Introduction/Background Prognosis of early-stage endometrial adenocarcinoma is favourable. However, some factors can influence the risk of recurrence: tumour size and grade, depth of myometrial invasion, cervical stromal involvement and lympho-vascular space invasion (LVSI). A microcytic, elongated, and fragmented (MELF) pattern of invasion has also been implicated in poor prognosis. Many studies had describe the association between MELF pattern with non-vaginal recurrences and lymph-node metastases.

Methodology This case describe an early-stage MELF pattern endometrial adenocarcinoma with no LVSI and multiple vaginal recurrences.

Results A 74-year-old woman with hypertension and history of cerebral aneurysm was referred to our institution for an endometrial adenocarcinoma G1 diagnosed in a previous biopsy. A total abdominal hysterectomy and bilateral salpingo-oophorectomy was performed (due to her comorbidities, we didn’t accomplish bilateral pelvic lymphadenectomy). Histologic diagnosis revealed an endometrioid adenocarcinoma G2, with myometrial invasion depth >50%, negative LVSI, MELF pattern of myometrial invasion and negative peritoneal washing cytology - FIGO stage IB. One month later, the patient referred vaginal bleeding and presented a vaginal vault vegetant lesion measuring 1,5 cm. The biopsy showed metastasis of endometrioid adenocarcinoma. She was submitted to a full lesion resection and started adjuvant vaginal brachytherapy (50 Gy/5 fractions). Four months later, she presented with 2 vaginal vault milimetric lesions whose biopsy revealed metastases of adenocarcinoma. The complete resection of the lesions confirmed the diagnosis. She repeated vaginal brachytherapy treatment (30Gy/5fractions). Pelvic MRI didn’t show lymph-node metastases. The patient remains in clinical control in our institution.

Conclusion The significance of MELF pattern is still unclear. Although many studies describe its association with lymph node metastases and non-vaginal recurrences, this case shows that this histologic pattern can also be associated to vaginal metastases. In the future, MELF pattern could be useful for identifying patients in early-stage endometrial tumours with higher risk of recurrence.

Disclosure Nothing to disclose.