CASE 12 - A 61-year-old woman with postmenopausal bleeding

Abstract

Postmenopausal vaginal bleeding is a concerning presentation with both benign and malignant etiologies. Endometrial cancer typically presents with abnormal vaginal bleeding. Unopposed estrogen, obesity, and low parity are risk factors. Endometrioid endometrial carcinoma is the most common histologic type and often arises in a background of endometrial hyperplasia; however, carcinoma is distinguished from hyperplasia by architecture consisting of sheets of glands without intervening stroma and invasion. The International Federation of Gynecology and Obstetrics or FIGO grading scheme, based on percentage of tumor with a solid growth pattern, is used to classify endometrioid endometrial carcinoma. Serous endometrial carcinoma occurs in a background of atrophic endometrium and is a high-grade, aggressive malignancy with mutations in the p53 gene and high mitotic rate. Other histologic types include carcinosarcoma, mucinous, clear cell, and neuroendocrine tumors. The staging of endometrial carcinoma depends on depth of invasion into the myometrium and extent of involvement into surrounding tissue. Pathologic staging helps guide treatment decisions and determine the risk of recurrence and metastasis.