199 Unusual metastatic spread of endometrial adenocarcinoma to the abdominal wall: a case report

Introduction/Background Endometrial endometrioid cancer is the most common gynaecological cancer and is associated with good prognosis. Abdominal wall metastasis of endometrial cancer are not typical. Given the rare presentation of endometrial cancer metastasis and the challenges it presented in its diagnosis, it is of the uttermost importance to share this clinical case with the scientific community. Methodology Case-file analysis. Results This case highlights an intriguing case of a 56-year-old woman with a history of endometriosis, infertility, and irritable bowel syndrome, who underwent hormone therapy for 5 years. She initially presented with endometrial endometrioid G1 adenocarcinoma with myometrial focal invasion (FIGO IA2), leading to a total hysterectomy and bilateral adnexectomy. After 19 months, the patient noticed an abdominal wall nodule, causing abdominal discomfort. Imaging studies revealed a non-vascularized 19mm solid nodule in the infraumbilical midline, within the abdominal rectus muscle, initially suspected to be a foreign body, desmoid tumor, or endometriosis. Biopsy results unexpectedly showed a papillary adenocarcinoma with an intestinal pattern. Histological and immunohistochemistry studies confirmed abdominal wall metastasis of endometrial carcinoma. PET imaging indicated hypermetabolic adenopathy posterior to the right iliac external vessels. In a multidisciplinary approach, the decision was made to surgically excise the lesion and perform pelvic right lymphadenectomy. A peritoneal biopsy was also performed. The abdominal wall nodule and peritoneal biopsy revealed metastatic endometrial adenocarcinoma without free margins, while lymph nodes remained negative. The metastases were positive for estrogen receptors, microsatellite stable, and had a wild-type p53. POLE mutation is under investigation. Subsequently, palliative chemotherapy with carboplatin and paclitaxel was initiated as per multidisciplinary team's recommendation. Conclusion This case underscores the unpredictable nature of endometrial carcinoma and emphasizes the need for a comprehensive diagnostic and treatment approach, especially in cases of atypical metastatic sites. Further research and long-term follow-up are necessary to better understand and manage such rare presentations of endometrial adenocarcinoma. Disclosures No conflicts of interests to declare.