Endometrial Carcinoma (INTRO)

7/24/2019 Endometrial Carcinoma (INTRO)

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ENDOMETRIAL

CARCINOMA

ByA.CharumathyFinal yr mbbs

ll unit KGHMadras medical college


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EPIDEMIOLOGY

In India, incidence is 5-7%.Cervical cancerremains the most common gynecologicalmalignancy.

4THleading cancer in incidence but only 8thleading cause o death rom malignancy among!omen.

"ore re#uently occuring gynecologicalcancer$&-5%' in develo(ed countries.


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7 times more common in )orth *mericansthan Chinese counter(arts.

"ostly occurs in +th7thdecade o lie.

&-5% - (erimeno(ausal !omen

5% - belo! 45yrs o age

verall 5 year survival rate is

75% - *denocarcinoma

5&% - clear cell serous C*"ostly s(oradic,&% is hereditary.


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/I01 2*CT/0)ulli(arity


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Tamo3ien


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FACTORS REDUCINGRISK

ral Contrace(tive ills-4&-5&%rogesterone-%arly meno(ause


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PATHOLOGY

)/"*6)"T/I"

PROLIFERATIVEPHASE

SECRETORY PHASE


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ENDOMETRIAL

HYPERPLASIAIt is an increased (rolieration o theendometrial glands relative to the stroma,resulting in an increased gland-to-stroma

ratio !hen com(ared !ith normal(rolierative endometrium.

volves in the bac9ground o (rolierativeendometrium due to (rotracted oestrogenstimulation in the absence o (rogestin.


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C6*00I2IC*TI)


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GROSS MORPHOLOGY


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HISTOPATHOLOGY


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ATYPICAL HYPERPLASIA

*ty(ical eatures-:

6arge nuclei o variable si;e sha(e

6oss o (olarityIncrease in nuclear to cyto(lasmic ratio

rominent nucleoli

Irregularly clum(ed chromatin !ith

(arachromatin clearing


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The endometrial glands are highly irregular in size and shaeand sho! "re#uent outou$hings. The atypia is characterized

by enlarged round nu$lei% irregular $hromatin distri&ution% androminent nu$leoli.


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ENDOMETRIAL

CARCINOMAndometrial cancer is a biologically andhistologically diverse grou( o neo(lasmscharacteri;ed by a dualistic model o

(athogenesis.Ty(e I endometrioid adenocarcinomascom(rise 75 (ercent o all cases. They areestrogen deendent% lo! grade% and

deri'ed "rom atyi$al endometrialhyerlasia(


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In contrast, ty(e II cancers usually haveserous or $lear $ell histology% nore$ursor lesion% and a more aggressiveclinical course


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Feature Tye I Tye II


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CLASSIFICATION


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ADENOCARCINOMA

*lso called lands resembling normal endometrialglands,

Columnar cells !ith basally oriented nuclei ,

6ittle or no intracyto(lasmic mucin


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2eatures o carninoma ?

esmo(lastic reaction@ac9 to bac9 glands !ithout intervening

stroma

3tensive (a(illary (attern

0#uamous e(ithelial dierentiation


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GROSS MORPHOLOGY


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HISTOPATHOLOGY


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GRADING (FIGO)

@ased on di""erentiation%glandularar$hite$ture and nu$lear "eaturestumours are graded into ollo!ing

>/* I - A 5% 06I >/BTH>/* II - +-5&% 06I>/BTH

>/* III - 5&% 06I >/BTH

PRESENCE OF NUCLEAR ATYPIAINCREASES GRAE !Y " IRRESPECTI#E OFARC$ITECTURAL GRAING.%


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>/* II >/* III

>/* I


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VARIANTS

Bith areas o s#uamous dierentiation@enign -*denocanthoma

"alignant -*denos#uamous

CarcinomaDilloglandular dierentiation

-Bell dierentiated

-Tumour cells arranged alongibrovascular stal9s

0ecretory carcinoma

-/are variant,e3cellent (rognosis


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SECRETORY CARCINOMA

The &e'p(astic )(a&ds c'&tai& (ar)e su&nu$lear 'a$uoles i*parti&) a+iano )ey* appeara&ce.


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MUCINOUS CARCINOMA

5% o endometrial carcinoma.

>ood (rognosis

@ehaves as normal endometroid tumour

E o tumour com(osed o cells !ithintracyto(lasmic mucin


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Ab,&da&t mu$inis -i((i&) the cyt'p(as* '- neolasti$ $ells(a(s' prese&t i&(,*i&a( spaces


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SEROUS CARCINOMA

F-4% o endometrial carcinoma

*ggressive tumour !ith (oor (rognosis

0imilar to serous carcinoma o ovary

allo(ian tube*lso called


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Psammoma &odies are seen.

High rate o reccurence.

0erous carcinoma have lymho'as$ular

and dee myometrial in'asion(


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The i*a)e sh'saillary $lusters'- high,grade neolasti$ $ells.N,*er',s mitoti$ "iguresca& be see&. Other -eat,res that are -re/,e&t(y see&

i&c(,de ne$rosis% sammoma &odies0 a&d in'asion o" the myometrium.


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CLEAR CELL

CARCINOMAA5% o endometrial carcinoma

ccurs in older !omen.

*ggressive tumour !ith (oor (rognosis.

"i3ed histologic (attern$aillary%tu&ulo$y$ti$% glandular -solid tyes.(

Cells have hobnail coniguration arranged in(a(illae !ith hyanili;ed stal9


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The t,*'r is c'*p'sed '-olygonal $ellsith a&undant $lear$ytolasm1d,e t' )(yc')e& c'&te&t2. It has distin$t $ytolasmi$

&ordersa&d *'derate cyt'(')ic atypia.


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SQUAMOUS CARCINOMA

/are variant, es(ecially the (urevariety.ten glands are (resent.

ten associated !ith cervical stenosis,chronic inlammation, (yometra at the time odiagnosis

It has a very (oor (rognosis !ith F+%survival rate.


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SPREAD

Contiguous s(read to endometrium

"yometrium invasion

ee(er invasion o lym(hatic vascular

s(aceirect s(read to (ara aortic nodes.

Cervical involvement

"etastasis


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Endometrial Carcinoma (INTRO)

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