Difference between revisions of "Endometrioid endometrial carcinoma"

Revision as of 03:16, 22 January 2014

Endometrioid endometrial carcinoma is a type of endometrial carcinoma.

AKA 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:

Complex endometrial hyperplasia with atypia.
Complex endometrial hyperplasia.
Microglandular hyperplasia of the cervix.
Endocervical adenocarcinoma.
Serous carcinoma of the endometrium - esp. if high-grade nuclear features are present diffusely.
Clear cell carcinoma of the endometrium - esp. when clear cells present.

Images

EEA - low mag. (WC)
EEA - intermed. mag. (WC)
EEA - high mag. (WC)
EEA - very high mag. (WC)

www:

Squamous morule with dyskeratotic cell (diagnosticpathology.org).

IHC

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

Others:

p16 -ve -- positive in serous endometrial carcinoma^[7] and endocervical adenocarcinoma.
CEA -ve.

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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.

References

↑ 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.
↑ ^2.0 ^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.
↑ URL: http://www.cap.org/apps/docs/committees/cancer/cancer_protocols/2011/Endometrium_11protocol.pdf. Accessed on: 12 January 2012.
↑ URL: http://dictionary.reference.com/browse/dyskeratosis. Accessed on: 5 September 2011.
↑ 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.
↑ 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.
↑ Cite error: Invalid <ref> tag; no text was provided for refs named pmid17581420

[Ref_GP239-1] 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.

[pmid7074572-2] 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.

[pmid7748076-5] 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.

[pmid15333650-6] 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.

[pmid17581420-7] Cite error: Invalid <ref> tag; no text was provided for refs named pmid17581420

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@@ Line 1: / Line 1: @@
-#redirect [[Endometrial_carcinoma#Endometrioid_endometrial_carcinoma]]
+'''Endometrioid endometrial carcinoma''' is a type of [[endometrial carcinoma]].
 *[[AKA]] ''endometrioid endometrial adenocarcinoma''.
-===General===
+==General==
 *Good prognosis - usually.
 *Women in 40s & 50s.