Clear cell carcinoma of the endometrium confined to atrophic endometrial polyp--case report

Clear cell carcinoma is a rare form of endometrial carcinoma inline type II estrogen-independent. It accounts for only 1% to 5.5% of all endometrial carcinomas. It is usually detected in postmenopausal women, who are older than those with endometrioid carcinoma. Clear cell carcinoma may exhibit solid, papillary, tubular and cystic patterns. The malignant cells are characterized by a moderate amount of clear or foamy cytoplasm; however, its recognition as a clear cell type of cancer cytologically is not often possible. The tumor is usually poorly differentiated, tends to be high grade, with deep myometrial invasion, lymphovascular space invasion, and metastasis in pelvic lymph node. That is why this tumor has a poor prognosis, as in our case of a 72-year-old woman with symptoms of deficient uterine bleeding. In a period of two months, two suction endometrial curettages were performed. The material obtained by endometrial curettage for histopathologic verification was very scanty. The assessment described an inactive endometrium with degenerative epithelial cells in scanty necrotic background. Direct endometrial samples with uterobrush yielded a finding of atypical epithelial cells of open etiology with dense chromatin and prominent nucleoli, also with foam cell histiocytes and old blood in the background. Cytologic diagnosis of intraepithelial lesion, possible adenocarcinoma was made. Ultrasonography of the uterus was suspect of neoplasm. After surgery, the pathologic diagnosis of endometrial clear cell carcinoma was made. It was a rare case of aggressive type of endometrial carcinoma confined to an atrophic endometrial polyp. In conclusion, we might say that direct endometrial sample can provide accurate diagnosis of endometrial tumor, especially when the endometrial tumor is a small one, thus saving time for diagnostic testing. This is based on the potential of cytology to make malignant diagnosis possible even with a few tumor cells on the slide.