Sex Cord–like Endometrioid Carcinoma Arising From Broad Ligament, a Challenging Diagnosis: Report of 2 Cases

Endometrioid carcinoma is a common malignant epithelial tumor of the uterus and ovary, exhibiting variable histomorphology and immunophenotype. Sex cord-like endometrioid carcinoma (SCLEC) is a rare histologic subtype with significant morphologic and immunohistochemical variability. Extra-ovarian, extra-uterine SCLEC arising from the broad ligament has been rarely reported. We report 2 cases of SCLEC arising from the broad ligament. The first patient, a 62-yr-old woman, presented with vague abdominal pain, and diagnostic imaging suggested a broad ligament fibroid. The second patient, a 47-yr-old woman, presented with a clinical history of abdominal pain and abnormal uterine bleeding. Diagnostic imaging suggested a subserosal fibroid. Histologic evaluation revealed a sex cord-like pattern with only rare foci of conventional endometrioid carcinoma. Immunohistochemical evaluation of both cases showed positivity for CK-7, EMA, ER, PR, CDX-2, CD-10, and nuclear β-catenin, while CK-20, PAX-8, GATA3, TTF-1, WT-1, napsin-A, p16, p53, inhibin, calretinin, chromogranin, and CEA were negative. The diagnosis of primary broad ligament SCLEC is extremely challenging. A thorough histologic and immunohistochemical evaluation is essential before excluding differential diagnoses.