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Difference between revisions of "Endometrioid endometrial carcinoma"
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Endometrioid endometrial carcinoma (view source)
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{{ Infobox diagnosis | {{ Infobox diagnosis | ||
| Name = {{PAGENAME}} | | Name = {{PAGENAME}} | ||
| Image = Endometrioid endometrial adenocarcinoma high mag.jpg | | Image = Endometrioid endometrial adenocarcinoma high mag.jpg | ||
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| IF = | | IF = | ||
| Gross = endometrial thickening | | Gross = endometrial thickening | ||
| Grossing = | | Grossing = [[hysterectomy for endometrial cancer grossing]] | ||
| 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) | ||
| Line 37: | Line 37: | ||
*Good prognosis - usually. | *Good prognosis - usually. | ||
*Women in 40s & 50s. | *Women in 40s & 50s. | ||
*Associated with estrogen excess. | *Associated with estrogen excess (unopossed estrogen stimulation). | ||
**Typical patient is [[obese]]. | **Typical patient is [[obese]]. | ||
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*#Extensive papillary growth. † | *#Extensive papillary growth. † | ||
*#Severe cytologic atypia. † | *#Severe cytologic atypia. † | ||
*Squamous metaplasia - very common. | *Endometrioid features: | ||
**Look for ''squamous morules'': | **+/-Low-grade nuclear features. | ||
***Ball of cells with an intensely eosinophilic cytoplasm - '''key feature'''. | **Squamous metaplasia - very common. | ||
***Central nucleus. | ***Look for ''squamous morules'': | ||
***Intercellular bridges - may be hard to find. | ****Ball of cells with an intensely eosinophilic cytoplasm - '''key feature'''. | ||
***+/-Dyskeratotic cells. | ****Central nucleus. | ||
****Intercellular bridges - may be hard to find. | |||
****+/-Dyskeratotic cells. | |||
Notes: | Notes: | ||
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Modifiers/adjustment: | Modifiers/adjustment: | ||
*High grade nuclei upgrades cancer by one | *High grade nuclei upgrades cancer by one. | ||
**Tadrous says: high grade nuclei = increased size, irregular large nucleoli, irregular chromatin pattern (clumped, coarse).<ref>{{Ref DCHH|240}}</ref> | |||
**Winham ''et al''. describe it as: [[nuclear pleomorphism]] identifiable with the 10× objective or enlarged nuclei (1.5-2× normal) with [[prominent nucleoli]], irregular nuclear contours, and dispersed chromatin.<ref name=pmid24487465>{{Cite journal | last1 = Winham | first1 = WM. | last2 = Lin | first2 = D. | last3 = Stone | first3 = PJ. | last4 = Nucci | first4 = MR. | last5 = Quick | first5 = CM. | title = Architectural versus nuclear atypia-defined FIGO grade 2 endometrial endometrioid adenocarcinoma (EEC): a clinicopathologic comparison of 154 cases with clinical follow-up. | journal = Int J Gynecol Pathol | volume = 33 | issue = 2 | pages = 120-6 | month = Mar | year = 2014 | doi = 10.1097/PGP.0b013e31828bb4ed | PMID = 24487465 }}</ref> | |||
===Images=== | ===Images=== | ||
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==Sign out== | ==Sign out== | ||
===Biopsy=== | |||
<pre> | |||
Endometrium, Curettage: | |||
- ENDOMETRIOID ENDOMETRIAL ADENOCARCINOMA, preliminary FIGO grade I. | |||
</pre> | |||
<pre> | |||
Endometrium, Curettage: | |||
- ENDOMETRIOID ENDOMETRIAL ADENOCARCINOMA, preliminary FIGO grade II. | |||
Comment: | |||
The architecture is in keeping with FIGO I; however, nuclear atypia is | |||
present and therefore it is FIGO II. | |||
</pre> | |||
====Block letters==== | |||
<pre> | <pre> | ||
ENDOMETRIUM, BIOPSY: | ENDOMETRIUM, BIOPSY: | ||
- ENDOMETRIOID ENDOMETRIAL ADENOCARCINOMA, FIGO GRADE I/III. | - ENDOMETRIOID ENDOMETRIAL ADENOCARCINOMA, FIGO GRADE I/III. | ||
</pre> | |||
===Hysterectomy=== | |||
<pre> | |||
UTERUS WITH CERVIX AND FALLOPIAN TUBES, TOTAL HYSTERECTOMY AND BILATERAL SALPINGECTOMY: | |||
- ENDOMETRIOID ENDOMETRIAL ADENOCARCINOMA, FIGO GRADE I/III, pT2, pNx. | |||
-- SURGICAL MARGINS NEGATIVE. | |||
-- PLEASE SEE TUMOUR SUMMARY. | |||
- LEIOMYOMAS WITH HYALINIZATION. | |||
- FALLOPIAN TUBES WITHOUT SIGNIFICANT PATHOLOGY. | |||
</pre> | </pre> | ||
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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. | 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=== | A subtle pattern of myoinvasion in low grade endometrial endometrioid carcinomas, microcystic, elongated and fragmented (MELF) should be searched for in the absence of frank invasion. At low power, microcystic tumor glands lie separated by muscle from non-invasive carcinoma in edematous stroma. At higher power lie microcystic glands with neutrophils, as well as elongated glands lined by flattened tumor cells. Eosinophilic tumor cells or squamous cells can often be seen within the lumens. <ref name=pmid14501811>{{cite journal |author= Murray SK, Young RH, Scully RE |title= Unusual epithelial and stromal changes in myoinvasive endometrioid adenocarcinoma: a study of their frequency, associated diagnostic problems, and prognostic significance |journal= Int J Gynecol Pathol |volume=22 |issue= |pages=324-333 |year=2003 | pmid=14501811 |doi=10.1097/01.pgp.0000092161.33490.a9 }}</ref> | ||
====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. | 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. | ||
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*[[Endometrial carcinoma]]. | *[[Endometrial carcinoma]]. | ||
*[[Endometrial hyperplasia]]. | *[[Endometrial hyperplasia]]. | ||
*[[Ductal adenocarcinoma of the prostate gland]]. | |||
*[[Microcystic elongated and fragmented glands in endometrioid endometrial carcinoma]] (MELF). | |||
==References== | ==References== | ||