Background: Uterine serous endometrial intraepithelial carcinoma (SEIC) is an immediate precursor of invasive\ncarcinoma. The majority of stage IA SEICs are curable, but those with latent peritoneal metastasis and/or capillary\nlymphatics invasion may have poor prognoses Careful pathologic staging is thus needed to predict the risk of\nrecurrence and to determine postoperative therapeutic strategies.\nCase Presentation: A 71-year-old woman was hospitalized for the treatment of peritoneal carcinoma. She had\nundergone total hysterectomy and bilateral salpingo-oophorectomy due to SEIC (stage IA) at age 63 years, and had\nreceived medical check-ups every year since. Elevated serum CA125 (184 U/mL) was detected for the first time 8 years\nafter surgery. A thorough workup revealed no potential primary lesion other than that in the peritoneum. Tumor\nreduction surgery was performed. Histologic analysis of the peritoneal lesion was high-grade serous carcinoma. The\nperitoneal carcinoma was diffusely immunostained for p53; thus, possible recurrence of SEIC was suspected. Tumor\nDNAs were microdissected from the uterine and peritoneal lesions and p53 mutation analysis was done. SEIC and\nperitoneal carcinomas had distinct p53 mutations that were mutually exclusive.\nConclusions: The present case raised a concern about the difficulty of histologic staging for SEICs. Although\nSEICs confined to the uterine endometrium in most cases predict a good prognosis, microscopic metastasis\nto the peritoneum may not be detectable at hysterectomy. If secondary malignancies of a serous phenotype\ndevelop years later, comprehensive reexamination of SEIC is mandated, with the help of DNA analysis.
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