Endometrial carcinoma
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.
Clinical
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.
Management
"Hysterectomy" is the short answer.
Details: --- NEED REF. + CONFIRM.
- Low grade and low stage endometrioid carcinoma: total hysterectomy (includes cervix).
- Non-endometrioid or high stage or grade endometrioid: radical hysterectomy (includes cervix, vaginal cuff, parametrial tissue).
If the woman isn't done with their childbearing hormones may be given and surveillance biopsies. (???)
Subtypes
- Endometrioid - most common, patient typically is 55-65 years old and obese.
- Serous - classically older than endometrioid subtype.
- Clear cell.
Histol. 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) - (image of squamous morule with dyskeratotic cell (diagnosticpathology.org)).
- Look for squamous morules:
- Clear cell.
- Classically clear cells... but not always.
- Hobnailing (apical cytoplasm > cytoplasm on basement membrane). ???
Notes:
- Dyskeratosis = abnormal keratinization;[5] classically have intensely eosinophilic cytoplasm +/- nuclear fragmentation (karyorrhexis) - see: several dyskeratotic cells.
Grading (FIGO)
- Based on gland formation & adjusted by nuclear pleomorphism:[6][7]
- 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).[8]
- 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).
See also
- Endometrium.
- Uterine tumours - other uterine tumours, e.g. carcinosarcoma, endometrial stromal sarcoma.
- Gynecologic pathology - overview.
References
- ↑ 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.
- ↑ TN07 GY40
- ↑ Brown, K. (Sep 2009). "Is tamoxifen a genotoxic carcinogen in women?". Mutagenesis 24 (5): 391-404. doi:10.1093/mutage/gep022. PMID 19505894.
- ↑ 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.
- ↑ http://dictionary.reference.com/browse/dyskeratosis
- ↑ PBoD P.1087-8.
- ↑ [1][2][3]
- ↑ DCHIH P.240.
- ↑ PBoD P.1088.
- ↑ http://www.emedicine.com/med/topic2832.htm
- ↑ - Staging with groovy graphics