Endometrial adenocarcinoma with signet ring cell features – A report of a rare case with literature review

Abstract

Endometrial cancers are the sixth most common cancer diagnosis in women and the second most common female genital organ cancer diagnosis [1]. Endometrial adenocarcinoma with signet ring cell morphology is a rare finding. The most common differential diagnosis for this histologic pattern is metastasis from distant organs like the breast and the stomach. Seven cases with this morphology have been published in the literature. Identification of this morphology in the endometrium creates a diagnostic conundrum, especially in patients with no known prior history of malignancy. The diagnosis of endometrial adenocarcinoma with signet ring cells requires an extensive panel of immunohistochemical stains to rule out metastatic disease. We present a case of a 72-year-old female who presented with intermittent and worsening post-menopausal bleeding. An endometrial biopsy was performed for a thickened endometrial stripe which showed FIGO grade III endometrioid adenocarcinoma of the endometrium. Upon histologic examination of the hysterectomy specimen, tumor cells with signet ring cell morphology were identified. The patient underwent total hysterectomy with bilateral salpingo-oophorectomy and bilateral pelvic lymph node dissection and received post-surgical chemotherapy and radiotherapy. She tolerated the treatment well and no recurrences were reported. Most patients with this disease have presented in an advanced stage with varying degrees of myometrial invasion. Surgical excision was the preferred mode of therapy. Signet ring cell histology is rarely identified in endometrial carcinoma and both primary and metastatic signet ring cell carcinomas should be kept in mind.

Keywords

• Uterine cancer
• Primary endometrial cancer
• Signet ring cell morphology
• Extrauterine metastasis
• Metastatic carcinoma to the uterus