Difference between revisions of "Endometrioid endometrial carcinoma"

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Line 17: Line 17:
| Site      = [[endometrium]] - see ''[[endometrial carcinoma]]''
| Site      = [[endometrium]] - see ''[[endometrial carcinoma]]''
| Assdx      = [[obesity]]
| Assdx      = [[obesity]]
| Syndromes  =
| Syndromes  = [[Lynch syndrome]], [[Cowden syndrome]]
| Clinicalhx =
| Clinicalhx =
| Signs      = [[abnormal uterine bleeding]] (AUB)
| Signs      = [[abnormal uterine bleeding]] (AUB)

Revision as of 00:06, 23 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
Syndromes Lynch syndrome, Cowden syndrome
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.

Associated syndromes:

Gross

  • Thickened endometrium.

Microscopic

Features:

  • Atypical (ovoid) glands with - one of the following four:[3][4][5]
    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.[4]
  • Dyskeratosis = abnormal keratinization;[6] classically have intensely eosinophilic cytoplasm +/- nuclear fragmentation (karyorrhexis) - see: several dyskeratotic cells.
  • Squamous metaplasia != neoplastic -- it may occur due to hormones.[7]
  • Squamous morules in endometrioid endometrial carcinoma - not associated with HPV infection.[8]

DDx:

Grading

  • FIGO system most commonly used.
  • Based on gland formation & adjusted by nuclear pleomorphism.

Preliminary grade based on gland formation:[9][10][11][12]

  • Grade 1: <5% solid component.
  • Grade 2: 5-50% solid component.
  • Grade 3: >50% solid component.

Modifiers/adjustment:

  • High grade nuclei upgrades cancer by one; high grade nuclei = increased size, irregular large nucleoli, irregular chromatin pattern (clumped, coarse).[13]

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:

Sign out

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. ↑ Lax, SF. (Jan 2002). "[Dualistic model of molecular pathogenesis in endometrial carcinoma].". Zentralbl Gynakol 124 (1): 10-6. doi:10.1055/s-2002-20303. PMID 11873308.
  2. ↑ Karamurzin, Y.; Soslow, RA.; Garg, K. (Apr 2013). "Histologic evaluation of prophylactic hysterectomy and oophorectomy in Lynch syndrome.". Am J Surg Pathol 37 (4): 579-85. doi:10.1097/PAS.0b013e3182796e27. PMID 23426126.
  3. ↑ 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.
  4. ↑ 4.0 4.1 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.
  5. ↑ URL: http://www.cap.org/apps/docs/committees/cancer/cancer_protocols/2011/Endometrium_11protocol.pdf. Accessed on: 12 January 2012.
  6. ↑ URL: http://dictionary.reference.com/browse/dyskeratosis. Accessed on: 5 September 2011.
  7. ↑ 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.
  8. ↑ 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.
  9. ↑ Cotran, Ramzi S.; Kumar, Vinay; Fausto, Nelson; Nelso Fausto; Robbins, Stanley L.; Abbas, Abul K. (2005). Robbins and Cotran pathologic basis of disease (7th ed.). St. Louis, Mo: Elsevier Saunders. pp. 1087-8. ISBN 0-7216-0187-1.
  10. ↑ URL: http://www.pathologyoutlines.com/uterus.html#endometrialcarc.
  11. ↑ URL: http://www.emedicine.com/med/topic2832.htm.
  12. ↑ Ayhan A, Taskiran C, Yuce K, Kucukali T (January 2003). "The prognostic value of nuclear grading and the revised FIGO grading of endometrial adenocarcinoma". Int. J. Gynecol. Pathol. 22 (1): 71–4. PMID 12496701.
  13. ↑ Tadrous, Paul.J. Diagnostic Criteria Handbook in Histopathology: A Surgical Pathology Vade Mecum (1st ed.). Wiley. pp. 240. ISBN 978-0470519035.
  14. ↑ 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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