Difference between revisions of "Serous carcinoma of the endometrium"

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#redirect [[Endometrial_carcinoma#Serous_carcinoma_of_the_endometrium]]
'''Serous carcinoma of the endometrium''' is an aggressive type of [[endometrial carcinoma]] that typically afflicts post-menopausal women.


It is also known as '''serous endometrial carcinoma''', '''serous carcinoma of the uterus''', '''uterine serous carcinoma''' and '''uterine papillary serous carcinoma'''.
==General==
*Arising in the setting of atrophy.
*Usually post-menopausal.
*Precursor lesion: ''endometrial intraepithelial carcinoma''.<ref name=pmid22249577>{{Cite journal  | last1 = Roelofsen | first1 = T. | last2 = van Kempen | first2 = LC. | last3 = van der Laak | first3 = JA. | last4 = van Ham | first4 = MA. | last5 = Bulten | first5 = J. | last6 = Massuger | first6 = LF. | title = Concurrent endometrial intraepithelial carcinoma (EIC) and serous ovarian cancer: can EIC be seen as the precursor lesion? | journal = Int J Gynecol Cancer | volume = 22 | issue = 3 | pages = 457-64 | month = Mar | year = 2012 | doi = 10.1097/IGC.0b013e3182434a81 | PMID = 22249577 }}</ref>
*Aggressive behaviour - high probability of disseminated disease.
==Gross==
*Thin endometrium.
*+/-Polypoid mass.
==Microscopic==
Features - serous:
*Architecture - classically papillary.
**May be glomeruloid, tubulocystic, solid (uncommon).
*Cytology:
**Columnar or cuboidal cells.
**#Moderate to marked nuclear pleomorphism - variation of size, shape and staining.
**#*Large nuclear size variation between cells often esp. prominent.
**#Singular prominent, classically red, [[red nucleolus|nucleolus]].
*+/-[[Psammoma bodies]].
DDx:
*High-grade [[endometrioid endometrial carcinoma]] - uncommon, typically younger age.
*[[Clear cell carcinoma of the endometrium]] - usually have less nuclear pleomorphism and less mitoses.
*[[Arias-Stella reaction]].
===Images===
<gallery>
Image:Uterine_papillary_serous_carcinoma_low_mag.jpg | Uterine serous carcinoma - low mag. (WC)
Image:Uterine_serous_carcinoma_high_mag.jpg | Uterine serous carcinoma - high mag. (WC)
</gallery>
==IHC==
*p16 +ve<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> - should be strong.
*p53 +ve<ref name=pmid19623034>{{Cite journal  | last1 = Yemelyanova | first1 = A. | last2 = Ji | first2 = H. | last3 = Shih | first3 = IeM. | last4 = Wang | first4 = TL. | last5 = Wu | first5 = LS. | last6 = Ronnett | first6 = BM. | title = Utility of p16 expression for distinction of uterine serous carcinomas from endometrial endometrioid and endocervical adenocarcinomas: immunohistochemical analysis of 201 cases. | journal = Am J Surg Pathol | volume = 33 | issue = 10 | pages = 1504-14 | month = Oct | year = 2009 | doi = 10.1097/PAS.0b013e3181ac35f5 | PMID = 19623034 }}</ref> diffuse & strong > 50% ''or'' 75% of the tumour - depending on the paper one reads.
**Subset is p53 -ve.
*Ki-67 "high" - no cut-point defined.
*ER often -ve.<ref name=pmid10786803>{{Cite journal  | last1 = Kounelis | first1 = S. | last2 = Kapranos | first2 = N. | last3 = Kouri | first3 = E. | last4 = Coppola | first4 = D. | last5 = Papadaki | first5 = H. | last6 = Jones | first6 = MW. | title = Immunohistochemical profile of endometrial adenocarcinoma: a study of 61 cases and review of the literature. | journal = Mod Pathol | volume = 13 | issue = 4 | pages = 379-88 | month = Apr | year = 2000 | doi = 10.1038/modpathol.3880062 | PMID = 10786803 }}</ref>
*PR often -ve.<ref name=pmid10786803/>
High-grade endometrioid carcinoma versus serous carcinoma:<ref name=pmid15577675>{{Cite journal  | last1 = Darvishian | first1 = F. | last2 = Hummer | first2 = AJ. | last3 = Thaler | first3 = HT. | last4 = Bhargava | first4 = R. | last5 = Linkov | first5 = I. | last6 = Asher | first6 = M. | last7 = Soslow | first7 = RA. | title = Serous endometrial cancers that mimic endometrioid adenocarcinomas: a clinicopathologic and immunohistochemical study of a group of problematic cases. | journal = Am J Surg Pathol | volume = 28 | issue = 12 | pages = 1568-78 | month = Dec | year = 2004 | doi =  | PMID = 15577675 }}</ref>
*p53 -ve, PR +ve, PTEN loss -- suggest endometrioid.
*p16 and PTEN superior to ER, PR, and p53.<ref name=pmid20567148>{{Cite journal  | last1 = Alkushi | first1 = A. | last2 = Köbel | first2 = M. | last3 = Kalloger | first3 = SE. | last4 = Gilks | first4 = CB. | title = High-grade endometrial carcinoma: serous and grade 3 endometrioid carcinomas have different immunophenotypes and outcomes. | journal = Int J Gynecol Pathol | volume = 29 | issue = 4 | pages = 343-50 | month = Jul | year = 2010 | doi = 10.1097/PGP.0b013e3181cd6552 | PMID = 20567148 }}</ref>
Notes:
*p16 +ve in tubal metaplasia.<ref name=pmid17429140>{{Cite journal  | last1 = Horree | first1 = N. | last2 = Heintz | first2 = AP. | last3 = Sie-Go | first3 = DM. | last4 = van Diest | first4 = PJ. | title = p16 is consistently expressed in endometrial tubal metaplasia. | journal = Cell Oncol | volume = 29 | issue = 1 | pages = 37-45 | month =  | year = 2007 | doi =  | PMID = 17429140 }}</ref>
*WT1 usu. -ve -- useful to differentiate from [[ovarian serous carcinoma]].<ref name=pmid21993272>{{Cite journal  | last1 = Bárcena | first1 = C. | last2 = Oliva | first2 = E. | title = WT1 expression in the female genital tract. | journal = Adv Anat Pathol | volume = 18 | issue = 6 | pages = 454-65 | month = Nov | year = 2011 | doi = 10.1097/PAP.0b013e318234aaed | PMID = 21993272 }}</ref>
==See also==
*[[Endometrial carcinoma]].
*[[Serous carcinoma]].
==References==
{{Reflist|2}}
[[Category:Endometrial carcinoma]]
[[Category:Diagnosis]]
[[Category:Diagnosis]]

Revision as of 00:53, 23 January 2014

Serous carcinoma of the endometrium is an aggressive type of endometrial carcinoma that typically afflicts post-menopausal women.

It is also known as serous endometrial carcinoma, serous carcinoma of the uterus, uterine serous carcinoma and uterine papillary serous carcinoma.

General

  • Arising in the setting of atrophy.
  • Usually post-menopausal.
  • Precursor lesion: endometrial intraepithelial carcinoma.[1]
  • Aggressive behaviour - high probability of disseminated disease.

Gross

  • Thin endometrium.
  • +/-Polypoid mass.

Microscopic

Features - serous:

  • Architecture - classically papillary.
    • May be glomeruloid, tubulocystic, solid (uncommon).
  • Cytology:
    • Columnar or cuboidal cells.
      1. Moderate to marked nuclear pleomorphism - variation of size, shape and staining.
        • Large nuclear size variation between cells often esp. prominent.
      2. Singular prominent, classically red, nucleolus.
  • +/-Psammoma bodies.

DDx:

Images

  • Uterine serous carcinoma - low mag. (WC)

  • Uterine serous carcinoma - high mag. (WC)

IHC

  • p16 +ve[2] - should be strong.
  • p53 +ve[3] diffuse & strong > 50% or 75% of the tumour - depending on the paper one reads.
    • Subset is p53 -ve.
  • Ki-67 "high" - no cut-point defined.
  • ER often -ve.[4]
  • PR often -ve.[4]

High-grade endometrioid carcinoma versus serous carcinoma:[5]

  • p53 -ve, PR +ve, PTEN loss -- suggest endometrioid.
  • p16 and PTEN superior to ER, PR, and p53.[6]

Notes:

See also

References

  1. ↑ Roelofsen, T.; van Kempen, LC.; van der Laak, JA.; van Ham, MA.; Bulten, J.; Massuger, LF. (Mar 2012). "Concurrent endometrial intraepithelial carcinoma (EIC) and serous ovarian cancer: can EIC be seen as the precursor lesion?". Int J Gynecol Cancer 22 (3): 457-64. doi:10.1097/IGC.0b013e3182434a81. PMID 22249577.
  2. ↑ Chiesa-Vottero, AG.; Malpica, A.; Deavers, MT.; Broaddus, R.; Nuovo, GJ.; Silva, EG. (Jul 2007). "Immunohistochemical overexpression of p16 and p53 in uterine serous carcinoma and ovarian high-grade serous carcinoma.". Int J Gynecol Pathol 26 (3): 328-33. doi:10.1097/01.pgp.0000235065.31301.3e. PMID 17581420.
  3. ↑ Yemelyanova, A.; Ji, H.; Shih, IeM.; Wang, TL.; Wu, LS.; Ronnett, BM. (Oct 2009). "Utility of p16 expression for distinction of uterine serous carcinomas from endometrial endometrioid and endocervical adenocarcinomas: immunohistochemical analysis of 201 cases.". Am J Surg Pathol 33 (10): 1504-14. doi:10.1097/PAS.0b013e3181ac35f5. PMID 19623034.
  4. ↑ 4.0 4.1 Kounelis, S.; Kapranos, N.; Kouri, E.; Coppola, D.; Papadaki, H.; Jones, MW. (Apr 2000). "Immunohistochemical profile of endometrial adenocarcinoma: a study of 61 cases and review of the literature.". Mod Pathol 13 (4): 379-88. doi:10.1038/modpathol.3880062. PMID 10786803.
  5. ↑ Darvishian, F.; Hummer, AJ.; Thaler, HT.; Bhargava, R.; Linkov, I.; Asher, M.; Soslow, RA. (Dec 2004). "Serous endometrial cancers that mimic endometrioid adenocarcinomas: a clinicopathologic and immunohistochemical study of a group of problematic cases.". Am J Surg Pathol 28 (12): 1568-78. PMID 15577675.
  6. ↑ Alkushi, A.; Köbel, M.; Kalloger, SE.; Gilks, CB. (Jul 2010). "High-grade endometrial carcinoma: serous and grade 3 endometrioid carcinomas have different immunophenotypes and outcomes.". Int J Gynecol Pathol 29 (4): 343-50. doi:10.1097/PGP.0b013e3181cd6552. PMID 20567148.
  7. ↑ Horree, N.; Heintz, AP.; Sie-Go, DM.; van Diest, PJ. (2007). "p16 is consistently expressed in endometrial tubal metaplasia.". Cell Oncol 29 (1): 37-45. PMID 17429140.
  8. ↑ Bárcena, C.; Oliva, E. (Nov 2011). "WT1 expression in the female genital tract.". Adv Anat Pathol 18 (6): 454-65. doi:10.1097/PAP.0b013e318234aaed. PMID 21993272.
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