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Mu’ath M.A. Rjoub Supervised by: Dr. Huda Zahawi, FRCPath. King Abdullah University Hospital

Mu’ath M.A. Rjoub Supervised by: Dr. Huda Zahawi, FRCPath. King Abdullah University Hospital )KAUH(. Clinical History. A 56 year old single female , presented complaining of postmenopausal bleeding. She underwent Total Abdominal Hysterectomy .

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Mu’ath M.A. Rjoub Supervised by: Dr. Huda Zahawi, FRCPath. King Abdullah University Hospital

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  1. Mu’ath M.A. Rjoub Supervised by: Dr. Huda Zahawi, FRCPath. King Abdullah University Hospital )KAUH(

  2. Clinical History • A 56 year old single female, presented complaining of postmenopausal bleeding. She underwent Total Abdominal Hysterectomy. • Gross Description: We recieved apreviously opened and distorted TAH specimen from a peripheral hospital, the specimenmeasuring 16.5x10x6.5 cmand weighing 215 gm, the uterine cavity was totally replaced by papillary like necrotic and friable mass measuring 13.5x12x6 cm. • The cervix measuring 4.5 x 1 cm .The tumor is invading the myometriumand less than 1 cm away from serosa and totally replacing the endometrial andendocervical cavity.

  3. Microscopy

  4. H&E

  5. H&E

  6. H&E

  7. Differntial Diagnosis 1. Undifferentiated carcinoma. 2. High grade serous carcinoma. 3. Cervical lymphoepithelioma like carcinoma. 4. Endometrial lymphoepitheliomalike carcinoma. 5. Lymphoma. 6. Sarcoma.

  8. Cam 5.2

  9. EMA

  10. Differential Diagnosis 1. Undifferentiated carcinoma. 2. High grade serous carcinoma. 3. Cervical lymphoepithelioma like carcinoma. 4. Endometrial lymphoepithelioma like carcinoma. 5. Lymphoma. 6. Sarcoma.

  11. P53

  12. Differential Diagnosis 1. Undifferentiated carcinoma. 2. High grade serous carcinoma. 3. Cervical lymphoepithelioma like carcinoma. 4. Endometrial lymphoepithelioma like carcinoma. 5. Lymphoma. 6. Sarcoma.

  13. LCA

  14. Synaptophysin Chromogranin A

  15. Immunohistochemistry • Tumor cells were also negative for WT-1, ER, CD10, Actin and Desmin. • This leavesus with the diagnosis of lymphoepithelioma like carcinoma.

  16. EBV

  17. Diagnosis Endometrial lymphoepithelioma like carcinoma.

  18. Discussion • Lymphoepithelial carcinoma is a distinct neoplasm ofthe nasopharynx with consistent etiologic associationwith Epstein–Barr virus (EBV). • Carcinomas with morphologicfeatures of Lymphoepithelial carcinoma,which occur outside of the nasopharynx, are calledlymphoepitheliomalike carcinoma (LELC).

  19. Discussion cont. • Regarding the lowerfemale genital tract, LELC hasbeen described in the vulva, vagina and cervix. • To the best of our knowledge, only four caseshave been previously reported in the uterine corpus. In one of the reported cases, there was uterine and cervical involvement, but the main tumoral mass was locatedin the endometrial cavity inducing the authors to concludean endometrial origin.

  20. Discussion cont. • Microscopically, a diffuse and lymphoid rich stroma,the absence of glands and papillary architecture, together with cytologicfeatures excluded the diagnosis of endometrioidand serous type carcinoma. • Among the other rare types of nonendometrioid carcinoma, the tumor most similar to this diagnosis was undifferentiated, large cell-typecarcinoma, but the presence of an intense inflammatorycomponent was consistent with endometrial LELC.

  21. Discussion cont. • The tumor cell immunoprofile in our case was similar to those of the reported cases that werecytokeratin and epithelial membrane antigen positive. • Leucocyte common antigen, estrogen and progesteronereceptors, neuron specific enolase, chromogranin, synaptophysin, and p53 were negative. • They didnot find evidence of Epstein–Barr virus (EBV) infection usingimmunohistochemistry nor polymerase chainreaction (PCR).

  22. Discussion cont. • Further studies on large series of cases are warrantedto determine the relationship of this unusual typeof endometrial carcinoma with endometrioid and nonendometrioidcarcinoma, type I and type II, respectively. • In one of the reported cases, the uninvolved endometrium wasatrophic rather than hyperplastic, and the immunostainingfor p53 was negative.

  23. Prognosis • Unfortunately, our patient was transferred to another hospital for treatment and we lost her follow up. • The limited number ofendometrial LELC does not allow to determine theirprognosis. In one of the patients, a follow-up of 24 monthsdid not reveal relapse and/or distant metastasis, but one of the casesdescribed by Vargas et al had an aggressivecourse.

  24. Thank You

  25. References • Endometrial lymphoepitheliomalike carcinoma:absence of Epstein–Barr virus genomes.S. RAHIMI*, A. LENAy & G. VITTORIy,Departments of *Pathology and Gynaecology, Ospedale San Carlo-IDI IRCCS, Rome, Italy. • Vargas MP, Merino MJ. Lymphoepithelioma-like carcinoma: anunusual variant of endometrial cancer, a report of two cases. Int JGynecol Pathol 1998;17:272–6. • Axelsen SM, Stamp IM.Lymphoepithelioma-like carcinoma of thevulvar region. Histopathology 1995;27:281–3. • Dietl J, Horny HP, Kaiserling E. Lymphoepithelioma-like carcinomaof the vagina: a case report with special reference to the immunophenotypeof the tumor cells and tumor infiltrating lymphoreticularcells. Int J Gynecol Pathol 1994;13:186–9. • Mills SE, Austin MB, Randal ME. Lymphoepithelioma-like carcinomaof the uterine cervix. A distinctive undifferentiated carcinomawith inflammatory stroma. Am J Surg Pathol 1985;9:883–9.

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