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Department of Pathology and Laboratory Medicine

Department of Pathology and Laboratory Medicine

Residency Program - Case of the Month

February 2010 - Presented by Mary Tomic, M.D.

Clinical history:

The patient is a nulligravida 47 year old female with Turner’s Syndrome who presented with a 10 month history of irregular vaginal bleeding. Gynecologic history is further significant for menarche at age 15 with premarin and provera; the patient stopped hormone replacement therapy in her twenties with subsequent cessation of menstruation. Physical exam was significant for obesity; pelvic exam did not reveal any abnormalities but was limited. Endometrial biopsy revealed adenocarcinoma and the patient subsequently underwent a total abdominal hysterectomy.

Gross description:

Received fresh was a 34 gm hysterectomy specimen consisting of uterus and bilateral fallopian tubes. The ovaries were not grossly identified. Bivalving of the uterus revealed a polypoid mass involving the posterior lower uterine segment. On cut section the mass involved greater than 50% of the myometrial surface.

Microscopic photographs:

COTM Feb2010 Microscopic Image 1 COTM Feb2010 Microscopic Image 2 COTM Feb2010 Microscopic Image 3 COTM Feb2010 Microscopic Image 4 COTM Feb2010 Microscopic Image 5   

Immunohistochemical Stains:

ER: Negative
PR: Negative
P16: Negative
P53: Negative
CK7: Positive
EMA: Positive
CD10: Positive (focal and luminal)
Calretinin: Positive

Figure 1: CK7

COTM Feb2010 Immunohistochemical Stains: CK7 

Figure 2: EMA

COTM Feb2010 Immunohistochemical Stains: EMA

Figure 3: Calretinin

COTM Feb2010 Immunohistochemical Stains: Calretinin

Figure 4: CD10

COTM Feb2010 Immunohistochemical Stains: CD10
        


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