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Endometrial Epithelial Lesions

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Book cover Atlas of Intraoperative Frozen Section Diagnosis in Gynecologic Pathology

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Abstract

Among endometrial epithelial lesions, common nonneoplastic conditions (metaplasia, hormone-related changes, endometrial polyp, and gestational alterations) can mimic malignant or premalignant lesions of the endometrium. Endometrial carcinoma is the most common cancer of the female genital tract. Long-term estrogen overload through obesity, hormone replacement, oral contraceptives, and smoking is significantly associated with the most common subtype, endometrioid adenocarcinoma (type 1 endometrial cancer, 70–80 %) and its precursor lesion—atypical endometrial hyperplasia. A smaller subset of endometrial cancers (10–15 %) is represented by serous and clear cell carcinomas (type 2 endometrial cancer) that are high grade by definition and almost always occur in postmenopausal women. Mixed carcinoma is defined by the presence of two histological types of epithelial malignancy, one of which is type 2 (serous or clear cell carcinoma) and the minor component constitutes at least 5 % of the entire tumor. The current (2014) WHO classification of endometrial carcinomas is summarized in Table 4.1. Other histological subtypes of endometrial carcinoma are rare, including neuroendocrine tumors and undifferentiated/dedifferentiated carcinomas.

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References

  1. Siegel R, Naishadham D, Jemal A. Cancer statistics, 2013. CA Cancer J Clin. 2013;63:11–30.

    Article  PubMed  Google Scholar 

  2. Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer. 2010;127:2893–917.

    Article  CAS  PubMed  Google Scholar 

  3. Sherman ME. Theories of endometrial carcinogenesis: a multidisciplinary approach. Mod Pathol. 2000;13:295–308.

    Article  CAS  PubMed  Google Scholar 

  4. Kurman RJ, Carcanglu ML, Herrington CS, Young RH. WHO classification of tumours of female reproductive organs. 4th ed. Lyon: International Agency for Research on Cancer (IARC); 2014; 121–135.

    Google Scholar 

  5. Acs G. Intraoperative consultation in gynecologic pathology. Semin Diagn Pathol. 2002;19:237–54.

    PubMed  Google Scholar 

  6. Hanggi W, Katz M, Fravi R, Konig C, Dreher E. [Discrepancy in histopathological findings of curettage material and hysterectomy specimens in malignant tumors of the uterine body]. Schweiz Rundsch Med Prax. 1990;79:1387–9. [Article in German].

    CAS  PubMed  Google Scholar 

  7. Soothill PW, Alcock CJ, MacKenzie IZ. Discrepancy between curettage and hysterectomy histology in patients with stage 1 uterine malignancy. BJOG. 1989;96:478–81.

    Article  CAS  Google Scholar 

  8. Kumar S, Bandyopadhyay S, Semaan A, Shah JP, Mahdi H, Morris R, et al. The role of frozen section in surgical staging of low risk endometrial cancer. PLoS One. 2011;6, e21912.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  9. Rahimi S, Marani C, Renzi C, Natale M, Giovannini P, Zeloni R. Endometrial polyps and the risk of atypical hyperplasia on biopsies of unremarkable endometrium: a study on 694 patients with benign endometrial polyps. Int J Gynecol Pathol. 2009;28:522–8.

    Article  PubMed  Google Scholar 

  10. Bakour SH, Khan KS, Gupta JK. The risk of premalignant and malignant pathology in endometrial polyps. Acta Obstet Gynecol Scand. 2000;79:317–20.

    Article  CAS  PubMed  Google Scholar 

  11. Hui P, Kelly M, O'Malley DM, Tavassoli F, Schwartz PE. Minimal uterine serous carcinoma: a clinicopathological study of 40 cases. Mod Pathol. 2005;18:75–82.

    Article  PubMed  Google Scholar 

  12. Clement PB, Young RH. Endometrioid carcinoma of the uterine corpus: a review of its pathology with emphasis on recent advances and problematic aspects. Adv Anat Pathol. 2002;9:145–84.

    Article  PubMed  Google Scholar 

  13. Hendrickson MR, Kempson RL. Endometrial epithelial metaplasias: proliferations frequently misdiagnosed as adenocarcinoma. Report of 89 cases and proposed classification. Am J Surg Pathol. 1980;4:525–42.

    Article  CAS  PubMed  Google Scholar 

  14. Ip PP, Irving JA, McCluggage WG, Clement PB, Young RH. Papillary proliferation of the endometrium: a clinicopathologic study of 59 cases of simple and complex papillae without cytologic atypia. Am J Surg Pathol. 2013;37:167–77.

    Article  PubMed  Google Scholar 

  15. Nucci MR, Prasad CJ, Crum CP, Mutter GL. Mucinous endometrial epithelial proliferations: a morphologic spectrum of changes with diverse clinical significance. Mod Pathol. 1999;12:1137–42.

    CAS  PubMed  Google Scholar 

  16. Arias-Stella J. The Arias-Stella reaction: facts and fancies four decades after. Adv Anat Pathol. 2002;9:12–23.

    Article  PubMed  Google Scholar 

  17. Huettner PC, Gersell DJ. Arias-Stella reaction in nonpregnant women: a clinicopathologic study of nine cases. Int J Gynecol Pathol. 1994;13:241–7.

    Article  CAS  PubMed  Google Scholar 

  18. Kurman RJ, Norris HJ. Evaluation of criteria for distinguishing atypical endometrial hyperplasia from well-differentiated carcinoma. Cancer. 1982;49:2547–59.

    Article  CAS  PubMed  Google Scholar 

  19. Wheeler DT, Bristow RE, Kurman RJ. Histologic alterations in endometrial hyperplasia and well-differentiated carcinoma treated with progestins. Am J Surg Pathol. 2007;31:988–98.

    Article  PubMed  Google Scholar 

  20. McKenney JK, Longacre TA. Low-grade endometrial adenocarcinoma: a diagnostic algorithm for distinguishing atypical endometrial hyperplasia and other benign (and malignant) mimics. Adv Anat Pathol. 2009;16:1–22.

    Article  PubMed  Google Scholar 

  21. Trimble CL, Kauderer J, Zaino R, Silverberg S, Lim PC, Burke 2nd JJ, et al. Concurrent endometrial carcinoma in women with a biopsy diagnosis of atypical endometrial hyperplasia: a Gynecologic Oncology Group study. Cancer. 2006;106:812–9.

    Article  PubMed  Google Scholar 

  22. Nofech-Mozes S, Ghorab Z, Ismiil N, Ackerman I, Thomas G, Barbera L, et al. Endometrial endometrioid adenocarcinoma: a pathologic analysis of 827 consecutive cases. Am J Clin Pathol. 2008;129:110–4.

    Article  PubMed  Google Scholar 

  23. Creasman W. Revised FIGO staging for carcinoma of the endometrium. Int J Gynaecol Obstet. 2009;105:109.

    Article  PubMed  Google Scholar 

  24. Zaino RJ, Kurman RJ, Diana KL, Morrow CP. The utility of the revised international federation of gynecology and obstetrics histologic grading of endometrial adenocarcinoma using a defined nuclear grading system. A Gynecologic Oncology Group study. Cancer. 1995;75:81–6.

    Article  CAS  PubMed  Google Scholar 

  25. Hendrickson MR, Kempson RL. Ciliated carcinoma–a variant of endometrial adenocarcinoma: a report of 10 cases. Int J Gynecol Pathol. 1983;2:1–12.

    Article  CAS  PubMed  Google Scholar 

  26. Tobon H, Watkins GJ. Secretory adenocarcinoma of the endometrium. Int J Gynecol Pathol. 1985;4:328–35.

    Article  CAS  PubMed  Google Scholar 

  27. Longacre TA, Chung MH, Jensen DN, Hendrickson MR. Proposed criteria for the diagnosis of well-differentiated endometrial carcinoma. A diagnostic test for myoinvasion. Am J Surg Pathol. 1995;19:371–406.

    Article  CAS  PubMed  Google Scholar 

  28. Zaino RJ, Silverberg SG, Norris HJ, Bundy N, Morrow CP, Okagaki T. The prognostic value of nuclear versus architectural grading in endometrial adenocarcinoma: a Gynecologic Oncology Group study. Int J Gynecol Pathol. 1994;13:29–36.

    Article  CAS  PubMed  Google Scholar 

  29. Murray SK, Clement PB, Young RH. Endometrioid carcinomas of the uterine corpus with sex cord-like formations, hyalinization, and other unusual morphologic features: a report of 31 cases of a neoplasm that may be confused with carcinosarcoma and other uterine neoplasms. Am J Surg Pathol. 2005;29:157–66.

    Article  PubMed  Google Scholar 

  30. Zaloudek C, Hayashi GM, Ryan IP, Powell CB, Miller TR. Microglandular adenocarcinoma of the endometrium: a form of mucinous adenocarcinoma that may be confused with microglandular hyperplasia of the cervix. Int J Gynecol Pathol. 1997;16:52–9.

    Article  CAS  PubMed  Google Scholar 

  31. Zaino RJ, Kurman RJ, Brunetto VL, Morrow CP, Bentley RC, Cappellari JO, Bitterman P. Villoglandular adenocarcinoma of the endometrium: a clinicopathologic study of 61 cases: a gynecologic oncology group study. Am J Surg Pathol. 1998;22:1379–85.

    Article  CAS  PubMed  Google Scholar 

  32. Murray SK, Young RH, Scully RE. Uterine endometrioid carcinoma with small nonvillous papillae: an analysis of 26 cases of a favorable-prognosis tumor to be distinguished from serous carcinoma. Int J Surg Pathol. 2000;8:279–89.

    Article  PubMed  Google Scholar 

  33. Stewart CJ, Brennan BA, Leung YC, Little L. MELF pattern invasion in endometrial carcinoma: association with low grade, myoinvasive endometrioid tumours, focal mucinous differentiation and vascular invasion. Pathology. 2009;41:454–9.

    Article  CAS  PubMed  Google Scholar 

  34. Hertel JD, Huettner PC, Pfeifer JD. Lymphovascular space invasion in microcystic elongated and fragmented (MELF)-pattern well-differentiated endometrioid adenocarcinoma is associated with a higher rate of lymph node metastasis. Int J Gynecol Pathol. 2014;33:127–34.

    Article  PubMed  Google Scholar 

  35. Hanley KZ, Dustin SM, Stoler MH, Atkins KA. The significance of tumor involved adenomyosis in otherwise low-stage endometrioid adenocarcinoma. Int J Gynecol Pathol. 2010;29:445–51.

    Article  PubMed  Google Scholar 

  36. Melhem MF, Tobon H. Mucinous adenocarcinoma of the endometrium: a clinico-pathological review of 18 cases. Int J Gynecol Pathol. 1987;6:347–55.

    Article  CAS  PubMed  Google Scholar 

  37. Carcangiu ML, Chambers JT. Uterine papillary serous carcinoma: a study on 108 cases with emphasis on the prognostic significance of associated endometrioid carcinoma, absence of invasion, and concomitant ovarian carcinoma. Gynecol Oncol. 1992;47:298–305.

    Article  CAS  PubMed  Google Scholar 

  38. Brinton LA, Felix AS, McMeekin DS, Creasman WT, Sherman ME, Mutch D, et al. Etiologic heterogeneity in endometrial cancer: evidence from a Gynecologic Oncology Group trial. Gynecol Oncol. 2013;129:277–84.

    Article  PubMed Central  PubMed  Google Scholar 

  39. Semaan A, Mert I, Munkarah AR, Bandyopadhyay S, Mahdi HS, Winer IS, et al. Clinical and pathologic characteristics of serous carcinoma confined to the endometrium: a multi-institutional study. Int J Gynecol Pathol. 2013;32:181–7.

    Article  PubMed  Google Scholar 

  40. Wheeler DT, Bell KA, Kurman RJ, Sherman ME. Minimal uterine serous carcinoma: diagnosis and clinicopathologic correlation. Am J Surg Pathol. 2000;24:797–806.

    Article  CAS  PubMed  Google Scholar 

  41. Kurman RJ, Scully RE. Clear cell carcinoma of the endometrium: an analysis of 21 cases. Cancer. 1976;37:872–82.

    Article  CAS  PubMed  Google Scholar 

  42. Abeler VM, Kjorstad KE. Clear cell carcinoma of the endometrium: a histopathological and clinical study of 97 cases. Gynecol Oncol. 1991;40:207–17.

    Article  CAS  PubMed  Google Scholar 

  43. Silva EG, Deavers MT, Bodurka DC, Malpica A. Association of low-grade endometrioid carcinoma of the uterus and ovary with undifferentiated carcinoma: a new type of dedifferentiated carcinoma? Int J Gynecol Pathol. 2006;25:52–8.

    Article  PubMed  Google Scholar 

  44. Tafe LJ, Garg K, Chew I, Tornos C, Soslow RA. Endometrial and ovarian carcinomas with undifferentiated components: clinically aggressive and frequently underrecognized neoplasms. Mod Pathol. 2010;23:781–9.

    Article  CAS  PubMed  Google Scholar 

  45. Altrabulsi B, Malpica A, Deavers MT, Bodurka DC, Broaddus R, Silva EG. Undifferentiated carcinoma of the endometrium. Am J Surg Pathol. 2005;29:1316–21.

    Article  PubMed  Google Scholar 

  46. Taraif SH, Deavers MT, Malpica A, Silva EG. The significance of neuroendocrine expression in undifferentiated carcinoma of the endometrium. Int J Gynecol Pathol. 2009;8:142–7.

    Article  Google Scholar 

  47. van Hoeven KH, Hudock JA, Woodruff JM, Suhrland MJ. Small cell neuroendocrine carcinoma of the endometrium. Int J Gynecol Pathol. 1995;14:21–9.

    Article  PubMed  Google Scholar 

  48. Chetty R, Clark SP, Bhathal PS. Carcinoid tumour of the uterine corpus. Virchows Arch A Pathol Anat Histopathol. 1993;422:93–5.

    Article  CAS  PubMed  Google Scholar 

  49. Quddus MR, Sung CJ, Zhang C, Lawrence WD. Minor serous and clear cell components adversely affect prognosis in “mixed-type” endometrial carcinomas: a clinicopathologic study of 36 stage-I cases. Reprod Sci. 2010;17:673–8.

    Article  PubMed  Google Scholar 

  50. Kumar NB, Hart WR. Metastases to the uterine corpus from extragenital cancers. A clinicopathologic study of 63 cases. Cancer. 1982;50:2163–9.

    Article  CAS  PubMed  Google Scholar 

  51. Houghton JP, Ioffe OB, Silverberg SG, McGrady B, McCluggage WG. Metastatic breast lobular carcinoma involving tamoxifen-associated endometrial polyps: report of two cases and review of tamoxifen-associated polypoid uterine lesions. Mod Pathol. 2003;16:395–8.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Pathology, Yale University School of Medicine, New Haven, CT, USA

    Pei Hui & Natalia Buza

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  1. Pei Hui
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  2. Natalia Buza
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Hui, P., Buza, N. (2015). Endometrial Epithelial Lesions. In: Atlas of Intraoperative Frozen Section Diagnosis in Gynecologic Pathology. Springer, Cham. https://doi.org/10.1007/978-3-319-21807-6_4

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  • DOI: https://doi.org/10.1007/978-3-319-21807-6_4

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-21806-9

  • Online ISBN: 978-3-319-21807-6

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