Difference between revisions of "Endometrioid endometrial carcinoma"

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Endometrial carcinoma#Endometrioid endometrial carcinoma

AKA endometrioid endometrial adenocarcinoma.

General

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

Gross

Thickened endometrium.

Microscopic

Features:

Atypical (ovoid) glands with - one of the following four:^[1]^[2]^[3]
1. Desmoplastic stromal response.
2. Confluent cribriform growth. †
3. Extensive papillary growth. †
4. Severe cytologic atypia. †
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.^[2]
Dyskeratosis = abnormal keratinization;^[4] classically have intensely eosinophilic cytoplasm +/- nuclear fragmentation (karyorrhexis) - see: several dyskeratotic cells.
Squamous metaplasia != neoplastic -- it may occur due to hormones.^[5]
Squamous morules in endometrioid endometrial carcinoma - not associated with HPV infection.^[6]

DDx:

Complex endometrial hyperplasia with atypia.
Complex endometrial hyperplasia.
Microglandular hyperplasia of the cervix.
Endocervical adenocarcinoma.
Serous carcinoma of the endometrium - esp. if high-grade nuclear features are present diffusely.
Clear cell carcinoma of the endometrium - esp. when clear cells present.

Images

EEA - low mag. (WC)
EEA - intermed. mag. (WC)
EEA - high mag. (WC)
EEA - very high mag. (WC)

www:

Squamous morule with dyskeratotic cell (diagnosticpathology.org).

IHC

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

Others:

p16 -ve -- positive in serous endometrial carcinoma^[7] and endocervical adenocarcinoma.
CEA -ve.

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

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.

References

↑ 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.
↑ ^2.0 ^2.1 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.
↑ URL: http://www.cap.org/apps/docs/committees/cancer/cancer_protocols/2011/Endometrium_11protocol.pdf. Accessed on: 12 January 2012.
↑ URL: http://dictionary.reference.com/browse/dyskeratosis. Accessed on: 5 September 2011.
↑ 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.
↑ 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.
↑ Cite error: Invalid <ref> tag; no text was provided for refs named pmid17581420

[Ref_GP239-1] 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.

[pmid7074572-2] 2.0 ^2.1 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.

[3] URL: http://www.cap.org/apps/docs/committees/cancer/cancer_protocols/2011/Endometrium_11protocol.pdf. Accessed on: 12 January 2012.

[4] URL: http://dictionary.reference.com/browse/dyskeratosis. Accessed on: 5 September 2011.

[pmid7748076-5] 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.

[pmid15333650-6] 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.

[pmid17581420-7] Cite error: Invalid <ref> tag; no text was provided for refs named pmid17581420

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@@ Line 1: / Line 1: @@
 #redirect [[Endometrial_carcinoma#Endometrioid_endometrial_carcinoma]]
+*[[AKA]] ''endometrioid endometrial adenocarcinoma''.
+===General===
+*Good prognosis - usually.
+*Women in 40s & 50s.
+*Associated with estrogen excess.
+**Typical patient is [[obese]].
+===Gross===
+*Thickened endometrium.
+===Microscopic===
+Features:
+*Atypical (ovoid) glands with - one of the following four:<ref name=Ref_GP239>{{Ref GP|239}}</ref><ref name=pmid7074572>{{Cite journal  | last1 = Kurman | first1 = RJ. | last2 = Norris | first2 = HJ. | title = Evaluation of criteria for distinguishing atypical endometrial hyperplasia from well-differentiated carcinoma. | journal = Cancer | volume = 49 | issue = 12 | pages = 2547-59 | month = Jun | year = 1982 | doi =  | PMID = 7074572 }}</ref><ref>URL: [http://www.cap.org/apps/docs/committees/cancer/cancer_protocols/2011/Endometrium_11protocol.pdf http://www.cap.org/apps/docs/committees/cancer/cancer_protocols/2011/Endometrium_11protocol.pdf]. Accessed on: 12 January 2012.</ref>
+*#[[Desmoplastic stromal response]].
+*#Confluent cribriform growth. †
+*#Extensive papillary growth. †
+*#Severe cytologic atypia. †
+*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.<ref name=pmid7074572/>
+*Dyskeratosis = abnormal keratinization;<ref>URL: [http://dictionary.reference.com/browse/dyskeratosis http://dictionary.reference.com/browse/dyskeratosis]. Accessed on: 5 September 2011.</ref> classically have intensely eosinophilic cytoplasm +/- nuclear fragmentation ([http://dictionary.reference.com/browse/karyolysis?db=medical&q=karyolysis karyorrhexis]) - see: [http://www.drmihm.com/pictures/Figure%203.jpg several dyskeratotic cells].
+*[[Squamous metaplasia]] != neoplastic -- it may occur due to hormones.<ref name=pmid7748076>{{Cite journal  | last1 = Miranda | first1 = MC. | last2 = Mazur | first2 = MT. | title = Endometrial squamous metaplasia. An unusual response to progestin therapy of hyperplasia. | journal = Arch Pathol Lab Med | volume = 119 | issue = 5 | pages = 458-60 | month = May | year = 1995 | doi =  | PMID = 7748076 }}</ref>
+*Squamous morules in endometrioid endometrial carcinoma - not associated with [[HPV]] infection.<ref name=pmid15333650>{{Cite journal  | last1 = Chinen | first1 = K. | last2 = Kamiyama | first2 = K. | last3 = Kinjo | first3 = T. | last4 = Arasaki | first4 = A. | last5 = Ihama | first5 = Y. | last6 = Hamada | first6 = T. | last7 = Iwamasa | first7 = T. | title = Morules in endometrial carcinoma and benign endometrial lesions differ from squamous differentiation tissue and are not infected with human papillomavirus. | journal = J Clin Pathol | volume = 57 | issue = 9 | pages = 918-26 | month = Sep | year = 2004 | doi = 10.1136/jcp.2004.017996 | PMID = 15333650 }}</ref>
+DDx:
+*[[Complex endometrial hyperplasia with atypia]].
+*[[Complex endometrial hyperplasia]].
+*[[Microglandular hyperplasia]] of the cervix.
+*[[Endocervical adenocarcinoma]].
+*[[Serous carcinoma of the endometrium]] - esp. if high-grade nuclear features are present diffusely.
+*[[Clear cell carcinoma of the endometrium]] - esp. when clear cells present.
+====Images====
+<gallery>
+Image:Endometrioid endometrial adenocarcinoma low mag.jpg | EEA - low mag. (WC)
+Image:Endometrioid endometrial adenocarcinoma intermed mag.jpg | EEA - intermed. mag. (WC)
+Image:Endometrioid endometrial adenocarcinoma high mag.jpg | EEA - high mag. (WC)
+Image: Endometrioid endometrial adenocarcinoma very high mag.jpg | EEA - very high mag. (WC)
+</gallery>
+www:
+*[http://www.diagnosticpathology.org/content/2/1/40/figure/F1?highres=y Squamous morule with dyskeratotic cell (diagnosticpathology.org)].
+===IHC===
+*Vimentin +ve.
+*ER +ve.
+*PR +ve.
+Others:
+*p16 -ve -- positive in [[serous endometrial carcinoma]]<ref name=pmid17581420/> and [[endocervical adenocarcinoma]].
+*CEA -ve.
+===Sign out===
+<pre>
+ENDOMETRIUM, BIOPSY:
+- ENDOMETRIOID ENDOMETRIAL ADENOCARCINOMA, FIGO GRADE I/III.
+</pre>
+====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==
+*[[Endometrial carcinoma
+==References==
+{{Reflist|2}}
 [[Category:Diagnosis]]
+[[Category:Endometrial carcinoma]]