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[[File:Pie chart of relative incidences of endometrial carcinoma.png|thumb|Relative incidences of endometrial carcinomas by histopathology, being endometrioid in a majority of cases.<ref>{{cite journal|last1=Mendivil|first1=Alberto|last2Presentations=Schuler|first2=Kevin M.|last3=Gehrig|first3=Paola A.|title=Non-Endometrioid Adenocarcinoma of the Uterine Corpus: A Review of Selected Histological Subtypes|journal=Cancer Control|volume=16|issue=1|year=2009|pages=46–52|issn=1073-2748|doi=10.1177/107327480901600107}}</ref>]]
==Presentations==
→Microscopy report: CAP
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}}
*[[Hysterectomy]]
*[[Endometrial curettage]]
*[[Endometrial polyp]]
*[[Endometrial thickening]]
==Gross processing==
[[File:Gross pathology of endometrial adenocarcinoma.jpg|thumb|240px|Gross pathology of extensive endometrial adenocarcinoma (endometrioid type).]]
A '''[[Hysterectomy|regular hysterectomy grossing]]''' is performed, but with the following sampling and additions:<ref>{{cite web|url=https://voices.uchicago.edu/grosspathology/gyne/uterus-endometrial-cancer/|title=Gross Pathology Manual - Uterus, Endometrial Cancer|website=The University of Chicago Department of Pathology|author=Nicole Cipriani|date=2020-06-22}}</ref>
*2 longitudinal sections through '''ecto/endocervix''' (1 anterior and 1 posterior).
*2 longitudinal sections through '''upper endocervix/lower uterine segment''' (1 anterior and 1 posterior), contiguous with sections taken from cervix.
*'''Tumor''':
:*Measure '''greatest dimension''' of tumor.
::*If tumor is '''smaller''' than 3 cm, submit entirely.
::*If tumor is '''larger''' than 3 cm, submit 1 per cm.
:*Measure tumor '''thickness''' (cavity to border of invasion) and entire thickness of the wall (cavity to serosa), at the location of greatest percentage of tumor relative to wall thickness.
:*Include 2 '''full-thickness sections''' (1 anterior and 1 posterior), including location with greatest percentage. It may need multiply contiguous sections.
:*Remaining sections can be superficial to include tumor and inner myometrium, such as from lower uterine segment to fundus to maintain orientation.
:*If possible, include 1 section with interface between tumor and normal.
*Sections of any '''additional pathology''', such as leiomyomas, polyps in their entirety.
*1 section of '''uninvolved''' endometrium if present.
*Inspect '''serosa''' for implants and submit sections if grossly detected.
*For '''serous''' carcinomas, submit the entire ovary and fallopian tube:
:*Ovary, serially sectioned perpendicular to long axis.
:*SEE-FIM protocol for fallopian tubes:
::*Remove the distal 2 cm (fimbriae) and section it parallel to the long axis.
::Section the remainder of the tube transversely at 2-3 mm intervals.
*For all other cancer types, submit adnexa as follows:
:*'''Ovaries''': 2 representative sections of each.
:*'''Fallopian tubes:''' Entire fimbriae (longitudinally sectioned) and 2 representative cross-sections on each side.
*'''[[Lymph node]]s'''
:*Size '''smaller''' than 2 mm: submit intact.
:*Size '''larger''' than 2 mm: serially section perpendicular to the long axis in 2 mm intervals.
::*If no gross tumor, submit entirely.
::*If grossly positive, submit 1-2 representative sections showing the greatest tumor dimension and extranodal fat.
==Microscopic evaluation==
===Diagnosis===
<gallery mode="packed " heights="200">File:Pie chart of relative incidences of endometrial carcinoma.png|Relative incidences of endometrial carcinomas by histopathology, being '''endometrioid''' in a majority of cases.<ref>{{cite journal|last1=Mendivil|first1=Alberto|last2=Schuler|first2=Kevin M.|last3=Gehrig|first3=Paola A.|title=Non-Endometrioid Adenocarcinoma of the Uterine Corpus: A Review of Selected Histological Subtypes|journal=Cancer Control|volume=16|issue=1|year=2009|pages=46–52|issn=1073-2748|doi=10.1177/107327480901600107}}</ref> Endometrioid carcinoma has patterns reminiscent of normal endometrium, with many new glands formed from columnar epithelium with some abnormal nuclei:
File:Histopathology of low-grade (FIGO grade 1) endometrial endometrioid adenocarcinoma.png|'''Endometrioid adenocarcinoma'''<ref>{{cite journal|last1=Stewart|first1=Colin J.R.|last2=Crum|first2=Christopher P.|last3=McCluggage|first3=W. Glenn|last4=Park|first4=Kay J.|last5=Rutgers|first5=Joanne K.|last6=Oliva|first6=Esther|last7=Malpica|first7=Anais|last8=Parkash|first8=Vinita|last9=Matias-Guiu|first9=Xavier|last10=Ronnett|first10=Brigitte M.|title=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|journal=International Journal of Gynecological Pathology|volume=38|year=2019|pages=S75–S92|issn=0277-1691|doi=10.1097/PGP.0000000000000553}}<br>- "Figures - available via license: Creative Commons Attribution 4.0 International"</ref>, 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.<ref name="RabbanGilks2019">{{cite journal|last1=Rabban|first1=Joseph T.|last2=Gilks|first2=C. Blake|last3=Malpica|first3=Anais|last4=Matias-Guiu|first4=Xavier|last5=Mittal|first5=Khush|last6=Mutter|first6=George L.|last7=Oliva|first7=Esther|last8=Parkash|first8=Vinita|last9=Ronnett|first9=Brigitte M.|last10=Staats|first10=Paul|last11=Stewart|first11=Colin J.R.|last12=McCluggage|first12=W. Glenn|title=Issues in the Differential Diagnosis of Uterine Low-grade Endometrioid Carcinoma, Including Mixed Endometrial Carcinomas|journal=International Journal of Gynecological Pathology|volume=38|year=2019|pages=S25–S39|issn=0277-1691|doi=10.1097/PGP.0000000000000512}}</ref>
File:Histopathology of complex hyperplasia with atypia.jpg|'''Complex hyperplasia with atypia''' for comparison: Sparse intervening stroma.<ref>{{cite journal|last1=Rao|first1=Shalinee|last2=Sundaram|first2=Sandhya|last3=Narasimhan|first3=Raghavan|title=Biological behavior of preneoplastic conditions of the endometrium: A retrospective 16-year study in south India|journal=Indian Journal of Medical and Paediatric Oncology|volume=30|issue=4|year=2009|pages=131|issn=0971-5851|doi=10.4103/0971-5851.65335}}<br>- [https://www.researchgate.net/figure/Closely-packed-endometrial-glands-with-sparse-intervening-stroma-and-stratification-of_fig2_46256480 Figure- available via license: Creative Commons Attribution 2.0 Generic]</ref>
File:Histopathology of serous carcinoma of uterus.jpg|'''Papillary serous carcinoma''' of uterus, with characteristic discohesiveness of cells (like falling apart) around fibrovascular cores.{{MH}}
File:Histopathology of papillary serous carcinoma of the endometrium.jpg|'''Papillary serous carcinoma''' of uterus, in this case showing both papillary and micropapillary architecture.<ref name=Murali2019/>
File:Histopathology of clear cell carcinoma of the endometrium with papillary architecture.png|'''Clear cell carcinoma''' of the endometrium with '''papillary''' architecture, characteristically small round papillae lacking overt stratification.<ref name=Murali2019/> Clear cell carcinoma is defined as a carcinoma demonstrating a combination of papillary, tubulocystic and/or solid architectural patterns, with cuboidal or polygonal cells containing nuclei with a variable pleomorphism (although usually lacking discernible pleomorphism).<ref name=Murali2019/>
File:Histopathology of clear cell carcinoma of the endometrium with tubulocystic architecture.png|'''Clear cell carcinoma''' of the endometrium with '''tubulocystic''' architecture.<ref name=Murali2019/>
File:Histopathology of clear cell carcinoma of the endometrium with solid architecture.png|'''Clear cell carcinoma''' of the endometrium with '''solid''' architecture.<ref name=Murali2019/>
File:Histopathology of dedifferantiated carcinoma of the endometrium.png|'''Dedifferantiated carcinoma''', a tumor that contains a component of undifferentiated endometrial carcinoma (UEC) and a component of conventional, usually lower-grade, endometrioid adenocarcinoma.<ref name=Murali2019/>
File:Histopathology of carcinosarcoma of the endometrium.png|'''Carcinosarcoma''' of the endometrium, with carcinoma in addition to sarcoma (seen here as atypical fibrovascular cores).<ref name=Murali2019/>
</gallery>
===Endometrioid adenocarcinoma===
For endometrioid adenocarcinoma, perform '''grading''':<ref name="SoslowTornos2019">{{cite journal|last1=Soslow|first1=Robert A.|last2=Tornos|first2=Carmen|last3=Park|first3=Kay J.|last4=Malpica|first4=Anais|last5=Matias-Guiu|first5=Xavier|last6=Oliva|first6=Esther|last7=Parkash|first7=Vinita|last8=Carlson|first8=Joseph|last9=McCluggage|first9=W. Glenn|last10=Gilks|first10=C. Blake|title=Endometrial Carcinoma Diagnosis|journal=International Journal of Gynecological Pathology|volume=38|year=2019|pages=S64–S74|issn=0277-1691|doi=10.1097/PGP.0000000000000518}}</ref>
*'''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
<gallery mode="packed " heights="200">
File:Histopathology of low-grade (FIGO grade 1) endometrial endometrioid adenocarcinoma.png|'''Grade 1'''<ref>{{cite journal|last1=Stewart|first1=Colin J.R.|last2=Crum|first2=Christopher P.|last3=McCluggage|first3=W. Glenn|last4=Park|first4=Kay J.|last5=Rutgers|first5=Joanne K.|last6=Oliva|first6=Esther|last7=Malpica|first7=Anais|last8=Parkash|first8=Vinita|last9=Matias-Guiu|first9=Xavier|last10=Ronnett|first10=Brigitte M.|title=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|journal=International Journal of Gynecological Pathology|volume=38|year=2019|pages=S75–S92|issn=0277-1691|doi=10.1097/PGP.0000000000000553}}<br>- "Figures - available via license: Creative Commons Attribution 4.0 International"</ref>
File:Histopathology of endometrial adenocarcinoma, endometrioid type.jpg|'''Grade 2'''.
File:Histopathology of grade 2 endometrioid endometrial adenocarcinoma with mucinous differentiation, low magnification.jpg|'''Grade 2''' (with mucinous differentiation)<ref group=notes>Mucinous endometrioid adenocarcinoma is an altered differentiation / metaplasia with intracytoplasmic mucin (intraluminal mucin pooling does not qualify).<br>- {{cite web|url=http://www.pathologyoutlines.com/topic/uterusendometrioid.html|title=Uterus - Carcinoma - Endometrioid carcinoma|author=Aarti Sharma, M.D., Ricardo R. Lastra, M.D.|website=PathologyOutlines}} Topic Completed: 3 September 2020. Minor changes: 21 September 2020</ref>
File:Histopathology of FIGO grade 3 endometrioid carcinoma of the endometrium with glandular architecture.png|'''Grade 3''', with glandular architecture.<ref name=Murali2019/>
File:Histopathology of solid FIGO grade 3 endometrioid carcinoma of the endometrium.png|3 endometrioid carcinoma|'''Grade 3''', with solid architecture.<ref name=Murali2019>{{cite journal| author=Rajmohan Murali, M.B.B.S., M.D., F.R.C.P.A., Ben Davidson, M.D., Ph.D., Oluwole Fadare, M.D., Joseph A. Carlson, M.D., Ph.D., Christopher P. Crum, M.D., C. Blake Gilks, M.D., Julie A. Irving, M.D., F.R.C.P.C., Anais Malpica, M.D., Xavier Matias-Guiu, M.D., Ph.D., W. Glenn McCluggage, F.R.C.Path., Khush Mittal, M.D., Esther Oliva, M.D., Vinita Parkash, M.D., Joanne K. L. Rutgers, M.D., Paul N. Staats, M.D., Colin J. R. Stewart, M.D., Carmen Tornos, M.D., and Robert A. Soslow, M.D. | title=High-grade Endometrial Carcinomas: Morphologic and Immunohistochemical Features, Diagnostic Challenges and Recommendations. | journal=Int J Gynecol Pathol | year= 2019 | volume= 38 Suppl 1 | issue= | pages= S40-S63 | pmid=30550483 | doi=10.1097/PGP.0000000000000491 | pmc=6296248 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30550483 }}<br>- "This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited."</ref> Carcinomas with identifiable endometrial component, and with over 50% solid architecture should be classified as grade 3 endometrioid carcinoma.<ref name=Murali2019/>
</gallery>
:{{Comprehensive-begin}}Also perform '''nuclear grading:'''{{Comprehensive-end}}
<gallery mode="packed" heights="200">
File:Histopathology of endometrioid cancer, grade 1, nuclear grade 1.jpg|'''Nuclear grade 1''': Oval, mildly enlarged nucleus with evenly distributed chromatin.{{MH}}<ref name="pmid22496699">{{cite journal| author=Nofech-Mozes S, Ismiil N, Dubé V, Saad RS, Ghorab Z, Grin A | display-authors=etal| title=Interobserver agreement for endometrial cancer characteristics evaluated on biopsy material. | journal=Obstet Gynecol Int | year= 2012 | volume= 2012 | issue= | pages= 414086 | pmid=22496699 | doi=10.1155/2012/414086 | pmc=3306930 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22496699 }} </ref>
File:Histopathology of endometrioid cancer, grade 1, nuclear grade 2.jpg|'''Nuclear grade 2''': Intermediate features.{{MH}}<ref name="pmid22496699"/>
</gallery>
*'''Nuclear grade 3''': Markedly enlarged and pleomorphic nuclei, with coarse chromatin and distinct nucleoli.<ref name="pmid22496699"/>
===Staging===
If possible, perform '''staging''' by the FIGO system:<ref>{{cite web |title=Stage Information for Endometrial Cancer |url=http://www.cancer.gov/cancertopics/pdq/treatment/endometrial/HealthProfessional/page3 |publisher=National Cancer Institute |access-date=23 April 2014 |url-status=live |archive-url=https://web.archive.org/web/20140406044240/http://www.cancer.gov/cancertopics/pdq/treatment/endometrial/HealthProfessional/page3 |archive-date=6 April 2014 |date=January 1980 }}</ref><ref>{{cite web|url=https://www.ncbi.nlm.nih.gov/books/NBK525981/|title=Endometrial Cancer|author=Murray J. Casey; Garth K. Summers; David Crotzer.|website=StatPearls, National Center for Biotechnology Information}} Last Update: July 13, 2020</ref>
[[File:Histopathology of grade 2 endometrioid endometrial cancer with myometrial invasion.jpg|thumb|230px|For biopsies, at least look for myometrial invasion (pictured).]]
[[File:Histopathology of endometrial cancer with lymphovascular invasion.jpg|thumb|230px|Generally look for '''lymphovascular invasion''' (pictured) as well.]]
{| class="wikitable"
!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:
{| class="wikitable"
| (Endometrium, polypectomy:)<br> Endometrial adenocarcinoma, endometrioid type, FIGO grade 2, with mucinous differentiation. Carcinoma focally invades myometrial smooth muscle.
<gallery mode="packed">
File:Histopathology of grade 2 endometrioid endometrial adenocarcinoma with mucinous differentiation, low magnification.jpg
File:Histopathology of grade 2 endometrioid endometrial adenocarcinoma with mucinous differentiation, high magnification.jpg
File:Histopathology of grade 2 endometrioid endometrial cancer with myometrial invasion.jpg
</gallery>
|}
{{CAP}}
{{Bottom}}
<references />
