Endometrioid endometrial carcinoma

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Endometrioid endometrial carcinoma, abbreviated EEC, is the most common type of endometrial carcinoma. It is strongly associated with obesity.

Endometrioid endometrial carcinoma
Diagnosis in short

Endometrioid endometrial adenocarcinoma. H&E stain.
Synonyms endometrioid endometrial adenocarcinoma
LM DDx 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
IHC ER +ve, PR +ve, vimentin +ve, p16 -ve, CEA -ve
Gross endometrial thickening
Grossing notes hysterectomy for endometrial cancer grossing
Site endometrium - see endometrial carcinoma
Associated Dx obesity
Syndromes Lynch syndrome, Cowden syndrome
Signs abnormal uterine bleeding (AUB)
Prevalence common
Prognosis good - esp. low-grade
Treatment usu. total hysterectomy

It is also known as endometrioid endometrial adenocarcinoma.

General

  • Good prognosis - usually.
  • Women in 40s & 50s.
  • Associated with estrogen excess.
    • Typical patient is obese.

Associated syndromes:

Gross

  • Thickened endometrium.

Microscopic

Features:

  • Atypical (ovoid) glands with - one of the following four:[3][4][5]
    1. Desmoplastic stromal response.
    2. Confluent cribriform growth. †
    3. Extensive papillary growth. †
    4. Severe cytologic atypia. †
  • Endometrioid features:
    • +/-Low-grade nuclear features.
    • Squamous metaplasia - very common.
      • Look for squamous morules:
        • Ball of cells with an intensely eosinophilic cytoplasm - key feature.
        • Central nucleus.
        • Intercellular bridges - may be hard to find.
        • +/-Dyskeratotic cells.

Notes:

  • † There is a size cut-off for criteria 2, 3 and 4: > 2.1 mm.[4]
  • Dyskeratosis = abnormal keratinization;[6] classically have intensely eosinophilic cytoplasm +/- nuclear fragmentation (karyorrhexis) - see: several dyskeratotic cells.
  • Squamous metaplasia != neoplastic -- it may occur due to hormones.[7]
  • Squamous morules in endometrioid endometrial carcinoma - not associated with HPV infection.[8]

DDx:

Grading

  • FIGO system most commonly used.
  • Based on gland formation & adjusted by nuclear pleomorphism.

Preliminary grade based on gland formation:[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.
    • Tadrous says: high grade nuclei = increased size, irregular large nucleoli, irregular chromatin pattern (clumped, coarse).[13]
    • 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.[14]

Images

  • EEA - low mag. (WC)

  • EEA - intermed. mag. (WC)

  • EEA - high mag. (WC)

  • EEA - very high mag. (WC)

www:

IHC

  • Vimentin +ve.
  • ER +ve.
  • PR +ve.

Others:

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Biopsy

Endometrium, Curettage: 
- ENDOMETRIOID ENDOMETRIAL ADENOCARCINOMA, preliminary FIGO grade I.

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.


Block letters

ENDOMETRIUM, BIOPSY: 
- ENDOMETRIOID ENDOMETRIAL ADENOCARCINOMA, FIGO GRADE I/III.

Hysterectomy

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.

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.

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.

See also

References

  1. ↑ Lax, SF. (Jan 2002). "[Dualistic model of molecular pathogenesis in endometrial carcinoma].". Zentralbl Gynakol 124 (1): 10-6. doi:10.1055/s-2002-20303. PMID 11873308.
  2. ↑ Karamurzin, Y.; Soslow, RA.; Garg, K. (Apr 2013). "Histologic evaluation of prophylactic hysterectomy and oophorectomy in Lynch syndrome.". Am J Surg Pathol 37 (4): 579-85. doi:10.1097/PAS.0b013e3182796e27. PMID 23426126.
  3. ↑ Nucci, Marisa R.; Oliva, Esther (2009). Gynecologic Pathology: A Volume in Foundations in Diagnostic Pathology Series (1st ed.). Churchill Livingstone. pp. 239. ISBN 978-0443069208.
  4. ↑ 4.0 4.1 Kurman, RJ.; Norris, HJ. (Jun 1982). "Evaluation of criteria for distinguishing atypical endometrial hyperplasia from well-differentiated carcinoma.". Cancer 49 (12): 2547-59. PMID 7074572.
  5. ↑ URL: http://www.cap.org/apps/docs/committees/cancer/cancer_protocols/2011/Endometrium_11protocol.pdf. Accessed on: 12 January 2012.
  6. ↑ URL: http://dictionary.reference.com/browse/dyskeratosis. Accessed on: 5 September 2011.
  7. ↑ Miranda, MC.; Mazur, MT. (May 1995). "Endometrial squamous metaplasia. An unusual response to progestin therapy of hyperplasia.". Arch Pathol Lab Med 119 (5): 458-60. PMID 7748076.
  8. ↑ Chinen, K.; Kamiyama, K.; Kinjo, T.; Arasaki, A.; Ihama, Y.; Hamada, T.; Iwamasa, T. (Sep 2004). "Morules in endometrial carcinoma and benign endometrial lesions differ from squamous differentiation tissue and are not infected with human papillomavirus.". J Clin Pathol 57 (9): 918-26. doi:10.1136/jcp.2004.017996. PMID 15333650.
  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. ↑ Winham, WM.; Lin, D.; Stone, PJ.; Nucci, MR.; Quick, CM. (Mar 2014). "Architectural versus nuclear atypia-defined FIGO grade 2 endometrial endometrioid adenocarcinoma (EEC): a clinicopathologic comparison of 154 cases with clinical follow-up.". Int J Gynecol Pathol 33 (2): 120-6. doi:10.1097/PGP.0b013e31828bb4ed. PMID 24487465.
  15. ↑ 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.
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