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The ciliated cell variant of endometrioid adenocarcinoma is a very rare tumour with sporadic reports in the literature. It is only briefly mentioned in most textbooks on gynaecological pathology.1–3 We report a case of ciliated adenocarcinoma arising from the endometrium.
A 52 year old woman presented with continuous vaginal bleeding for 10 weeks. Of interest, she had two older sisters who had both undergone hysterectomy for bleeding problems. An ultrasound scan suggested the possibility of cystic glandular hyperplasia of the endometrium. An endometrial biopsy was performed, raising the possibility of a neoplastic process. A total abdominal hysterectomy and bilateral salpingo-oophorectomy was then carried out for definitive diagnosis.
Grossly, the endometrial cavity was expanded by thick friable material interspersed with areas of haemorrhage. Macroscopic invasion was not seen. Histologically, the endometrium was seen to be extensively and almost totally replaced by an adenocarcinoma composed predominantly of ciliated cells (fig 1), with a focally cribriform appearance. Minute foci of necrosis were present. The tumour was noted to have a pushing border, infiltrating the inner half of the myometrium. Vascular invasion was also seen.
Adenocarcinomas of the endometrium often contain a few ciliated cells.1,2,4 Rarely, they may be composed predominantly, or even exclusively, of ciliated cells. At least 75% of the tumour cells have to be ciliated for the tumour to be termed a ciliated cell carcinoma.4
These very rare and distinctive tumours consist of sheets of cells with a cribriform pattern imparted by scattered extracellular lumina. The lining cells have prominent cilia, projecting into the luminal space.2
Because most ciliated endometrial proliferations are benign, the diagnosis of ciliated cell carcinoma necessitates caution, with the presence of myometrial or vascular invasion establishing the diagnosis.1–5 Although these tumours can extensively invade the myometrium, the prognosis of the few reported cases has been relatively favourable.4