case_images: PMC11000832_01
case_images: Computed Tomography of the hip. CT demonstrates the presence of left hip intertrochanteric (arrowhead) and greater trochanter (arrow) fractures. An enlarged uterus is incidentally visualized (asterix).
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case_images: Tomography (CT) of the left lower extremity without contrast which demonstrated a left hip fracture involving the intertrochanteric region and greater trochanter and an incidental finding of enlarged uterus (Fig. 1). Transvaginal pelvic ultrasound demonstrated an enlarged uterus, measuring 14.1 x 11.5 x 8.4 cm and the associated finding of a heterogenous, mass-like endometrial lesion measuring 9.5 x 7.0 x 6.9 cm.
case_images: Magnetic Resonance and Positron Emission Tomography Imaging. MRI (Panel A) demonstrates a heterogeneously enhancing metastatic lesion within the left frontal lobe and associated vasogenic edema (arrowhead), consistent with metastasis. PET-CT (Panel B) demonstrates a hypermetabolic lobulated mass medial left upper lobe that extends contiguously into the left hilum compatible with metastasis.
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case_images: Magnetic resonance imaging (MRI) of the brain demonstrated metastases with vasogenic edema without midline shift (Fig. 2). PET/CT scan noted metastases in the chest and in pelvic lymph nodes (Fig. 2).
case_images: Histopathology. Hematoxylin & Eosin staining reveals a papillary architecture (characterized by slender, finger-like projections) typical of clear cell carcinoma (Panel A; 4x magnification). Panel B (40x magnification) demonstrates numerous foci of tumor cells with abundant clear cytoplasm, due to the presence of cytoplasmic glycogen, and nuclear atypia, characterized by enlarged nuclei with irregular nuclear membranes. Panel C (40x magnification) reveals strong cytoplasmic Napsin A staining, consistent with Clear cell carcinoma.
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case_images: Surgical exploration demonstrated slightly enlarged peri-aortic lymph nodes at the level of the superior mesenteric artery with histological evidence of lymphovascular invasion; pathology demonstrated an endometrial clear cell carcinoma (Fig. 3) arising from within the endometrium and invading into the lower uterine segment, myometrium, cervix, and right ovary.