uterine papillary serous carcinoma ( upsc ) is an uncommon but aggressive type of endometrial carcinoma with high recurrence rate and poor survival outcomes . although upsc represents approximately 3% to 10% of the endometrial carcinomas , it accounts for almost 40% of all endometrial cancer - related death .
unfortunately , advanced - stage disease or recurrence is common even when upsc is apparently only minimally invasive or even confined to the endometrium.1,2,3 we report a case of a 58-year - old patient with abdominal wall metastasis in upsc stage ia : no lymphovascular invasion and no metastasis in regional lymph nodes were present .
a 58-year - old post - menopausal woman presented upsc defined through the international federation of obstetrics and gynecology ( figo ) at stage ia , diagnosed in october 2008 .
her past medical history had reported a modified radical mastectomy on right breast due to infiltrating ductal carcinoma in august 2001 and the patient subsequently took toremifene , 40 mg daily , for 5 years .
she appeared healthy postoperatively . in october 2008 , an abnormal hypermetabolic lesion on her uterus
was noted on a follow - up positron emission tomography - computed tomography ( pet - ct ; ge healthcare , milwaukee , wi , usa ) .
she underwent a total abdominal hysterectomy and bilateral salpingo - oophorectomy with surgical staging in october 2008 .
the peritoneal cavity was entered through low midline skin incision and drain was inserted . the pathological
finding revealed stage ia upsc that the tumor was limited to the endometrium without lymphovascular space invasion and no lymph node metastasis ( fig .
after surgical staging , an egg sized palpable mass had developed in her lower right abdomen after 8 months .
abdominopelvic ct ( showed a 4.4  4.1 cm sized low - attenuated septated cystic mass in the abdominal wall ( fig .
2 ) . pet - ct revealed an abnormal hypermetabolic lesion in the abdominal wall with no other metastasis ( fig .
the frozen and permanent pathological findings showed metastatic upsc with clear resection margin ( fig .
after diagnosis of upsc metastasis in the abdominal wall , she received chemotherapy utilizing paclitaxel ( body surface area [ bsa ]  175 mg ) and carboplatin ( area under the curve [ auc ]  5 ) every 3 weeks .
even among diseases that occur after menopause , upsc is a highly malignant variant of endometrial adenocarcinoma that histologically and clinically resembles ovarian papillary serous carcinoma .
it is usually found in an advanced stage.4 lymphovascular space invasion is common in the myometrium .
the meticulous surgical staging is important for predicting the prognosis of upsc , because most patients tend to be upstaged after a comprehensive surgical staging.1,4,5,6 upsc truly confined to the uterus has an overall excellent prognosis , whereas patients with extrauterine disease , even if it is revealed only in a microscopy , almost always suffers from recurrence and subsequent death caused by the tumor.7,8 upsc tends to spread in a fashion similar to ovarian cancer with a high propensity for upper abdominal relapse and has a poor prognosis even in the absence of deep myometrial invasion or lymph node metastasis .
with such a poor survival rate , additional adjuvant therapy with whole abdomen radiation or systemic chemotherapy has been applied in hopes of improving survival .
lim et al.9 reported 78 patients with stage i - iiia upsc : 58 patients were treated with whole abdominal radiation and 20 patients did not receive treatment .
the corresponding 5-year disease - specific survival rates were 74.9% and 41.3% , respectively ( p = 0.04).9 in gog study 94 , the 3-year disease - free and overall survival rates for the 60 patients with stage iii papillary serous or clear cell carcinomas were 40.9% and 45.0% , respectively.10 the data on whole abdominal radiation is somewhat encouraging , but effective systemic therapy is needed , because the rate of relapse is still substantial .
trials investigating paclitaxel and carboplatin in upscs reported response rates of 60% to 70%.11,12 gehrig13 reported that paclitaxel and platinum - based chemotherapy for three cycles followed by radiation therapy and then an additional three cycles of chemotherapy was tried for advanced - staged upsc .
the progression free survival in 9 patients was 46.4 months.13 a study of 74 patients with stage i upsc between 1987 and 2004 , who underwent complete staging at yale university , reported that stage ia patients with residual uterine disease , who were treated with platinum - based chemotherapy , had no recurrence ( n = 7 ) , while 6 of 14 ( 43% ) stage ia patients with residual uterine disease , who did not receive chemotherapy , experienced a recurrence .
the 15 patients with stage ib upsc who received platinum - based chemotherapy had no recurrences but 10 of the 13 ( 77% ) stage ib patients who did not receive chemotherapy had recurrence .
platinum - based chemotherapy was associated with improved progression - free ( p < 0.01 ) and overall survival ( p < 0.05 ) .
in addition , no patient who received radiation to the vaginal cuff had recurrence at the cuff , but 6 of 31 ( 19% ) patients who were not treated with vaginal radiation had recurrence at the cuff.14 these retrospective , limited data supported the potential benefit of platinum - based chemotherapy with vaginal cuff irradiation in upsc . a randomized
, prospective study is needed to define optimal treatment stage i upsc . in conclusion ,
we suggest that even when upsc is confined to the endometrium without regional lymph node metastasis and with no lymphovascular invasion , chemotherapy should be considered as a postoperative adjuvant therapy .
 uterine papillary serous carcinoma ( upsc ) is an aggressive form of endometrial cancer characterized by a high recurrence rate and poor prognosis . 
 we report a case of a 58-year - old post - menopausal woman with an abdominal wall metastasis in stage ia upsc . 
 after surgical staging , she did not receive additional adjuvant therapy . 
 an egg sized palpable mass developed in the right lower abdomen after 8 months . both abdominopelvic computed tomography ( ct ) and positron emission tomography ( pet)-ct revealed a metastatic lesion in the abdominal wall . 
 hence , surgical excision was performed . 
 the pathological findings showed metastatic upsc with clear resection margin . 
 after the diagnosis of upsc metastasis in the abdominal wall , she received chemotherapy utilizing paclitaxel and carboplatin . 
 after 3 years , no evidence of recurrence was found . 
 therefore , we suggest that even when upsc is confined to the endometrium without lymph node metastasis and without lymphovascular invasion , chemotherapy should be considered as a postoperative adjuvant therapy . 
Introduction
Case Report
Discussion