title: Metachronous serous endometrial intraepithelial carcinoma and serous peritoneal carcinoma: analysis of probable independent lesions.
abstract: BACKGROUND
  Uterine serous endometrial intraepithelial carcinoma (SEIC) is an immediate precursor of invasive carcinoma. The majority of stage IA SEICs are curable, but those with latent peritoneal metastasis and/or capillary lymphatics invasion may have poor prognoses Careful pathologic staging is thus needed to predict the risk of recurrence and to determine postoperative therapeutic strategies.
  
  
  METHODS
  A 71-year-old woman was hospitalized for the treatment of peritoneal carcinoma. She had undergone total hysterectomy and bilateral salpingo-oophorectomy due to SEIC (stage IA) at age 63 years, and had received medical check-ups every year since. Elevated serum CA125 (184 U/mL) was detected for the first time 8 years after surgery. A thorough workup revealed no potential primary lesion other than that in the peritoneum. Tumor reduction surgery was performed. Histologic analysis of the peritoneal lesion was high-grade serous carcinoma. The peritoneal carcinoma was diffusely immunostained for p53; thus, possible recurrence of SEIC was suspected. Tumor DNAs were microdissected from the uterine and peritoneal lesions and p53 mutation analysis was done. SEIC and peritoneal carcinomas had distinct p53 mutations that were mutually exclusive.
  
  
  CONCLUSIONS
  The present case raised a concern about the difficulty of histologic staging for SEICs. Although SEICs confined to the uterine endometrium in most cases predict a good prognosis, microscopic metastasis to the peritoneum may not be detectable at hysterectomy. If secondary malignancies of a serous phenotype develop years later, comprehensive reexamination of SEIC is mandated, with the help of DNA analysis.
authors.affiliation: Department of Molecular Pathology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan. mfuruya@yokohama-cu.ac.jp.
authors.forename: Mitsuko
authors.initials: M
authors.lastname: Furuya
authors.affiliation: Departments of Pathology, Keiyu, Hospital, Yokohama, Japan.
authors.forename: Teiko
authors.initials: T
authors.lastname: Sato
authors.affiliation: Medical Mycology Research Center, Chiba University, Chiba, Japan.
authors.forename: Reiko
authors.initials: R
authors.lastname: Tanaka
authors.affiliation: Department of Gynecology, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
authors.forename: Masafumi
authors.initials: M
authors.lastname: Yamamoto
authors.affiliation: Department of Gynecology, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
authors.forename: Naho Ruiz
authors.initials: NR
authors.lastname: Yokota
authors.affiliation: Department of Gynecology, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
authors.forename: Etsuko
authors.initials: E
authors.lastname: Miyagi
mesh_terms: D065311:Adenocarcinoma in Situ / Q000235:genetics / Q000473:pathology*; D000368:Aged; D014408:Biomarkers, Tumor / Q000032:analysis; D018284:Cystadenocarcinoma, Serous / Q000235:genetics / Q000473:pathology*; D004252:DNA Mutational Analysis; D016889:Endometrial Neoplasms / Q000235:genetics / Q000473:pathology*; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D009154:Mutation; D009378:Neoplasms, Multiple Primary / Q000235:genetics / Q000473:pathology*; D010534:Peritoneal Neoplasms / Q000235:genetics / Q000473:pathology*; D016159:Tumor Suppressor Protein p53 / Q000235:genetics
chemical_list: D014408:Biomarkers, Tumor; C495901:TP53 protein, human; D016159:Tumor Suppressor Protein p53
keywords: Case report; Immunohistochemistry; Peritoneal serous carcinoma; Somatic mutation; Superficial uterine serous carcinoma (SEIC); p53