Endometrial carcinoma

Endometrial carcinoma is a common gynecologic malingnancy 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:

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

Notes:

• Dyskeratosis = abnormal keratinization; classically have intensely eosinophilic cytoplasm +/- nuclear fragmentation (karyorrhexis) - see: several dyskeratotic cells.

Grading (FIGO)

• Based on gland formation & adjusted by nuclear pleomorphism:
  • 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 = incr. size, irregular large nucleoli, irregular chromatin pattern (clumped, coarse).
• 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: ,

See also

• Endometrium.
• Endometrial stromal tumours.
• Gynecologic pathology - overview.

External links

• Image of squamous morule with dyskeratotic cell (diagnosticpathology.org).