest CT: Nonspecific pulmonary nodule in the apicoposterior segment of the left upper lobe. The patient is taken to segmental lobectomy wedge resection of left lung lesion by thoracoscopy. Pathology report:confirms metastatic disease of gynecological origin, with edges of section and pleura compromised by tumor.

Conclusion: Sixty-nine-year-old patient with a history of Hysterectomy 18 years before with metastatic endometrial adenocarcinoma to abdominal wall and lung.