Difference between revisions of "Endometrioid endometrial carcinoma"

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Endometrioid endometrial carcinoma (view source)

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-#redirect [[Endometrial_carcinoma#Endometrioid_endometrial_carcinoma]]
+{{ Infobox diagnosis
+| Name       = {{PAGENAME}}
+| Image      = Endometrioid endometrial adenocarcinoma high mag.jpg
+| Width      =
+| Caption    = Endometrioid endometrial adenocarcinoma. [[H&E stain]].
+| Synonyms   = endometrioid endometrial adenocarcinoma
+| Micro      =
+| Subtypes   =
+| LMDDx      = [[complex endometrial hyperplasia]], [[microglandular hyperplasia]] of the cervix, [[endocervical adenocarcinoma]], [[serous carcinoma of the endometrium]] - esp. for high-grade tumours, [[clear cell carcinoma of the endometrium]], [[simple endometrial hyperplasia]], [[endometrium with squamous morules]]
+| Stains     =
+| IHC        = ER +ve, PR +ve, vimentin +ve, p16 -ve, CEA -ve
+| EM         =
+| Molecular  =
+| IF         =
+| Gross      = endometrial thickening
+| Grossing   = [[hysterectomy for endometrial cancer grossing]]
+| Site       = [[endometrium]] - see ''[[endometrial carcinoma]]''
+| Assdx      = [[obesity]]
+| Syndromes  = [[Lynch syndrome]], [[Cowden syndrome]]
+| Clinicalhx =
+| Signs      = [[abnormal uterine bleeding]] (AUB)
+| Symptoms   =
+| Prevalence = common
+| Bloodwork  =
+| Rads       =
+| Endoscopy  =
+| Prognosis  = good - esp. low-grade
+| Other      =
+| ClinDDx    =
+| Tx         = usu. total hysterectomy
+}}
+'''Endometrioid endometrial carcinoma''', abbreviated '''EEC''', is the most common type of [[endometrial carcinoma]].  It is strongly associated with [[obesity]].
-*[[AKA]] ''endometrioid endometrial adenocarcinoma''.
+It is also known as '''endometrioid endometrial adenocarcinoma'''.
-===General===
+==General==
 *Good prognosis - usually.
 *Women in 40s & 50s.
-*Associated with estrogen excess.
+*Associated with estrogen excess (unopossed estrogen stimulation).
 **Typical patient is [[obese]].
-===Gross===
+Associated syndromes:
+*[[Lynch syndrome]].<ref name=pmid11873308>{{Cite journal  | last1 = Lax | first1 = SF. | title = [Dualistic model of molecular pathogenesis in endometrial carcinoma]. | journal = Zentralbl Gynakol | volume = 124 | issue = 1 | pages = 10-6 | month = Jan | year = 2002 | doi = 10.1055/s-2002-20303 | PMID = 11873308 }}</ref><ref name=pmid23426126>{{Cite journal  | last1 = Karamurzin | first1 = Y. | last2 = Soslow | first2 = RA. | last3 = Garg | first3 = K. | title = Histologic evaluation of prophylactic hysterectomy and oophorectomy in Lynch syndrome. | journal = Am J Surg Pathol | volume = 37 | issue = 4 | pages = 579-85 | month = Apr | year = 2013 | doi = 10.1097/PAS.0b013e3182796e27 | PMID = 23426126 }}</ref>
+*[[Cowden syndrome]].
+==Gross==
 *Thickened endometrium.
-===Microscopic===
+==Microscopic==
 Features:
 *Atypical (ovoid) glands with - one of the following four:<ref name=Ref_GP239>{{Ref GP|239}}</ref><ref name=pmid7074572>{{Cite journal  | last1 = Kurman | first1 = RJ. | last2 = Norris | first2 = HJ. | title = Evaluation of criteria for distinguishing atypical endometrial hyperplasia from well-differentiated carcinoma. | journal = Cancer | volume = 49 | issue = 12 | pages = 2547-59 | month = Jun | year = 1982 | doi =  | PMID = 7074572 }}</ref><ref>URL: [http://www.cap.org/apps/docs/committees/cancer/cancer_protocols/2011/Endometrium_11protocol.pdf http://www.cap.org/apps/docs/committees/cancer/cancer_protocols/2011/Endometrium_11protocol.pdf]. Accessed on: 12 January 2012.</ref>
@@ Line 19: / Line 54: @@
 *#Extensive papillary growth. †
 *#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:
@@ Line 40: / Line 77: @@
 *[[Clear cell carcinoma of the endometrium]] - esp. when clear cells present.
-====Images====
+===Grading===
+*FIGO system most commonly used.
+*Based on gland formation & adjusted by nuclear pleomorphism.
+Preliminary grade based on gland formation:<ref>{{Ref PBoD|1087-8}}</ref><ref>URL: [http://www.pathologyoutlines.com/uterus.html#endometrialcarc http://www.pathologyoutlines.com/uterus.html#endometrialcarc].</ref><ref>URL: [http://www.emedicine.com/med/topic2832.htm http://www.emedicine.com/med/topic2832.htm].</ref><ref name=pmid12496701>{{cite journal |author=Ayhan A, Taskiran C, Yuce K, Kucukali T |title=The prognostic value of nuclear grading and the revised FIGO grading of endometrial adenocarcinoma |journal=Int. J. Gynecol. Pathol. |volume=22 |issue=1 |pages=71–4 |year=2003 |month=January |pmid=12496701 |doi= |url=}}</ref>
+*Grade 1: <5% solid component.
+*Grade 2: 5-50% solid component.
+*Grade 3: >50% solid component.
+Modifiers/adjustment:
+*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===
 <gallery>
 Image:Endometrioid endometrial adenocarcinoma low mag.jpg | EEA - low mag. (WC)
@@ Line 50: / Line 101: @@
 *[http://www.diagnosticpathology.org/content/2/1/40/figure/F1?highres=y Squamous morule with dyskeratotic cell (diagnosticpathology.org)].
-===IHC===
+==IHC==
 *Vimentin +ve.
 *ER +ve.
@@ Line 56: / Line 107: @@
 Others:
-*p16 -ve -- positive in [[serous endometrial carcinoma]]<ref name=pmid17581420/> and [[endocervical adenocarcinoma]].
+*p16 -ve -- positive in [[serous endometrial carcinoma]]<ref name=pmid17581420>{{Cite journal  | last1 = Chiesa-Vottero | first1 = AG. | last2 = Malpica | first2 = A. | last3 = Deavers | first3 = MT. | last4 = Broaddus | first4 = R. | last5 = Nuovo | first5 = GJ. | last6 = Silva | first6 = EG. | title = Immunohistochemical overexpression of p16 and p53 in uterine serous carcinoma and ovarian high-grade serous carcinoma. | journal = Int J Gynecol Pathol | volume = 26 | issue = 3 | pages = 328-33 | month = Jul | year = 2007 | doi = 10.1097/01.pgp.0000235065.31301.3e | PMID = 17581420 }}</ref> and [[endocervical adenocarcinoma]].
 *CEA -ve.
-===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>
 ENDOMETRIUM, BIOPSY:
@@ Line 65: / Line 133: @@
 </pre>
-====Micro====
+===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>
+===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.
+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====
@@ Line 72: / Line 152: @@
 ==See also==
-*[[Endometrial carcinoma
+*[[Endometrial carcinoma]].
+*[[Endometrial hyperplasia]].
+*[[Ductal adenocarcinoma of the prostate gland]].
+*[[Microcystic elongated and fragmented glands in endometrioid endometrial carcinoma]] (MELF).
 ==References==

Difference between revisions of "Endometrioid endometrial carcinoma"

Endometrioid endometrial carcinoma (view source)

Revision as of 21:40, 22 February 2023

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