Liver recurrence in early endometrial cancer with focal myometrial invasion
In May 2007, a 69-year-old Korean woman presented at our emergency room with a chief complaint of vaginal bleeding, which had started a few days earlier. She was healthy at birth and had no history of underlying disease or a clotting abnormality. In addition, there was no history of oral medication, pregnancy, or any other gynecological/surgical problem. Transvaginal ultrasound revealed hematometra and necrotic materials in the uterine cavity. Abdomino-pelvic computed tomography (CT) revealed hematometra occupying the whole distended uterine cavity and ascites (). An endometrial biopsy obtained via dilation and curettage showed endometrioid adenocarcinoma of the uterus, grade 2 (). Her serum CA-125 level was 514.0 U/mL (normal range, <35.0 U/mL). The patient subsequently underwent surgical staging, including total abdominal hysterectomy, bilateral salpingooophorectomy, and pelvic and para-aortic lymphadenectomy. Final pathological findings revealed 2009 International Federation of Obstetrics and Gynecology stage IA endometrioid adenocarcinoma, grade 2, with focal myometrial invasion. Peritoneal washings were negative for malignant cells. The patient was then treated with adjuvant brachytherapy to a total dose of 3,000 cGy in 6 fractions of 500 cGy each. After treatment, serum CA-125 had returned to the normal range.\nThe patient remained under close follow-up every three month (CA-125 and pelvic exam) and was without any evidence of recurrent disease until November 2008. At that time, her serum CA-125 level was found to have increased to 93.03 U/mL, and a subsequent F-18 fluorodeoxyglucose positron emission tomography/computed tomography (F-18 FDG PET/CT) scan revealed recurrent mass with abnormal FDG uptake in the liver. A liver biopsy revealed recurrent adenocarcinoma. The patient then underwent six cycles of a 3 weekly paclitaxel and carboplatin chemotherapy regimen. However, 8 months after completing chemotherapy, serum CA-125 was elevated and abdomino-pelvic CT revealed multiple recurrences. Second-line chemotherapy with 5-FU and cisplatin was attempted, but her response was poor, and her general condition became aggravated. The patient is currently under hospice care, and is being treated as a terminal cancer patient.