Endometrial cancer

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Author: Mikael Häggström [note 1]

Relative incidences of endometrial carcinomas by histopathology, being endometrioid in a majority of cases.[1]

Presentations

Microscopic evaluation

Diagnosis

  • Endometrioid adenocarcinoma[2], with low-grade being distinguished from hyperplasia with atypia by the presence of glandular crowding with endometrial stromal exclusion, and significant cribriform, confluent glandular, labyrinthine, papillary/villoglandular, or non-squamous solid architecture.[3]

  • Complex hyperplasia with atypia for comparison: Sparse intervening stroma.[4]

Endometrioid adenocarcinoma

For endometrioid adenocarcinoma, perform grading:[5]

  • Grade 1: ≤5% solid non-glandular, non-squamous growth
  • Grade 2: >5% and ≤50% solid non-glandular, non-squamous growth
  • Grade 3: >50% solid non-glandular, non-squamous growth

  • Grade 1[6]

  • Grade 2 (with mucinous differentiation)[notes 1]

Staging

If possible, perform staging by the FIGO system:[7][8]

For biopsies, at least look for myometrial invasion (pictured).
Stage Description
IA Tumor is confined to the uterus with less than half myometrial invasion
IB Tumor is confined to the uterus with more than half myometrial invasion
II Tumor involves the uterus and the cervical stroma
IIIA Tumor invades serosa or adnexa
IIIB Vaginal and/or parametrial involvement
IIIC1 Pelvic lymph node involvement
IIIC2 Para-aortic lymph node involvement, with or without pelvic node involvement
IVA Tumor invades bladder mucosa and/or bowel mucosa
IVB Distant metastases including abdominal metastases and/or inguinal lymph nodes

Microscopy report

Example:

(Endometrium, polypectomy:)
Endometrial adenocarcinoma, endometrioid type, FIGO grade 2, with mucinous differentiation. Carcinoma focally invades myometrial smooth muscle.
  • Histopathology of grade 2 endometrioid endometrial adenocarcinoma with mucinous differentiation, low magnification.jpg
  • Histopathology of grade 2 endometrioid endometrial adenocarcinoma with mucinous differentiation, high magnification.jpg
  • Histopathology of grade 2 endometrioid endometrial cancer with myometrial invasion.jpg

Notes

  1. ↑ Mucinous endometrioid adenocarcinoma is an altered differentiation / metaplasia with intracytoplasmic mucin (intraluminal mucin pooling does not qualify).
    - Aarti Sharma, M.D., Ricardo R. Lastra, M.D.. Uterus - Carcinoma - Endometrioid carcinoma. PathologyOutlines. Topic Completed: 3 September 2020. Minor changes: 21 September 2020
  1. ↑ For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Patholines:Authorship for details.

Main page

References

  1. ↑ Mendivil, Alberto; Schuler, Kevin M.; Gehrig, Paola A. (2009). "Non-Endometrioid Adenocarcinoma of the Uterine Corpus: A Review of Selected Histological Subtypes ". Cancer Control 16 (1): 46–52. doi:10.1177/107327480901600107. ISSN 1073-2748. 
  2. ↑ Stewart, Colin J.R.; Crum, Christopher P.; McCluggage, W. Glenn; Park, Kay J.; Rutgers, Joanne K.; Oliva, Esther; Malpica, Anais; Parkash, Vinita; et al. (2019). "Guidelines to Aid in the Distinction of Endometrial and Endocervical Carcinomas, and the Distinction of Independent Primary Carcinomas of the Endometrium and Adnexa From Metastatic Spread Between These and Other Sites ". International Journal of Gynecological Pathology 38: S75–S92. doi:10.1097/PGP.0000000000000553. ISSN 0277-1691. 
    - "Figures - available via license: Creative Commons Attribution 4.0 International"
  3. ↑ Rabban, Joseph T.; Gilks, C. Blake; Malpica, Anais; Matias-Guiu, Xavier; Mittal, Khush; Mutter, George L.; Oliva, Esther; Parkash, Vinita; et al. (2019). "Issues in the Differential Diagnosis of Uterine Low-grade Endometrioid Carcinoma, Including Mixed Endometrial Carcinomas ". International Journal of Gynecological Pathology 38: S25–S39. doi:10.1097/PGP.0000000000000512. ISSN 0277-1691. 
  4. ↑ Rao, Shalinee; Sundaram, Sandhya; Narasimhan, Raghavan (2009). "Biological behavior of preneoplastic conditions of the endometrium: A retrospective 16-year study in south India ". Indian Journal of Medical and Paediatric Oncology 30 (4): 131. doi:10.4103/0971-5851.65335. ISSN 0971-5851. 
    - Figure- available via license: Creative Commons Attribution 2.0 Generic
  5. ↑ Soslow, Robert A.; Tornos, Carmen; Park, Kay J.; Malpica, Anais; Matias-Guiu, Xavier; Oliva, Esther; Parkash, Vinita; Carlson, Joseph; et al. (2019). "Endometrial Carcinoma Diagnosis ". International Journal of Gynecological Pathology 38: S64–S74. doi:10.1097/PGP.0000000000000518. ISSN 0277-1691. 
  6. ↑ Stewart, Colin J.R.; Crum, Christopher P.; McCluggage, W. Glenn; Park, Kay J.; Rutgers, Joanne K.; Oliva, Esther; Malpica, Anais; Parkash, Vinita; et al. (2019). "Guidelines to Aid in the Distinction of Endometrial and Endocervical Carcinomas, and the Distinction of Independent Primary Carcinomas of the Endometrium and Adnexa From Metastatic Spread Between These and Other Sites ". International Journal of Gynecological Pathology 38: S75–S92. doi:10.1097/PGP.0000000000000553. ISSN 0277-1691. 
    - "Figures - available via license: Creative Commons Attribution 4.0 International"
  7. ↑ . Stage Information for Endometrial Cancer. National Cancer Institute (January 1980).
  8. ↑ Murray J. Casey; Garth K. Summers; David Crotzer.. Endometrial Cancer. StatPearls, National Center for Biotechnology Information. Last Update: July 13, 2020

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