A CASE OF PRIMARY ENDOMETRIAL CLEAR CELL ADENOCARCINOMA MIMICKING A SUBMUCOUS LEIOMYOMA IN A PERIMENOPAUSAL FEMALE

Endometrial Clear Cell Adenocarcinoma typically occurs in the setting of Endometrial Atrophy in an elderly female with Post-Menopausal Bleeding, demonstrating papillary, tubulo-cystic, solid or mixed architectural pattern and pleomorphic polygonal, cuboidal, at or hobnail cells with clear to eosinophilic cytoplasm. A 45years aged female presented with persistent abnormal uterine bleeding for last 6 months, not relieved on medication. Transvaginal Sonography revealed a large, well-dened, solid, hypoechoic mass with thickened endometrium whereas Gross Examination of Hysterectomy specimen showed a solitary, yellow-tan, well-circumscribed, large, smooth exophytic growth, 11 cm in maximum dimension, attached to uterus, obliterating entire endometrial cavity, typical of Submucous Leiomyoma. Sections from growth on Microscopy showed conuent glands and papillae, arranged in mixed tubulo-cystic and papillary pattern, lined by monolayered, pleomorphic, cuboidal, polygonal and hobnail cells with abundant clear to eosinophilic cytoplasm, prominent cell membrane, pleomorphic, atypical nuclei, prominent nucleoli, few mitotic gures along with unremarkable histology of Cervix, Bilateral Tubes and Ovary, diagnostic of Primary Clear Cell Endometrial Adenocarcinoma. Endometrial Clear Cell Adenocarcinoma may mimic a Leiomyoma on Sonography and Gross Examination. Diagnosis is made based on characteristic cellular morphology and architectural pattern on Histopathology. Although very rare, Primary Endometrial Clear Cell Adeno- Carcinoma should be kept in mind while evaluating Abnormal Uterine Bleeding in a Peri-menopausal female.