Uterine papillary serous carcinoma following radiation therapy for carcinoma of cervix: a case report

Uterine papillary serous carcinoma (UPSC) is a clinically aggressive and mo rphologically distinctive variant of endometrial carcinoma that has been re cognized recently as a distinct entity. The association between radiation t herapy (RT) and UPSC is rarely described in the literature. We describe the clinicopathologic features of a 71-year-old patient with UPSC that develop ed 15 years after radiation therapy for squamous cell carcinoma of cervix, stage IIB. In the subtotal hysterectomy specimen the endometrium was irregu lar with multifocally raised masses. Microscopically, the tumor was compose d of high-grade papillary serous carcinoma focally admired with solid trans itional cell carcinomatous areas and multifocal intraepithelial carcinoma i n adjacent atrophic endometrium. The tumor exhibited diffuse infiltrative g rowth with frequent lymphatic tumor emboli in the myometrium. Immunohistoch emical staining for p53 and c-erbB-2 were positive in about 70% of the tumo r cells. Carcinoembryonic antigen (CEA) was focally positive. Ki-67 positiv e cells were present in about 60% of the tumor cells. The tumor directly ex tended to the cervix and perirectal soft tissue and metastasized to the ome ntum. Intraoperative pelvic washing cytology was positive for papillary ade nocarinoma cells. The possible etiologic role of radiation is discussed, an d the literature on endometrial carcinomas developing after RT is reviewed.