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

Introduction
Endometrial cancer (EC) is the sixth most common malignancy in women worldwide; in developed countries this oncological entity climbs to fourth place. In 2012 worldwide 319 600 new cases were registered and about 1/3 of those were diagnosed in Europe, i.e. more than 100 000 cases. Statistics in Bulgaria show an increase in the incidence; the National Cancer Registry reported an incidence rate of 8.6% for 2013, with 1293 new cases; about 300 women die because of this diagnosis every year. Clear-cell endometrial carcinoma (EC) is relatively rare, in 1–6% of cases, with significantly shorter survival rates even for early stages (I and II), compared to the other histological subtypes.

Case report
A 62-year-old patient was subjected to surgery for clear-cell endometrial carcinoma, stage pT1N0M0, FIGO stage IA. Despite radical surgical treatment as per Bulgarian oncological standards – total hysterectomy with bilateral adnexectomy and pelvic lymph node dissection with postoperative radiotherapy – there was a recurrence in a the paraaortic lymph node 15 months later. A second surgical intervention with radical resection of the parailiac metastatic lymph nodes on the left was done with subsequent pseudo-adjuvant platinum-based chemotherapy, and no further relapse has occurred 36 months later.

Conclusions
Clear-cell EC is an aggressive disease with worse prognosis than the endometroid subtype. Therefore, comprehensive surgery and surgical staging should be performed, including pelvic and paraaortic lymph node dissection, regardless of stage.