endometrioid carcinoma ovary pathology outlines
Polycystic ovarian syndrome (PCOS, Stein-Leventhal syndrome): Increased circulating androgens peripherally converted into estrogen, Chronic anovulation: dysregulated estrogen without opposing progesterone secretion → simultaneous proliferation and breakdown, Estrogen supplementation: systemic therapy to alleviate symptoms of menopause → endometrial proliferation, Tamoxifen: hormonal treatment for breast cancer acts as estrogen receptor antagonist in breast but agonist in endometrium, Obesity: adipose tissue produces aromatase (enzyme converting circulating androgens to estrogen) → peripheral hyperestrinism (, Stromal hyperplasia and hyperthecosis: stromal luteinization → hyperandrogenism → hyperestrinism (, Hormone secreting stromal tumors: granulosa cell tumor, thecoma, Hereditary nonpolyposis colon cancer / Lynch syndrome: defect in mismatch repair proteins (see, Abnormal, dysfunctional or postmenopausal uterine bleeding, Pelvic pain or mass / compression effect on adjacent structures, General stigmata of malignancy, i.e. they appear to shed cells. Microscopic. Visual survey of surgical pathology with 11065 high-quality images of benign and malignant neoplasms & related entities. Ovarian endometrioid carcinomas and endometrial endometrioid carcinomas share many histological and molecular alterations. Six (40%) of the 15 endometrioid adenocarcinoma were found to have endometriosis in the tumor. Molecular testing for, Artifactual crowding due to glandular collapse, predecidual necrosis and regenerative atypia, Has basal squamous metaplasia, prominent subnuclear vacuolization, relatively low proliferation index, lacks stromal foam cells and does not have a conventional EEC pattern present (, Mimics solid growth of EEC but should not factor into FIGO scoring, Caveat: some EECs may demonstrate nuclear expression of, Abortive pseudopapillary structures with abundant eosinophilic cytoplasm in background of stromal breakdown, Can be hyperchromatic and atypical but presence of cilia is (usually) a clue to benign nature, Florid tortuosity of glands may appear disorganized and crowded, hence mimicking hyperplasia / carcinoma, In comparison with endometrial intraepithelial neoplasia (EIN), lacks (, Glandular crowding distinct from background secretory endometrium, Architectural disorder - long axis of glands in different directions; budding / branching / staghorn contours, Distinction challenging on small biopsies, Controversial but 1) cribriforming, 2) solid growth, 3) complex labyrinthine architecture should occupy a diameter ≤ 2.1 mm (half of one 4x low power field) (, Distinction especially challenging with and should not be made on biopsy material, where lobular / polypoid architecture of APA can be lost, Atypical, angulated endometrial glands with centrally necrotic squamous morules embedded in fibromyomatous stroma are usual features of APA, Appearance of characteristic APA glands in muscular stroma can mimic myometrial invasion by well differentiated EEC, Prominent pleomorphism and mitotic activity, Arises in background of atrophy and often within endometrial polyps, Apical borders are hobnailed and exfoliative, i.e. https://librepathology.org/wiki/Serous_carcinoma_of_the_ovary It proposed a classification that separates endometrial carcinomas in 4 groups: Copy number - high (frequently involving mutations of, Copy number - low (frequently involving mutations of, Microsatellite instability hypermutated (frequently involving alterations of mismatch repair protein genes), Molecular based classification correlates with clinical outcomes: survival rates are best in, Thus, the molecular fingerprint can better assist in patient risk stratification and management, Ancillary testing using formalin fixed, paraffin embedded tumoral tissue can serve as a surrogate to detect its molecular alterations and determine the molecular group (, When combined with clinicopathologic features, the molecular classifier is highly correlated with outcome and survival curves, Some carcinomas harbor more than one molecular classifying feature and are referred to as multiple classifier; recent evidence suggests that MMR deficiency and, MMR deficient, p53 abnormal tumors should be categorized in the MMR deficient / microsatellite instable group, Nuclear expression of beta catenin is usually associated with. METHODS: Available records for all patients on the gynecologic oncology service with epithelial ovarian carcinoma from January 1, 1981 through December 31, 1989, were reviewed. 37 Endometrioid carcinomas are usually cystic and solid tumors with foci of necrosis and hemorrhage. weight and appetite loss, malaise, fatigue, Incidental finding in specimens removed for benign pathology (up to 0.7% including other endometrial histotypes) (, Observed in 43% of specimens removed for atypical hyperplasia / endometrioid intraepithelial neoplasia (, Incidental finding on cervical cytology screening or endocervical curettings, In rare cases, CA-125 and CEA may be elevated (, Thickened endometrial stripe with heterogenous echotexture, increased vascularity and ill defined endomyometrial interface, Hypointense mass or heterogenous thickening of endometrium, Best modality to detect integrity of endomyometrial junction, Hypoattenuating, hypoechoic mass in endometrial cavity, Used mostly for staging of advanced disease (i.e. Microcystic, ELongated and Fragmented (MELF): Generally associated with low grade (FIGO 1 - 2); associated with higher rate of lymphovascular invasion and lymph node metastases but not overall survival, Fragmented microcystic, elongated glands lined by flattened or histiocytoid epithelium, which can lead to depth of invasion underestimation, Distinctive fibromyxoid stromal reaction with acute inflammation, Diffusely infiltrative carcinomatous glands with irregular contours, invading myometrium in clusters without or with minimal associated stromal response, Can lead to depth of invasion underestimation, Distinguish from carcinoma involving adenomyosis, which should not be interpreted as invasion, Will have nonneoplastic endometrial glands or stroma at periphery and conventional adenomyosis in other areas, Important distinction between 1) carcinoma involving adenomyosis and 2) carcinoma involving adenomyosis with invasion from that focus, Regarding 1: depth of invasion = distance from endomyometrial junction to deepest point of invasion elsewhere (the nonmyoinvasive carcinoma within the adenomyotic focus is not considered invasion), Regarding 2: depth of invasion = distance from endomyometrial junction to the point of invasion arising in that specific focus of adenomyosis (irrespective of the deep or superficial location of that focus of adenomyosis within the myometrial wall), Only invasion into underlying myometrium should be considered in depth of invasion from endomyometrial junction, not invasion into the polyp stroma itself, Thickness of exophytic component should not be considered, only invasion from endomyometrial junction, Invasive carcinomas overlying / extending into a leiomyoma: wall thickness should incorporate (not subtract) the leiomyoma; unless there is a greater percentage of invasion elsewhere, Grade 1: 5% or less nonsquamous solid growth pattern, Grade 2: 6 - 50% nonsquamous solid growth pattern, Grade 3: > 50% nonsquamous solid growth pattern, Nuclear atypia exceeding that expected for the architectural grade increases FIGO grade by 1, Glandular variant of endometrial serous carcinoma or component thereof, must be excluded, Squamous, morular and mucinous differentiation are characteristically associated to endometrioid type adenocarcinomas; generally not observed in serous, clear cell or other histotypes, Squamous or "squamous" morular: usually banal but occasionally cytologically malignant; former can be glycogenated which imparts appearance of clear cytoplasm, Mucinous: intracytoplasmic mucin (intraluminal mucin pooling does not qualify), Secretory: sub / supranuclear vacuolization, Ciliated / tubal: resembles fallopian tube lining; scattered cells with apical terminal bars and ciliation, Microglandular hyperplasia-like: microcystic, microacinar glands with intraluminal neutrophils, Spindled: bland spindling of carcinomatous cells merging with epithelioid carcinomatous component, Corded and Hyalinized Endometrial Carcinoma (CHEC): linear cords of carcinoma cells molded by an abundant myxohyaline background, Defined as combination of at least 2 endometrial histologic subtypes (most commonly endometrioid and serous), the minor component of which must constitute at least 5% of tumor volume on resection specimen (WHO 2014), Distinction important as prognosis is similar to that of the higher grade component (i.e. and Ricardo R. Lastra, M.D. Universal screening of all endometrial carcinomas for Lynch syndrome (endometrioid and clear cell histotypes, but testing endometrial serous carcinomas is controversial): Endometrial carcinoma (not colonic) is more frequently the presenting neoplasm for female patients with Lynch syndrome, MMR IHC (MLH1, PMS2, MSH2, MSH6) validated on both EEC biopsies / curettings and resections (, Loss of any component of MSH2 / MSH6 complex → likely Lynch syndrome, refer for genetic testing, Loss of MLH1 / PMS2 complex → likely sporadically derived → reflex hypermethylation testing of. Although such assessment is often sufficient, recent evidence has suggested that molecular analysis may facilitate the diagnosis in problematic cases. Epithelial ovarian carcinoma is the leading cause of death in women with gynecologic malignancies, because most patients are diagnosed at clinically advanced stages; the 5-year survival rate is less than 45%. Ratio of myoinvasion is crucial to staging: Numerator: depth of furthest invasion (endomyometrial junction to deepest focus of invasive glands), Denominator: myometrial thickness (distance from endomyometrial junction to uterine serosa). In this study, the author reviewed 15 cases of endometrioid adenocarcinoma of the ovary in the last 15 years of our pathology laboratory in search for the presence of endometriosis within the tumor. Prognosis largely dependent on FIGO / TNM stage: Presence and extent of myometrial invasion (< 50% or > 50%), Low grade (FIGO grades 1 and 2) have excellent survival compared with high grade (FIGO grade 3) tumors, the prognosis of which is similar to that of endometrial serous carcinoma, However, other parameters such as age, tumor size, histologic features (lymphovascular invasion, microcystic elongated and fragmented glands / MELF pattern invasion) and most recently, molecular features (see, 31 year old woman with coexistent endometrioid and mesonephric-like endometrial carcinoma treated with progesterone (, 49 year old woman with HER2-amplified tumor efficaciously treated with afatinib (, 56 year old woman with paraneoplastic syndrome (PTHrP) and hypercalcemia (, 61 year old woman with tarsal metastasis as the presenting lesion of well differentiated tumor (, 71 year old woman with biphenotypic epithelial and sex cord differentiation (, Primary treatment is surgical (hysterectomy and bilateral salpingo-oophorectomy with staging), unless patient desires fertility, Hormonal therapy (progesterone, leuprolide) alone can lead to complete remission in early stage, low grade tumor for women who want to preserve fertility but long term follow up studies not available (, Adjuvant chemo / radiotherapy largely dependent on postoperative surgical stage and histologic grade but incorporates other factors (lymphovascular invasion, age, tumor size and involvement of lower uterine segment / surface cervical glands), Mass arising from endometrial surface with varied appearances / sizes but usually exophytic and friable in texture, Tumor / myometrial interface usually vaguely demarcated, which is useful to grossly assess depth of invasion during intraoperative evaluation, Occasionally, no grossly appreciable mass, in which case the entire endometrium must be submitted for histologic evaluation (if prior biopsy showed carcinoma / atypical hyperplasia), Diagnosing adenocarcinoma in a patient with a preoperative diagnosis of atypical hyperplasia / endometrioid intraepithelial neoplasia, Section entire endometrium / mass to assess and freeze area of deepest apparent invasion.