We report a rare case of squamous cell carcinoma of endometrium arising in icthyosis uteri in a 60 years old lady presenting with vaginal bleedin

J, Padmini

K, Amita

English

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Squamous Cell Carcinoma of Endometrium with Extensive Icthyosis Uteri

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Case Report:
Squamous Cell Carcinoma of Endometrium with Extensive Icthyosis Uteri
Amita K, Assistant Professor, 
Padmini J, Professor & Head,
Department of Pathology, MVJ Medical College & Research Hospital, Hosakote, Bangalore, Karnataka, India
Address For Correspondence:
Dr. Amita K,
Assistant Professor,
Department of Pathology,
MVJ Medical College & Research Hospital,
Hosakote, Bangalore,
Karnataka, India
E-mail: dramitay@rediffmail.com
Citation:  Amita K, Padmini J. Squamous Cell Carcinoma of Endometrium with Extensive Icthyosis Uteri. Online J Health Allied 
Scs. 2010;9(4):25
URL: http://www.ojhas.org/issue36/2010-4-25.htm
Open Access Archives: http://cogprints.org/view/subjects/OJHAS.html and http://openmed.nic.in/view/subjects/ojhas.html
Submitted: Dec 12, 2010; Accepted Dec 31, 2010; Published: Jan 20, 2011
Abstract:
We  report  a  rare  case  of  squamous  cell  carcinoma  of 
endometrium arising in icthyosis uteri in a 60 years old lady 
presenting with vaginal bleeding.
Key  Words:  Squamous  cell  carcinoma;  Endometrium; 
Icthyosis uteri; Vaginal bleeding
Introduction:
Icthyosis uteri is a rare condition in which the entire surface of 
endometrium  is  replaced  by  stratified  squamous  epithelium. 
Squamous cell carcinoma of endometrium (SCC E) arising in 
icthyosis  uteri  is  still  rare,  with  only  few  cases  reported  in 
literature.
Case Report:
A 60 year female presented with history of bleeding per vagin-
um since 6 to 8 months duration. She was para 3, live 3 and had 
attained menopause  15  years  back.  There  was  no history  of 
tuberculosis or itrogenically introduced substance in the uterus 
in past.
Per  speculum examination  showed  an  atrophic  cervix  which 
was flushed with vagina.
Per  vaginal  examination  revealed  an  enlarged  uterus  of  14 
weeks gestation. Adnexa was not palpable through the cervix. 
Cervix appeared unremarkable.
Ultrasonography revealed large fluid collection in the uterine 
cavity along with small soft tissue projections over the margins 
of cavity.
Hence a presumptive diagnosis of pyometra was made. Endo-
metrial cavity was drained by cervical dilatation. Endometrial 
curettage was done, histopathologic examination of which re-
vealed strips of stratified squamous epithelium with high grade 
dysplasia. No endometrial glands or stroma was identified. 
At surgery radical hysterectomy with adnexectomy was done.
Gross specimen consisted of uterus with cervix measuring 12 x 
11  x  7  cm.  Cut  surface  showed  widened  endometrial  cavity 
lined by irregular shaggy,  membrane like material. Also seen 
were grey white irregular nodules in the myometrium. Cervix 
was unremarkable.
Figure 1: Widened endometrial cavity and an irregular 
mass in the myometrium.
Multiple  sections  from endometrium  showed  replacement  of 
the  entire  endometrium  by  stratified  squamous  epithelium 
which showed transition from dysplasia through carcinoma in 
situ, area of micro invasion and frankly invasive squamous cell 
carcinoma in the myometrium. Cervix was unremarkable. Final 
diagnosis of primary SCC-E with extensive icthyosis uteri was 
made.
1
This work is licensed under a
Creative Commons Attribution-
No Derivative Works 2.5 India License
Online Journal of Health and Allied Sciences
Peer Reviewed, Open Access, Free Online Journal
Published Quarterly :  Mangalore, South India : ISSN 0972-5997
Volume 9, Issue 4; Oct-Dec 2010
Figure 2: Section from endo myometrium shows squamous 
metaplasia with high grade dysplasia. (H& E X 400)
Figure 3: Section shows foci of microinvasion. (H & E X 
100)
Figure 4: Section shows invasive squamous cell carcinoma 
of endometrium invading the myometrium. (H & E X 400)
Discussion:
Zeller in 1985 first coined the term icthyosis uteri in which the 
entire surface of endometrium is replaced by stratified squam-
ous epithelium following iatrogenically introduced substances 
like formalin or iodine.1
It  usually occur secondary to chronic inflammation, irritation, 
foreign  bodies  or  following  iatrogenically  introduced  sub-
stances  in  to  the  uterine  cavity.  According  to  some  authors 
icthyosis lack malignant potential. 2 However, dysplastic & ana-
plastic changes have been reported, with few exceptional case 
reports  describing  the  occurrence  of  primary  SCC-E  in  the 
background  of  icthyosis  uteri.  3,4 Till  date  only  64  cases  of 
SCC-E have been reported in the literature.5Among 1182 cases 
of  uterine  corpus  tumor,  Goodman  found  only  six  cases  of 
SCC-E.6 Various studies have put forth two plausible explana-
tions for the occurrence of SCC-E. One theory being the direct 
extension of squamous cell carcinoma of cervix to the endomet-
rium, other being its development from reserve cells.
In the present case, since cervix did not show any gross or mi -
croscopic abnormality,  the possibility of direct extension from 
squamous cell carcinoma cervix was ruled out.
Also the presence of spectrum of changes from squamous meta-
plasia through  dysplasia,  carcinoma in situ,  microinvasion  & 
frankly invasive squamous cell carcinoma favoured a primary 
SCC-E rather than extension from cervix which in turn will not 
show such changes.7
Chronic  irritation  due to long  standing pyometra  might  have 
lead to the malignant change in icthyosis uteri.
Fluhmann and Kay had put forth following criteria for the dia-
gnosis  of  primary SCC-E. 1) there should be no endometrial 
carcinoma,  2) no primary squamous cell  carcinoma of cervix 
and 3) if there is in situ change in cervix there should be no as-
sociation with the endometrial neoplasm.5Our case satisfied all 
the above criteria.
Therapy consists of total abdominal hysterectomy with adnex-
ectomy followed by radiotherapy in selected cases. Chemother-
apy  can  be  considered  in  addition  to  radiotherapy  in  these 
pateints. Prognosis is stage dependent, one forth die within two 
years of diagnosis. Survival rate for patients with stage I dis-
ease is 80% and for stage III it is 20%. Hence early diagnosis 
and prompt treatment is imperative to improve the survival rate. 
7
In summary, though rare, primary squamous cell carcinoma of 
endometrium can arise in icthyosis uteri. Hence the possibility 
of  squamous  cell  carcinoma  of  endometrium should  be  con-
sidered when strips of stratified squamous epithelium are found 
in  endometrial  curettage  specimen especially  in  a  postmeno-
pausal women with pyometra. 
References:
1. Patton WT, Squares GV. Ichthyosis uteri. A case re-
port. Am J Obstet Gynecol. 1962; 84:858-860.
2. Zaino  RJ.  Metaplasia.  In  Interpretation  of  endo-
metrial  biopsies  and curettings.  Edited  by:  Silver-
berg SG. Philadelphia: Lippincott-Raven; 1996:241-
261. 
3. Heckeroth V, Ziegler HK. Ichthyosis uteri. Case re-
port  on a rate clinical entity.  Geburtshilfe Frauen-
heilkd. 1986;46:248-249.
4. Kanchan  M,  Urmila  M,  Sridevi  V,  Rajkumar  T. 
Does "ichthyosis uteri" have malignant potential? : 
A case report of squamous cell carcinoma of endo-
metrium associated with extensive ichthyosis uteri. 
Diagnostic Pathology. 2008;3:4. 
5. Bagga  PK,  Jaswal  TS,  Datta  U,  Mahajan  NC. 
Primary endometrial squamous cell carcinoma with 
extensive squamous metaplasia and dysplasia.  Indi-
an J Pathol Microbiol.  2008 ;51:267-268.
6. Goodman A, Zukerberg LR, Rice LW,  Fuller AF, 
Young RH, Scully RE. Squamous cell carcinoma of 
endometrium: A report of eight cases and a review 
of the literature. Gynecol Oncol. 1996;61:54-60
7. Kennedy  AS,  Demars  LR,  Flannegan  LM,  Varia 
MA. Primary squamous cell carcinoma of the endo-
metrium: a first report of adjuvant chemoradiation. 
Gynecol Oncol. 1995;59:117-123.
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Squamous Cell Carcinoma of Endometrium with Extensive Icthyosis Uteri

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