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- Jan 18, 2013
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Dear Colleagues,
your opinion is highly appreciated on this case.
Mrs. X is a fit healthy 51 years old patient that underwent in 2016 a TAH-BSO for endometrial thickening in a remote clinic (pap smear was not suggestive, post-op pathology is not available). Her surgeon did not mention the presence of any malignancy nor he did advise any adjuvant treatment.
In 2018, she presented a right lower Limb edema, treated symptomatically and was relieved partially.
In march 2020, it became persistent and progressed bilaterally.
A CT Abdomen-pelvis showed multiple paraAortic and bilateral pelvic nodes.
Biopsy showed no biopsy.
Pet CT showed highly active paraAortic and pelvic nodes suggestive of a lymphoma with no signs of relapse at the vaginal cuff.
repeated excisional biopsy of a para-Aortic node showed high grade adenocarcinoma with extensive areas of necrosis, negative PAS, P53 neg, p16 positive, concordant with grade 3 endometrioid carcinoma.
She received induction chemotherapy Avastin, carboplatin and Taxol. Her lower Limbs edema improved significantly.
Mid-treatment Pet CT showed important partial response .
End-of treatment Pet september 2020: There is continuing decrease in size of all FDG avid lymph nodes. Some of the lymph nodes show also significant decrease in avidity while others do not. New 3 mm nodule in the right lung of unclear etiology. Overall impression is of continued partial favorable response to therapy.
your opinion is highly appreciated on this case.
Mrs. X is a fit healthy 51 years old patient that underwent in 2016 a TAH-BSO for endometrial thickening in a remote clinic (pap smear was not suggestive, post-op pathology is not available). Her surgeon did not mention the presence of any malignancy nor he did advise any adjuvant treatment.
In 2018, she presented a right lower Limb edema, treated symptomatically and was relieved partially.
In march 2020, it became persistent and progressed bilaterally.
A CT Abdomen-pelvis showed multiple paraAortic and bilateral pelvic nodes.
Biopsy showed no biopsy.
Pet CT showed highly active paraAortic and pelvic nodes suggestive of a lymphoma with no signs of relapse at the vaginal cuff.
repeated excisional biopsy of a para-Aortic node showed high grade adenocarcinoma with extensive areas of necrosis, negative PAS, P53 neg, p16 positive, concordant with grade 3 endometrioid carcinoma.
She received induction chemotherapy Avastin, carboplatin and Taxol. Her lower Limbs edema improved significantly.
Mid-treatment Pet CT showed important partial response .
End-of treatment Pet september 2020: There is continuing decrease in size of all FDG avid lymph nodes. Some of the lymph nodes show also significant decrease in avidity while others do not. New 3 mm nodule in the right lung of unclear etiology. Overall impression is of continued partial favorable response to therapy.
| She underwent a laparoscopic paraaortic, pelvic lymphadenectomy with omentectomy: Right pelvic nodes: fragments of fibro-adipose tissue containing residual lymphoid aggregates with many areas of acellular necrosis. some are well-delineated, oval shaped, probably representing pre-existing LN with no residual viable tumor. the surgeon stated that he was unable to completely resect the magma on the right side due to important fibrosis. Left pelvic nodes : one Ln identified showing areas of hyaline fibrosis , negative for metastatic lesion. paraaortic nodes: one benign LN with fibrosis and many scattered psammoma bodies. no metastasis. What to offer her next ? 1- observation 2- focal RT to right pelvic nodes where there was partial resection as described by the surgeon 3- complete adjuvant RT to all pet+ involved areas (45Gy/25 fr ) and then offer a boost to partially resected right iliac region. |
