Difference between revisions of "Endometrial carcinoma"

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Endometrial carcinoma (view source)

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→‎Endometrioid endometrial carcinoma: split out
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=Specific types=
=Specific types=
==Endometrioid endometrial carcinoma==
==Endometrioid endometrial carcinoma==
*[[AKA]] ''endometrioid endometrial adenocarcinoma''.
{{Main|Endometrioid endometrial carcinoma}}
 
===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.


==Mucinous carcinoma of the endometrium==
==Mucinous carcinoma of the endometrium==
Michael
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