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Uterine papillary serous carcinoma: A rare type of endometrial carcinoma with worse outcomes

Introduction: Uterine papillary serous carcinoma (UPSC) is a clinically aggressive type of endometrial carcinoma. They represent about 10% of endometrial carcinomas and are responsible for 40% of deaths and recurrences associated with endometrial cancer. Patient Presentation: JM is a 75 year old woman who presented with eight months’ postmenopausal vaginal bleeding, loss of weight and low abdominal pain. Except for obesity and bilateral pitting edema, she had normal findings on physical examination. Management and Outcome: Pelvic ultrasound showed an intra-uterine mass of increased echo (4×4 cm) and a pelvic CT scan showed a bulky uterus bulky with prominent endometrium. Visual inspection with acetic acid and Lugol’s iodine was negative for cervical cancer whereas Pipelle biopsy indicated endometrial cancer. She had total hysterectomy with bilateral salpingo-oophorectomy. She is due to start chemotherapy. Conclusion: Even though endometrial biopsy using a Pipelle is highly sensitive for detection of high-grade endometrial carcinomas, it is less accurate at predicting UPSC. Patients undergoing surgery for endometrial cancer should therefore have a comprehensive surgical staging as the patient may have UPSC. Due to the risk of recurrence, adjuvant chemo-radiation should be administered after surgery.