Difference between revisions of "Endometrial carcinoma"

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An introduction to the endometrium is in the article ''[[endometrium]]''.
An introduction to the endometrium is in the article ''[[endometrium]]''.


==Clinical==
=Clinical=
===Risk factors===
===Risk factors===
Risk factors for endometrial carcinoma - mnemonic ''COLD NUT'':<ref>TN07 GY40</ref>
Risk factors for endometrial carcinoma - mnemonic ''COLD NUT'':<ref>TN07 GY40</ref>
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*Non-endometrioid ''or'' high stage endometrioid ''or'' high-grade endometrioid: ''radical hysterectomy'' (includes cervix, vaginal cuff, parametrial tissue).
*Non-endometrioid ''or'' high stage endometrioid ''or'' high-grade endometrioid: ''radical hysterectomy'' (includes cervix, vaginal cuff, parametrial tissue).


==Subtypes==
==Subtypes - overview==
They are commonly grouped based on clinicopathologic features:<ref name=pmid21309259>{{Cite journal  | last1 = Lim | first1 = D. | last2 = Oliva | first2 = E. | title = Nonendometrioid endometrial carcinomas. | journal = Semin Diagn Pathol | volume = 27 | issue = 4 | pages = 241-60 | month = Nov | year = 2010 | doi =  | PMID = 21309259 }}</ref>
They are commonly grouped based on clinicopathologic features:<ref name=pmid21309259>{{Cite journal  | last1 = Lim | first1 = D. | last2 = Oliva | first2 = E. | title = Nonendometrioid endometrial carcinomas. | journal = Semin Diagn Pathol | volume = 27 | issue = 4 | pages = 241-60 | month = Nov | year = 2010 | doi =  | PMID = 21309259 }}</ref>
#Type I:
#Type I:
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#Serous - patients classically older than endometrioid subtype, arise in atrophic endometrium.
#Serous - patients classically older than endometrioid subtype, arise in atrophic endometrium.
#Clear cell.
#Clear cell.
===Microscopic (summary)===
Features in most common subtypes (in short):
*Serous:
**Columnar cells.
**Cilia.
**[[Psammoma bodies]].
**Papillae.
*Endometrioid:
**Tubular glands.
**Squamous metaplasia.
***Look for ''squamous morules'':
****Ball of cells with intensely eosinophilic cytoplasm, dyskeratotic cell(s) - ([http://www.diagnosticpathology.org/content/2/1/40/figure/F1?highres=y image of squamous morule with dyskeratotic cell (diagnosticpathology.org)]).
*Clear cell.
**Classically clear cells... but not always.
**Hobnailing (apical cytoplasm > cytoplasm on basement membrane).
Notes:
*Dyskeratosis = abnormal keratinization;<ref>URL: [http://dictionary.reference.com/browse/dyskeratosis http://dictionary.reference.com/browse/dyskeratosis]. Accessed on: 5 September 2011.</ref> classically have intensely eosinophilic cytoplasm +/- nuclear fragmentation ([http://dictionary.reference.com/browse/karyolysis?db=medical&q=karyolysis karyorrhexis]) - see: [http://www.drmihm.com/pictures/Figure%203.jpg several dyskeratotic cells].


==Grading (FIGO)==
==Grading (FIGO)==
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Ref: <ref>{{Ref PBoD|1088}}</ref>, <ref>[http://www.emedicine.com/med/topic2832.htm http://www.emedicine.com/med/topic2832.htm]</ref>, <ref>[http://www.cancerfacts.com/GeneralContent/Uterine/Gen_Diagnosis.asp?CB=11 Staging with groovy graphics (cancerfacts.com)]</ref>
Ref: <ref>{{Ref PBoD|1088}}</ref>, <ref>[http://www.emedicine.com/med/topic2832.htm http://www.emedicine.com/med/topic2832.htm]</ref>, <ref>[http://www.cancerfacts.com/GeneralContent/Uterine/Gen_Diagnosis.asp?CB=11 Staging with groovy graphics (cancerfacts.com)]</ref>


==See also==
=Specific types=
==Endometrioid endometrial carcinoma==
===Microscopic===
Features - endometrioid:
*Tubular glands.
*Squamous metaplasia.
**Look for ''squamous morules'':
**Ball of cells with intensely eosinophilic cytoplasm, dyskeratotic cell(s) - ([http://www.diagnosticpathology.org/content/2/1/40/figure/F1?highres=y image of squamous morule with dyskeratotic cell (diagnosticpathology.org)]).
 
Notes:
*Dyskeratosis = abnormal keratinization;<ref>URL: [http://dictionary.reference.com/browse/dyskeratosis http://dictionary.reference.com/browse/dyskeratosis]. Accessed on: 5 September 2011.</ref> classically have intensely eosinophilic cytoplasm +/- nuclear fragmentation ([http://dictionary.reference.com/browse/karyolysis?db=medical&q=karyolysis karyorrhexis]) - see: [http://www.drmihm.com/pictures/Figure%203.jpg several dyskeratotic cells].
 
==Serous endometrial carcinoma==
===Microscopic===
Features - serous:
*Serous:
**Columnar cells.
**Cilia.
**[[Psammoma bodies]].
**Papillae.
 
==Clear cell endometrial carcinoma==
===Microscopic===
Features - clear cell:
**Classically clear cells... but not always.
**Hobnailing (apical cytoplasm > cytoplasm on basement membrane).
 
=See also=
*[[Endometrium]].
*[[Endometrium]].
*[[Uterine tumours]] - other uterine tumours, e.g. carcinosarcoma, endometrial stromal sarcoma.
*[[Uterine tumours]] - other uterine tumours, e.g. carcinosarcoma, endometrial stromal sarcoma.
*[[Gynecologic pathology]] - overview.
*[[Gynecologic pathology]] - overview.


==References==
=References=
{{reflist|2}}
{{reflist|2}}


Revision as of 12:48, 6 November 2011

Endometrial carcinoma is a common gynecologic malingnancy[1] that often arises from endometrial hyperplasia. The incidence of endometrial carcinoma is increasing, as the proportion of obese individuals is increasing.

An introduction to the endometrium is in the article endometrium.

Clinical

Risk factors

Risk factors for endometrial carcinoma - mnemonic COLD NUT:[2]

  • Cancer Hx (ovarian, breast, colon).
  • Obesity.
  • Late menopause.
  • Diabetes.
  • Nulliparity.
  • Unopposed estrogen (polycystic ovarian syndrome (PCOS), anovulation, hormone replacement therapy (HRT)).
  • Tamoxifen use.
    • Used for breast cancer; the risk is quite small[3] or possibly negligent.[4]

Family history

Several syndromes are seen in association with endometrial cancer:[5]

  • Cowden syndrome (PTEN mutation) - most common.
    • Associated with endometrioid endometrial carcinoma.
  • Lynch syndrome (mutation of a mismatch repair gene - there are several[6]).
    • Associated with non-endometrioid endometrial carcinoma.
    • Autosomal dominant.

Management

"Hysterectomy" is the standard treatment for endometrial carcinoma.

    • In low-grade carcinomas (i.e. low grade endometrioid type), if the woman isn't done with their childbearing, the treatment may be hormones and surveillance biopsies.[7]

Details:

  • Low grade and low stage endometrioid carcinoma: total hysterectomy (includes cervix).
  • Non-endometrioid or high stage endometrioid or high-grade endometrioid: radical hysterectomy (includes cervix, vaginal cuff, parametrial tissue).

Subtypes - overview

They are commonly grouped based on clinicopathologic features:[8]

  1. Type I:
    • Histologic types:
      • Endometrioid (most common).
      • Mucinous.
    • Clinical characteristics: premenopausal, estrogen excess.
  2. Group II:
    • Histologic types:
      • Serous carcinoma.
      • Clear cell carcinoma.
    • Clinical characteristics: postmenopausal, no estrogen excess, poor prognosis.

The most common as a list:

  1. Endometrioid - most common, patient typically is 55-65 years old and obese.
  2. Serous - patients classically older than endometrioid subtype, arise in atrophic endometrium.
  3. Clear cell.

Grading (FIGO)

  • Based on gland formation & adjusted by nuclear pleomorphism:[9][10][11][12]
    • 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; high grade nuclei = increased size, irregular large nucleoli, irregular chromatin pattern (clumped, coarse).[13]
  • Grading for endometrioid subtype ONLY --papillary serous carcinoma and clear cell carcinomas are grade 3 by definition.

Staging

  • Stage I: confined to uterine body.
    • Ia = endometrium only.
    • Ib = less than half of myometrium.
    • Ic = greater than half of myometrium.
  • Stage II: uterus + cervix.
    • IIa = endocervical glands only.
    • IIb = cervix stroma.
  • Stage III: outside uterus - but inside pelvis.
    • IIIa = serosal or adnexal involvement or peritoneal cytology positive.
    • IIIb = vaginal metstases.
    • IIIc = pelvic or paraaortic nodes.
  • Stage IV: outside true pelvis or in mucosa of bladder or GI tract.
    • IVa = bladder or bowel mucosa.
    • IVb = distant mets (intraabdominal, inguinal nodes).

Ref: [14], [15], [16]

Specific types

Endometrioid endometrial carcinoma

Microscopic

Features - endometrioid:

Notes:

Serous endometrial carcinoma

Microscopic

Features - serous:

Clear cell endometrial carcinoma

Microscopic

Features - clear cell:

    • Classically clear cells... but not always.
    • Hobnailing (apical cytoplasm > cytoplasm on basement membrane).

See also

References

  1. ↑ Fowler W, Mutch D (September 2008). "Management of endometrial cancer". Womens Health (Lond Engl) 4 (5): 479–89. doi:10.2217/17455057.4.5.479. PMID 19072487.
  2. ↑ TN07 GY40
  3. ↑ Brown, K. (Sep 2009). "Is tamoxifen a genotoxic carcinogen in women?". Mutagenesis 24 (5): 391-404. doi:10.1093/mutage/gep022. PMID 19505894.
  4. ↑ Ashraf, M.; Biswas, J.; Majumdar, S.; Nayak, S.; Alam, N.; Mukherjee, KK.; Gupta, S.. "Tamoxifen use in Indian women--adverse effects revisited.". Asian Pac J Cancer Prev 10 (4): 609-12. PMID 19827879.
  5. ↑ Okuda T, Sekizawa A, Purwosunu Y, et al. (2010). "Genetics of endometrial cancers". Obstet Gynecol Int 2010: 984013. doi:10.1155/2010/984013. PMC 2852605. PMID 20396392. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2852605/.
  6. ↑ Online 'Mendelian Inheritance in Man' (OMIM) 120435
  7. ↑ Zivanovic O, Carter J, Kauff ND, Barakat RR (December 2009). "A review of the challenges faced in the conservative treatment of young women with endometrial carcinoma and risk of ovarian cancer". Gynecol. Oncol. 115 (3): 504–9. doi:10.1016/j.ygyno.2009.08.011. PMID 19758691.
  8. ↑ Lim, D.; Oliva, E. (Nov 2010). "Nonendometrioid endometrial carcinomas.". Semin Diagn Pathol 27 (4): 241-60. PMID 21309259.
  9. ↑ Cotran, Ramzi S.; Kumar, Vinay; Fausto, Nelson; Nelso Fausto; Robbins, Stanley L.; Abbas, Abul K. (2005). Robbins and Cotran pathologic basis of disease (7th ed.). St. Louis, Mo: Elsevier Saunders. pp. 1087-8. ISBN 0-7216-0187-1.
  10. ↑ URL: http://www.pathologyoutlines.com/uterus.html#endometrialcarc.
  11. ↑ URL: http://www.emedicine.com/med/topic2832.htm.
  12. ↑ Ayhan A, Taskiran C, Yuce K, Kucukali T (January 2003). "The prognostic value of nuclear grading and the revised FIGO grading of endometrial adenocarcinoma". Int. J. Gynecol. Pathol. 22 (1): 71–4. PMID 12496701.
  13. ↑ Tadrous, Paul.J. Diagnostic Criteria Handbook in Histopathology: A Surgical Pathology Vade Mecum (1st ed.). Wiley. pp. 240. ISBN 978-0470519035.
  14. ↑ Cotran, Ramzi S.; Kumar, Vinay; Fausto, Nelson; Nelso Fausto; Robbins, Stanley L.; Abbas, Abul K. (2005). Robbins and Cotran pathologic basis of disease (7th ed.). St. Louis, Mo: Elsevier Saunders. pp. 1088. ISBN 0-7216-0187-1.
  15. ↑ http://www.emedicine.com/med/topic2832.htm
  16. ↑ Staging with groovy graphics (cancerfacts.com)
  17. ↑ URL: http://dictionary.reference.com/browse/dyskeratosis. Accessed on: 5 September 2011.

External links

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