Serous carcinoma of the endometrium

From Libre Pathology
(Redirected from Uterine serous carcinoma)
Jump to navigation Jump to search
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:

Sign out

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.