Аңдатпа
Relevance: Endometrial cancer is one of the most common gynecological malignancies worldwide, and its incidence continues to rise. Advanced-stage, high-risk endometrial cancer, particularly tumors with mismatch repair deficiency (MMRd), presents substantial diagnostic and therapeutic challenges despite recent advances in molecular classification and immunotherapy.The study aimed to describe the clinical course, molecular diagnostic work-up, and multimodal treatment of a patient with mismatch repair-deficient endometrioid adenocarcinoma, FIGO 2023 stage IVC, and to relate the applied management strategy to current ESGO-ESTRO-ESP 2025 and NCCN recommendations.Materials and Methods: Retrospective analysis of a single clinical case managed at the Kazakh Institute of Oncology and Radiology (Almaty, Kazakhstan). We collected clinical, imaging, histopathological, and immunohistochemical data and correlated them with a targeted review of guideline-based management and survival outcomes for MMRd and advanced endometrial cancer published within the last five years.Results: A 50-year-old woman presented with postmenopausal bleeding and was diagnosed with International Federation of Gynecology and Obstetrics (FIGO) 2023 stage IVC (T4N1M1), molecularly classified as IVCmMMRd, endometrioid adenocarcinoma, with metastasis to an inguinal lymph node. She underwent primary optimal cytoreductive surgery, six cycles of adjuvant carboplatin-paclitaxel chemotherapy, and six cycles of pembrolizumab following confirmation of MMRd. After pulmonary progression, she received six cycles of second-line cisplatin-doxorubicin chemotherapy, with subsequent stabilization and, at last follow-up (PET-CT, July 2026), a sustained clinical and radiological remission of 10 months, currently maintained on adjuvant letrozole.Conclusion: A guideline-concordant, molecularly informed, multimodal approach, combining cytoreductive surgery, chemotherapy, and immune checkpoint inhibition tailored to mismatch repair status, can achieve durable disease control even in FIGO stage IV, high-risk endometrial cancer, underscoring the value of routine molecular profiling in clinical oncogynecology practice.