Difference between revisions of "Serous carcinoma of the endometrium"

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Serous carcinoma of the endometrium (view source)

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#redirect [[Endometrial_carcinoma#Serous_carcinoma_of_the_endometrium]]
{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Image      = Uterine serous carcinoma high mag.jpg
| Width      =
| Caption    = Serous carcinoma of the endometrium. [[H&E stain]].
| Synonyms  = serous endometrial carcinoma, serous carcinoma of the uterus, uterine serous carcinoma, uterine papillary serous carcinoma
| Micro      =
| Subtypes  =
| LMDDx      = high-grade [[endometrioid endometrial carcinoma]], [[clear cell carcinoma of the endometrium]],[[Arias-Stella reaction]], [[serous carcinoma]] from elsewhere
| Stains    =
| IHC        = p16 +ve (strong), p53 +ve usu. (diffuse & strong > 50% ''or'' 75% of the tumour), Ki-67 "high", ER -ve, PR -ve
| EM        =
| Molecular  =
| IF        =
| Gross      =
| Grossing  =
| Site      = [[endometrium]] - see ''[[endometrial carcinoma]]''
| Assdx      =
| Syndromes  =
| Clinicalhx = usu. post-menopausal women
| Signs      =
| Symptoms  =
| Prevalence =
| Bloodwork  =
| Rads      =
| Endoscopy  =
| Prognosis  = moderate-to-poor - dependent on stage
| Other      =
| ClinDDx    =
| Tx        = total hysterectomy + lymph node dissection
}}
'''Serous carcinoma of the endometrium''' is an aggressive type of [[endometrial carcinoma]] that typically afflicts post-menopausal women.


It is also known as '''serous endometrial carcinoma''', '''serous carcinoma of the uterus''', '''uterine serous carcinoma''' and '''uterine papillary serous carcinoma'''.
==General==
*Arising in the setting of atrophy.
*Usually post-menopausal.
*Precursor lesion: ''endometrial intraepithelial carcinoma''.<ref name=pmid22249577>{{Cite journal  | last1 = Roelofsen | first1 = T. | last2 = van Kempen | first2 = LC. | last3 = van der Laak | first3 = JA. | last4 = van Ham | first4 = MA. | last5 = Bulten | first5 = J. | last6 = Massuger | first6 = LF. | title = Concurrent endometrial intraepithelial carcinoma (EIC) and serous ovarian cancer: can EIC be seen as the precursor lesion? | journal = Int J Gynecol Cancer | volume = 22 | issue = 3 | pages = 457-64 | month = Mar | year = 2012 | doi = 10.1097/IGC.0b013e3182434a81 | PMID = 22249577 }}</ref>
*Aggressive behaviour - high probability of disseminated disease.
==Gross==
*Thin endometrium.
*+/-Polypoid mass.
==Microscopic==
Features - serous:
*Architecture - classically papillary.
**May be glomeruloid, tubulocystic, solid (uncommon).
*Cytology:
**Columnar or cuboidal cells.
**#Moderate to marked nuclear pleomorphism - variation of size, shape and staining.
**#*Large nuclear size variation between cells often esp. prominent.
**#Singular prominent, classically red, [[red nucleolus|nucleolus]].
*+/-[[Psammoma bodies]].
DDx:
*High-grade [[endometrioid endometrial carcinoma]] - uncommon, typically younger age.
*[[Clear cell carcinoma of the endometrium]] - usually have less nuclear pleomorphism and less mitoses.
*[[Arias-Stella reaction]].
*Metastatic [[serous carcinoma]].
*[[Endometrium with psammoma bodies]] - no atypical cells.
===Images===
<gallery>
Image:Uterine_papillary_serous_carcinoma_low_mag.jpg | Uterine serous carcinoma - low mag. (WC)
Image:Uterine_serous_carcinoma_high_mag.jpg | Uterine serous carcinoma - high mag. (WC)
</gallery>
==IHC==
*[[p16]] +ve<ref name=pmid17581420>{{Cite journal  | last1 = Chiesa-Vottero | first1 = AG. | last2 = Malpica | first2 = A. | last3 = Deavers | first3 = MT. | last4 = Broaddus | first4 = R. | last5 = Nuovo | first5 = GJ. | last6 = Silva | first6 = EG. | title = Immunohistochemical overexpression of p16 and p53 in uterine serous carcinoma and ovarian high-grade serous carcinoma. | journal = Int J Gynecol Pathol | volume = 26 | issue = 3 | pages = 328-33 | month = Jul | year = 2007 | doi = 10.1097/01.pgp.0000235065.31301.3e | PMID = 17581420 }}</ref> - should be strong.
*p53 +ve<ref name=pmid19623034>{{Cite journal  | last1 = Yemelyanova | first1 = A. | last2 = Ji | first2 = H. | last3 = Shih | first3 = IeM. | last4 = Wang | first4 = TL. | last5 = Wu | first5 = LS. | last6 = Ronnett | first6 = BM. | title = Utility of p16 expression for distinction of uterine serous carcinomas from endometrial endometrioid and endocervical adenocarcinomas: immunohistochemical analysis of 201 cases. | journal = Am J Surg Pathol | volume = 33 | issue = 10 | pages = 1504-14 | month = Oct | year = 2009 | doi = 10.1097/PAS.0b013e3181ac35f5 | PMID = 19623034 }}</ref> diffuse & strong > 50% ''or'' 75% of the tumour - depending on the paper one reads.
**Subset is p53 -ve.
*Ki-67 "high" - no cut-point defined.
*ER often -ve.<ref name=pmid10786803>{{Cite journal  | last1 = Kounelis | first1 = S. | last2 = Kapranos | first2 = N. | last3 = Kouri | first3 = E. | last4 = Coppola | first4 = D. | last5 = Papadaki | first5 = H. | last6 = Jones | first6 = MW. | title = Immunohistochemical profile of endometrial adenocarcinoma: a study of 61 cases and review of the literature. | journal = Mod Pathol | volume = 13 | issue = 4 | pages = 379-88 | month = Apr | year = 2000 | doi = 10.1038/modpathol.3880062 | PMID = 10786803 }}</ref>
*PR often -ve.<ref name=pmid10786803/>
High-grade endometrioid carcinoma versus serous carcinoma:<ref name=pmid15577675>{{Cite journal  | last1 = Darvishian | first1 = F. | last2 = Hummer | first2 = AJ. | last3 = Thaler | first3 = HT. | last4 = Bhargava | first4 = R. | last5 = Linkov | first5 = I. | last6 = Asher | first6 = M. | last7 = Soslow | first7 = RA. | title = Serous endometrial cancers that mimic endometrioid adenocarcinomas: a clinicopathologic and immunohistochemical study of a group of problematic cases. | journal = Am J Surg Pathol | volume = 28 | issue = 12 | pages = 1568-78 | month = Dec | year = 2004 | doi =  | PMID = 15577675 }}</ref>
*p53 -ve, PR +ve, PTEN loss -- suggest endometrioid.
*p16 and PTEN superior to ER, PR, and p53.<ref name=pmid20567148>{{Cite journal  | last1 = Alkushi | first1 = A. | last2 = Köbel | first2 = M. | last3 = Kalloger | first3 = SE. | last4 = Gilks | first4 = CB. | title = High-grade endometrial carcinoma: serous and grade 3 endometrioid carcinomas have different immunophenotypes and outcomes. | journal = Int J Gynecol Pathol | volume = 29 | issue = 4 | pages = 343-50 | month = Jul | year = 2010 | doi = 10.1097/PGP.0b013e3181cd6552 | PMID = 20567148 }}</ref>
Notes:
*[[p16]] +ve in tubal metaplasia.<ref name=pmid17429140>{{Cite journal  | last1 = Horree | first1 = N. | last2 = Heintz | first2 = AP. | last3 = Sie-Go | first3 = DM. | last4 = van Diest | first4 = PJ. | title = p16 is consistently expressed in endometrial tubal metaplasia. | journal = Cell Oncol | volume = 29 | issue = 1 | pages = 37-45 | month =  | year = 2007 | doi =  | PMID = 17429140 }}</ref>
*WT1 usu. -ve -- useful to differentiate from [[ovarian serous carcinoma]].<ref name=pmid21993272>{{Cite journal  | last1 = Bárcena | first1 = C. | last2 = Oliva | first2 = E. | title = WT1 expression in the female genital tract. | journal = Adv Anat Pathol | volume = 18 | issue = 6 | pages = 454-65 | month = Nov | year = 2011 | doi = 10.1097/PAP.0b013e318234aaed | PMID = 21993272 }}</ref>
==Sign out==
<pre>
ENDOMETRIUM, BIOPSY:
- SEROUS CARCINOMA, HIGH-GRADE.
COMMENT:
The tumour stains as follows:
POSITIVE: p16 (strong, diffuse), p53 (strong >85% of tumour).
NEGATIVE: ER, PR.
PROLIFERATION (Ki-67): 80% of the tumour.
</pre>
==See also==
*[[Endometrial carcinoma]].
*[[Serous carcinoma]].
==References==
{{Reflist|2}}
[[Category:Endometrial carcinoma]]
[[Category:Diagnosis]]
[[Category:Diagnosis]]
Michael
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