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
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.
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 (MSH2/MSH6 protein complex - mutations).
- 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.[6]
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
- Endometrioid - most common, patient typically is 55-65 years old and obese.
- Serous - patients classically older than endometrioid subtype, arise in atrophic endometrium.
- 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) - (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;[7] classically have intensely eosinophilic cytoplasm +/- nuclear fragmentation (karyorrhexis) - see: several dyskeratotic cells.
Grading (FIGO)
- Based on gland formation & adjusted by nuclear pleomorphism:[8][9][10][11]
- 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).[12]
- 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.
- ↑ 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/.
- ↑ 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.
- ↑ http://dictionary.reference.com/browse/dyskeratosis
- ↑ 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.
- ↑ URL: http://www.pathologyoutlines.com/uterus.html#endometrialcarc.
- ↑ URL: http://www.emedicine.com/med/topic2832.htm.
- ↑ 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.
- ↑ Tadrous, Paul.J. Diagnostic Criteria Handbook in Histopathology: A Surgical Pathology Vade Mecum (1st ed.). Wiley. pp. 240. ISBN 978-0470519035.
- ↑ 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.
- ↑ http://www.emedicine.com/med/topic2832.htm
- ↑ Staging with groovy graphics (cancerfacts.com)