Fig. 7

a–d Poorly differentiated endometrial carcinoma with NE differentiation (FIGO IV-B; distant metastases). A 61-year-old female complaining of metrorrhagia. Axial T2-weighted MR image (a) and axial enhanced CT image (b). Large endometrial tumour invading the myometrium, serosa and surrounding adipose tissues. There is no invasion of the cervical stroma or bladder (not shown), but a right obturator node (arrow) is found. CT evaluation shows that the disease has disseminated outside the pelvis, revealing para-aortic lymph nodes (arrowhead) as well as retroperitoneal and peritoneal metastases (asterisks). Vagina biopsy (H&E) infiltrated by a solid tumour composed by sheets of uniform cells, with small oval nuclei and scarse cytoplasm (c). These cells have an intense cytoplasmatic staining for neuron-specific enolase (d) and have small chromogranine-positive granules in the cytoplasm (not shown). This tumour was synaptophysin negative