Recently, certain
endometrial carcinomas have been found to be associated with mismatch repair (MMR)
protein defects/deficiency. A 39-year-old female presented with
cough, decreased appetite and significant
weight loss since 2 months. Earlier, she had undergone total abdominal
hysterectomy with bilateral
salpingo-oophorectomy (TAH-BSO) for
endometrioid adenocarcinoma. Imaging disclosed an 8 cm-sized adrenal mass that was surgically excised. Histopathology of the adrenal
tumor, endocervical
tumor, and endometrial biopsy revealed Federation of Gynecology and Obstetrics (FIGO) Grade II to III
endometrioid adenocarcinoma. By immunohistochemistry,
tumor cells were positive for
cytokeratin 7,
epithelial membrane antigen, PAX8, MLH1 and PMS2 while negative for
estrogen receptor (ER),
progesterone receptor (PR), MSH2 and MSH6. She underwent
adjuvant radiotherapy and
chemotherapy. A 34-year-old lady presented with
vaginal bleeding since 9 months. She underwent TAH-BSO, reported as FIGO Grade III
endometrioid adenocarcinoma. By immunohistochemistry,
tumor cells were negative for ER, PR, MLH1, and PMS2 while positive for MSH2 and MSH6. She underwent
adjuvant radiotherapy and
chemotherapy. However, she developed multiple nodal and pericardial
metastases and succumbed to the disease within a year post-diagnosis. Certain high-grade
endometrioid adenocarcinomas occurring in younger women are MMR
protein deficient and display an aggressive
clinical course. Adrenal
metastasis in
endometrial carcinomas is rare.