1997 Volume 36 Issue 2 Pages 238-243
A case of signet ring cell predominent mucinous adenocarcinoma of the endometrium is reported. A 64-yearold woman with a gynecological history of 60 Co irradiation for cervical precancer (histologic type unclear) at 29, and early menopause at 32, underwent total hysterosalpingoophorectomy for an ovarian tumor diagnosed by image analysis. Pathologically, the tumor was demonstrated to be a cystically dilated uterus, containing abundant mucotenacious, necrotic and hemorrhagic substances. The imprint cytologic preparations showed mucinous adenocarcinoma with signet ring cells, being virtually identical to that arising in various other organs. Microscopically, the tumor was composed of mixed papillary tall columner mucinous cells and signet ring cells, and was almost completely confined to the inner surface of the uterus, with small invasive tumor foci in the vasculature and on the serosal aspect. Furthermore, the cervix, fallopian tubes, and ovaries were all tumor free and atrophic. The tumor might have arisen in mucinous metaplastic cells, observed in small areas in this case. If so, one could speculate that the early menopause was probably due to radiation therapy for the uterine cancer, then played a role in the development of the mucinous metaplasia, considering experimental evidence of an increased incidence of intestinal metaplasia of gastric mucosa due to irradiation to the stomach region in ovariectomized rats. Incidentally, the majority of patients with metaplastic changes of the endometrium are said to be postmenopausal and most have a history of oral estrogen replacement therapy. There was, however, no such history in this patient. In any case, mucinous adenocarcinoma of the endometrium with signet ring cell predominance is exceptional, and, to our knowledge, no similar cases have been reported in the literature, to date.
