Endometrial Cancer. Case Report and Review of the Literature

ABSTRACT


INTRODUCTION
Endometrial cancer is the second most common gynecologic malignancy worldwide, originating in the endometrium, due to chronic estrogenic stimulation.It mainly affects postmenopausal women.The average age at diagnosis is 60 years, the incidence is from 75 to 79 years in 85% of cases, and only 5% before 40 years of age.The most significant risk factors are age, race, metabolic syndrome, obesity, nulliparity, tamoxifen, raloxifene, aromatase inhibitors, unopposed estrogen exposure and genetic predispositions to endometrial cancer. 1,2,3t is divided into two large groups, according to their clinicopathological characteristics: Type I: endometroid, and type II: not related to estrogen exposure.They include endometroid grade 3 and non-endometroid subtypes: serous, carcinosarcomas, clear cell, mixedand undifferentiated. 4he WHO classification describes 7 different tumor types: endometroid carcinoma which comprises 80% of endometrial cancer, usual type and variants, mucinous adenocarcinoma in 1-9%, serous carcinoma which represents less than 10% of endometrial cancer, clear cell carcinoma <5%, neuroendocrine carcinoma, mixedcarcinoma, undifferentiated carcinoma, and undifferentiated carcinoma. 5ndometroid carcinoma is the most common carcinoma accounting for 75 to 80% of cases.Histologically they are composed of tall wall-to-wall aligned columnar cells with no intervening stroma and the glands have a smooth luminal contour.Most of these tumors express estrogen and progesterone receptors on the surface.Endometroid carcinoma is graded using the FIGO grading system, which takes into account the architectural pattern and nuclear grade: Grade 1: Less than 5% solid growth pattern.Grade 2: 6-50% solid growth pattern.Grade 3: >50% solid growth pattern. 6he diagnosis is made through the histopathological study of the endometrial biopsy, which can be performed by various methods: ambulatory endometrial biopsy, fractionated uterine curettage and hysteroscopy.Taking into account that the gold standard for endometrial tissue sampling is the biopsy guided by hysteroscopy. 1,7reatment in early stages is surgical, based on total abdominal hysterectomy, bilateral salpingo-oophorectomy and pelvic lymphadenectomy.No adjuvant treatment is recommended for this group, as it is not beneficial.The recommended adjuvant treatment for intermediate risk and high intermediate risk is tailored according to clinical risk factors.The high-risk group should receive radiotherapy or chemotherapy.Patients presenting with residual disease in the pelvis and limited distant metastases, rely on chemotherapy and radiotherapy to minimize local and distant recurrent risk.Metastatic disease may benefit from optimal cytoreductive surgery.The preferred adjuvant/neoadjuvant regimen is Carboplatin plus Paclitaxel. 8

OBJECTIVE
To present a case of a 23-year-old female patient diagnosed with endometroid carcinoma.

MATERIAL AND METHODS
Female patient, 23 years old, who began 3 months ago with Corresponding Author: Vigil Cariño edema of the right pelvic limb, in addition to a feeling of abdominal heaviness, and intestinal constipation, frank dysmenorrhea, self-medicated with NSAIDs, with moderate improvement, then began with intermittent pain and a feeling of mass in the abdomen.Within her medical history, heredofamilial antecedents: Diabetes Mellitus 2 and Systemic Arterial Hypertension, she denies a history of cancer.Personal pathological history: denies chronic degenerative diseases, denies allergies, denies surgeries, denies transfusions, denies previous hospitalizations, complete vaccination schedule, nonpathological personal history: adequate hygiene, inadequate nutrition in quality and quantity, sedentary, passive smoking, positive ethylism referred to as social, drug addictions denied, no tattoos, lives with 3 pets, dogs, gynecological history: menarche at 9 years of age, irregular amenorrhea type cycles of up to 120 days, followed by hypermenorrhea and dysmenorrhea, untreated, denies active sexual life, nulliparous.Cervical cytology denied, somatometry: height 1.65 m, weight 110 kg, BMI 35, obesity grade III.Laboratory and imaging studies were requested, prolactin 17.280ng/ml, estradiol 11.800 pg/ml, FSH 9.190mUl/ml, LH 4.430 mUl/ml T3 total 1.010 ng/ml, T4 total 8.910, TSH 3.750 Ul/ml.The pelvic ultrasound showed a heterogeneous irregular mass of 20 x 14 cm, it was decided to perform a contrasted abdominal tomography, where an anteverted uterus was observed with an increase in its dimensions at the expense of a solid lesion, measuring 21.5 x 14.1 x 14.4 cm, in the right adnexa a cyst of simple appearance was observed.

RESULT
In view of the diagnostic suspicion based on clinical data and tomographic findings, the patient underwent exploratory laparotomy with infraumbilical midline incision, under peridural block at L2-L3 level, and an irregular tumor lesion was identified.The definitive macroscopic histopathological study indicated endometroid carcinoma in both ovaries and uterus, with peritoneal implant.

CONCLUSIONS
Although there is ample scientific evidence supporting the risk factors associated with endometrial cancer, with the age of onset being more common in older women, it is also being diagnosed in younger and younger women.Young or premenopausal women diagnosed with endometrial cancer tend to have obesity, anovulatory cycles, or a genetic predisposition to develop this disease.Given its impact on early age of onset, more casecontrol studies are warranted to learn more about the risk factors involved in early endometrial cancer.