Difference between revisions of "Endometrioid endometrial carcinoma"

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{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Image      = Endometrioid endometrial adenocarcinoma high mag.jpg
| Width      =
| Caption    = Endometrioid endometrial adenocarcinoma. [[H&E stain]].
| Synonyms  = endometrioid endometrial adenocarcinoma
| Micro      =
| Subtypes  =
| LMDDx      = [[complex endometrial hyperplasia]], [[microglandular hyperplasia]] of the cervix, [[endocervical adenocarcinoma]], [[serous carcinoma of the endometrium]] - esp. for high-grade tumours, [[clear cell carcinoma of the endometrium]], [[simple endometrial hyperplasia]], [[endometrium with squamous morules]]
| Stains    =
| IHC        = ER +ve, PR +ve, vimentin +ve, p16 -ve, CEA -ve
| EM        =
| Molecular  =
| IF        =
| Gross      = endometrial thickening
| Grossing  =
| Site      = [[endometrium]] - see ''[[endometrial carcinoma]]''
| Assdx      = [[obesity]]
| Syndromes  =
| Clinicalhx =
| Signs      = [[abnormal uterine bleeding]] (AUB)
| Symptoms  =
| Prevalence = common
| Bloodwork  =
| Rads      =
| Endoscopy  =
| Prognosis  = good - esp. low-grade
| Other      =
| ClinDDx    =
| Tx        = usu. total hysterectomy
}}
'''Endometrioid endometrial carcinoma''', abbreviated '''EEC''', is the most common type of [[endometrial carcinoma]].  It is strongly associated with [[obesity]].
'''Endometrioid endometrial carcinoma''', abbreviated '''EEC''', is the most common type of [[endometrial carcinoma]].  It is strongly associated with [[obesity]].


Revision as of 03:43, 22 January 2014

Endometrioid endometrial carcinoma
Diagnosis in short

Endometrioid endometrial adenocarcinoma. H&E stain.
Synonyms endometrioid endometrial adenocarcinoma
LM DDx complex endometrial hyperplasia, microglandular hyperplasia of the cervix, endocervical adenocarcinoma, serous carcinoma of the endometrium - esp. for high-grade tumours, clear cell carcinoma of the endometrium, simple endometrial hyperplasia, endometrium with squamous morules
IHC ER +ve, PR +ve, vimentin +ve, p16 -ve, CEA -ve
Gross endometrial thickening
Site endometrium - see endometrial carcinoma
Associated Dx obesity
Signs abnormal uterine bleeding (AUB)
Prevalence common
Prognosis good - esp. low-grade
Treatment usu. total hysterectomy

Endometrioid endometrial carcinoma, abbreviated EEC, is the most common type of endometrial carcinoma. It is strongly associated with obesity.

It is also known as endometrioid endometrial adenocarcinoma.

General

  • Good prognosis - usually.
  • Women in 40s & 50s.
  • Associated with estrogen excess.
    • Typical patient is obese.

Gross

  • Thickened endometrium.

Microscopic

Features:

  • Atypical (ovoid) glands with - one of the following four:[1][2][3]
    1. Desmoplastic stromal response.
    2. Confluent cribriform growth. †
    3. Extensive papillary growth. †
    4. Severe cytologic atypia. †
  • Squamous metaplasia - very common.
    • Look for squamous morules:
      • Ball of cells with an intensely eosinophilic cytoplasm - key feature.
      • Central nucleus.
      • Intercellular bridges - may be hard to find.
      • +/-Dyskeratotic cells.

Notes:

  • † There is a size cut-off for criteria 2, 3 and 4: > 2.1 mm.[2]
  • Dyskeratosis = abnormal keratinization;[4] classically have intensely eosinophilic cytoplasm +/- nuclear fragmentation (karyorrhexis) - see: several dyskeratotic cells.
  • Squamous metaplasia != neoplastic -- it may occur due to hormones.[5]
  • Squamous morules in endometrioid endometrial carcinoma - not associated with HPV infection.[6]

DDx:

Images

  • EEA - low mag. (WC)

  • EEA - intermed. mag. (WC)

  • EEA - high mag. (WC)

  • EEA - very high mag. (WC)

www:

IHC

  • Vimentin +ve.
  • ER +ve.
  • PR +ve.

Others:

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ENDOMETRIUM, BIOPSY: 
- ENDOMETRIOID ENDOMETRIAL ADENOCARCINOMA, FIGO GRADE I/III.

Micro

The sections show endometrium with complex, fused and cribriform glands with scant intervening stroma over a region measuring greater than 2.1 millimetres. Focally, a desmoplastic stroma is also identified. No nuclear atypia is appreciated.

Endocervical versus endometrial - biopsy

The foamy histiocytes in the stroma and lack of desmoplasia slightly favour an endometrial origin; however, the lesion would be best classified with an excisional specimen and in conjunction with the clinical impression.

See also

References

  1. ↑ Nucci, Marisa R.; Oliva, Esther (2009). Gynecologic Pathology: A Volume in Foundations in Diagnostic Pathology Series (1st ed.). Churchill Livingstone. pp. 239. ISBN 978-0443069208.
  2. ↑ 2.0 2.1 Kurman, RJ.; Norris, HJ. (Jun 1982). "Evaluation of criteria for distinguishing atypical endometrial hyperplasia from well-differentiated carcinoma.". Cancer 49 (12): 2547-59. PMID 7074572.
  3. ↑ URL: http://www.cap.org/apps/docs/committees/cancer/cancer_protocols/2011/Endometrium_11protocol.pdf. Accessed on: 12 January 2012.
  4. ↑ URL: http://dictionary.reference.com/browse/dyskeratosis. Accessed on: 5 September 2011.
  5. ↑ Miranda, MC.; Mazur, MT. (May 1995). "Endometrial squamous metaplasia. An unusual response to progestin therapy of hyperplasia.". Arch Pathol Lab Med 119 (5): 458-60. PMID 7748076.
  6. ↑ Chinen, K.; Kamiyama, K.; Kinjo, T.; Arasaki, A.; Ihama, Y.; Hamada, T.; Iwamasa, T. (Sep 2004). "Morules in endometrial carcinoma and benign endometrial lesions differ from squamous differentiation tissue and are not infected with human papillomavirus.". J Clin Pathol 57 (9): 918-26. doi:10.1136/jcp.2004.017996. PMID 15333650.
  7. ↑ Chiesa-Vottero, AG.; Malpica, A.; Deavers, MT.; Broaddus, R.; Nuovo, GJ.; Silva, EG. (Jul 2007). "Immunohistochemical overexpression of p16 and p53 in uterine serous carcinoma and ovarian high-grade serous carcinoma.". Int J Gynecol Pathol 26 (3): 328-33. doi:10.1097/01.pgp.0000235065.31301.3e. PMID 17581420.
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