First-stage clear-cell endometrial carcinoma with paraaortic lymph node recurrence: a case report

Area of Science:

• Gynecologic Oncology
• Surgical Oncology
• Pathology

Background:

• Endometrial cancer (EC) is a prevalent malignancy globally, ranking fourth in developed countries.
• Clear-cell EC, a rare subtype (1-6%), exhibits significantly poorer survival rates compared to other histological types, even in early stages.
• Bulgarian statistics indicate a rising incidence of EC, with approximately 1293 new cases and 300 deaths annually.

Observation:

• A 62-year-old patient with stage IA clear-cell endometrial carcinoma underwent standard radical surgery and radiotherapy.
• Recurrence was observed in a paraaortic lymph node 15 months post-initial treatment.
• A subsequent surgery for metastatic parailiac lymph nodes, followed by platinum-based chemotherapy, resulted in no further relapse over 36 months.

Findings:

• Clear-cell EC demonstrates aggressive behavior and a worse prognosis than the common endometrioid subtype.
• Despite initial radical treatment, recurrence highlights the aggressive nature of this subtype.
• Aggressive surgical management and comprehensive staging, including extensive lymph node dissection, are vital.

Implications:

• Surgical staging for clear-cell EC should routinely include pelvic and paraaortic lymph node dissection, irrespective of the initial clinical stage.
• This approach may improve survival rates for patients diagnosed with this aggressive endometrial cancer subtype.
• Further research into optimal treatment strategies for clear-cell EC is warranted.