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Endometrioid endometrial carcinoma (view source)
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#redirect [[Endometrial_carcinoma#Endometrioid_endometrial_carcinoma]] | #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:Diagnosis]] | ||
[[Category:Endometrial carcinoma]] | |||