Serous carcinoma of the endometrium

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Serous carcinoma of the endometrium
Diagnosis in short

Serous carcinoma of the endometrium. H&E stain.

Synonyms serous endometrial carcinoma, serous carcinoma of the uterus, uterine serous carcinoma, uterine papillary serous carcinoma
LM DDx high-grade endometrioid endometrial carcinoma, clear cell carcinoma of the endometrium,Arias-Stella reaction, serous carcinoma from elsewhere
IHC p16 +ve (strong), p53 +ve usu. (diffuse & strong > 50% or 75% of the tumour), Ki-67 "high", ER -ve, PR -ve
Site endometrium - see endometrial carcinoma

Clinical history usu. post-menopausal women
Prognosis moderate-to-poor - dependent on stage
Treatment 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.[1]
  • 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.
      1. Moderate to marked nuclear pleomorphism - variation of size, shape and staining.
        • Large nuclear size variation between cells often esp. prominent.
      2. Singular prominent, classically red, nucleolus.
  • +/-Psammoma bodies.

DDx:

Images

IHC

  • p16 +ve[2] - should be strong.
  • p53 +ve[3] 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.[4]
  • PR often -ve.[4]

High-grade endometrioid carcinoma versus serous carcinoma:[5]

  • p53 -ve, PR +ve, PTEN loss -- suggest endometrioid.
  • p16 and PTEN superior to ER, PR, and p53.[6]

Notes:

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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.

See also

References

  1. Roelofsen, T.; van Kempen, LC.; van der Laak, JA.; van Ham, MA.; Bulten, J.; Massuger, LF. (Mar 2012). "Concurrent endometrial intraepithelial carcinoma (EIC) and serous ovarian cancer: can EIC be seen as the precursor lesion?". Int J Gynecol Cancer 22 (3): 457-64. doi:10.1097/IGC.0b013e3182434a81. PMID 22249577.
  2. Chiesa-Vottero, AG.; Malpica, A.; Deavers, MT.; Broaddus, R.; Nuovo, GJ.; Silva, EG. (Jul 2007). "Immunohistochemical overexpression of p16 and p53 in uterine serous carcinoma and ovarian high-grade serous carcinoma.". Int J Gynecol Pathol 26 (3): 328-33. doi:10.1097/01.pgp.0000235065.31301.3e. PMID 17581420.
  3. Yemelyanova, A.; Ji, H.; Shih, IeM.; Wang, TL.; Wu, LS.; Ronnett, BM. (Oct 2009). "Utility of p16 expression for distinction of uterine serous carcinomas from endometrial endometrioid and endocervical adenocarcinomas: immunohistochemical analysis of 201 cases.". Am J Surg Pathol 33 (10): 1504-14. doi:10.1097/PAS.0b013e3181ac35f5. PMID 19623034.
  4. 4.0 4.1 Kounelis, S.; Kapranos, N.; Kouri, E.; Coppola, D.; Papadaki, H.; Jones, MW. (Apr 2000). "Immunohistochemical profile of endometrial adenocarcinoma: a study of 61 cases and review of the literature.". Mod Pathol 13 (4): 379-88. doi:10.1038/modpathol.3880062. PMID 10786803.
  5. Darvishian, F.; Hummer, AJ.; Thaler, HT.; Bhargava, R.; Linkov, I.; Asher, M.; Soslow, RA. (Dec 2004). "Serous endometrial cancers that mimic endometrioid adenocarcinomas: a clinicopathologic and immunohistochemical study of a group of problematic cases.". Am J Surg Pathol 28 (12): 1568-78. PMID 15577675.
  6. Alkushi, A.; Köbel, M.; Kalloger, SE.; Gilks, CB. (Jul 2010). "High-grade endometrial carcinoma: serous and grade 3 endometrioid carcinomas have different immunophenotypes and outcomes.". Int J Gynecol Pathol 29 (4): 343-50. doi:10.1097/PGP.0b013e3181cd6552. PMID 20567148.
  7. Horree, N.; Heintz, AP.; Sie-Go, DM.; van Diest, PJ. (2007). "p16 is consistently expressed in endometrial tubal metaplasia.". Cell Oncol 29 (1): 37-45. PMID 17429140.
  8. Bárcena, C.; Oliva, E. (Nov 2011). "WT1 expression in the female genital tract.". Adv Anat Pathol 18 (6): 454-65. doi:10.1097/PAP.0b013e318234aaed. PMID 21993272.