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Endometrial cancer

170 bytes added, 11:32, 31 August 2021
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==Presentations==
 
*[[Hysterectomy]]
*[[Endometrial curettage]]
[[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 less '''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 ovary.:*'''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.
===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>
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>
===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 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>
===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
|}
{{Bottom}}
<references />

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