[Melanotic adenocarcinoma of the uterus. Neuroendocrine tumor of the uterus].
The case reported concerns a 76-year-old woman under treatment for a previously diagnosed "poorly differentiated endocervical adenocarcinoma". New biopsies revealed an adenocarcinomatous tumor with unexpected melanotic pigmentation. The patient underwent cesium therapy followed by colpohysterectomy with lymphadenectomy. As there were no metastases, external complementary radiotherapy was not used. Four months after surgery, a large recurrence was detected; surgical excision proved impossible but revealed a grossly pigmented tumor from which several samples were taken. The patient died 11 months after the first consultation. No autopsy was performed. Morphological study was done on the initial biopsy, on the uterine tumor and on the recurrent tumor, using histological, cytological, ultrastructural and immunohistochemical techniques. Flow cytometry and biochemical study were also carried out on the recurrent tumor. All the samples studied histologically revealed uniform tumor morphology showing a poorly differentiated adenocarcinoma with an irregular distribution of melanin pigmentation (Fontana +). Electron microscopy confirmed the epithelial nature of the tumor, showing differentiated apical poles with villosities, linked by desmosomes. Basement membranes were irregularly present. Electron microscopy also demonstrated the melanotic nature of the pigmentation with melanosomes and premelanosomes. A few membrane-bound neurosecretory granules were seen. Immunohistochemistry showed that the tumor contains no S 100 protein and that no staining was obtained with monoclonal antibodies against malignant melanoma. Hormonal secretion and chromogranin were not detected. Tumor cells contained neither GFAP nor neurofilaments. Positive staining was obtained for neuron specific enolase and synaptophysin. Tumor cells contained three types of intermediate filament proteins = Vimentin, cytokeratins and peripherin (peripherin is an intermediate filament protein identified in 1984 by Portier, of the college of France, who very kindly supplied the antiserum and was good enough to do most of the biochemical study. Peripherin is considered to be characteristic of the peripheral nervous system. This case is the first example of demonstration of peripherin in a tumor). The biochemical study gave the following results: Cytosol assays for estrogen and progesterone receptors were negative. Vimentin, cytokeratins and peripherin were demonstrated by a study carried out in the Collège de France. No GFAP was found. A study of the metabolism of melanin derivatives showed high levels of urinary dopamine, serum and cytosol L. dopa.(ABSTRACT TRUNCATED AT 400 WORDS)
Bertrand
G
G
Laboratoire d'Anatomie Pathologique, Centre Paul Papin, Angers.
D000230:Adenocarcinoma / Q000032:analysis / Q000473:pathology*; D000368:Aged; D005260:Female; D006801:Humans; D007381:Intermediate Filament Proteins / Q000032:analysis; D008543:Melanins / Q000032:analysis*; D009419:Nerve Tissue Proteins / Q000032:analysis; D014594:Uterine Neoplasms / Q000032:analysis / Q000473:pathology*
D007381:Intermediate Filament Proteins; D008543:Melanins; D009419:Nerve Tissue Proteins
Adénocarcinome mélanotique de l'utérus. Tumeur neuro-endocrine de l'utérus.