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Endometrioid Endometrial Carcinoma With NKX3.1 Expression in a Transgender Man: A Case Report
Abstract:
Endometrial cancer in transgender men is rare, and its histopathologic features remain unknown. A 30-yr-old transgender man with an intrauterine tumor, an ovarian mass, and a 2-yr history of testosterone use was referred to us for treatment. The presence of the tumors was confirmed via imaging, and the intrauterine tumor was identified as an endometrial endometrioid carcinoma via endometrial biopsy. The patient underwent hysterectomy, bilateral salpingo-oophorectomy, omentectomy, and lymph node dissection. Pathologic examination revealed grade 3 endometrioid endometrial carcinoma, and the synchronous endometrial and ovarian tumors were collectively characterized as primary endometrial carcinoma. Metastatic carcinomas were discovered in both ovaries and the omentum, pelvic peritoneum, and a para-aortic lymph node. On immunohistochemistry, the tumor cells diffusely expressed p53, retained expression of PTEN, ARID1A, PMS2, and MSH6, and focally expressed estrogen receptors, androgen receptors, and NKX3.1. NKX3.1 was also expressed in glandular structures within the exocervical squamous epithelium. Prostate-specific antigen and prostatic acid phosphatase were focally positive. In conclusion, we describe a transgender man with NKX3.1-expressing endometrioid endometrial carcinoma who provides valuable suggestions regarding the effects of testosterone on endometrial cancer and appropriate gynecological care for transgender men.
Insights
Endometrial cancer is rare in transgender men. This case highlights an NKX3.1-expressing endometrioid endometrial carcinoma in a transgender man with a history of testosterone use, offering insights into its effects and care.
Area of Science:
- Oncology
- Endocrinology
- Gynecology
Background:
- Endometrial cancer is uncommon in transgender men, with limited data on its histopathologic characteristics.
- Testosterone therapy is frequently used by transgender men, raising questions about its potential impact on gynecologic health.
Observation:
- A 30-year-old transgender man presented with an intrauterine tumor and ovarian mass after 2 years of testosterone use.
- Imaging confirmed the tumors, and biopsy identified the intrauterine lesion as endometrioid endometrial carcinoma.
Findings:
- The patient underwent hysterectomy and bilateral salpingo-oophorectomy; pathology revealed grade 3 endometrioid endometrial carcinoma.
- Synchronous primary endometrial and metastatic ovarian, omental, peritoneal, and lymph node carcinomas were identified.
- Immunohistochemistry showed diffuse p53 expression, retained PTEN, ARID1A, PMS2, MSH6, and focal expression of ER, AR, and NKX3.1.
Implications:
- This case presents a unique instance of NKX3.1-expressing endometrioid endometrial carcinoma in a transgender man.
- Findings suggest potential effects of testosterone on endometrial cancer development and progression.
- Highlights the need for tailored gynecologic surveillance and care strategies for transgender individuals.
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