Abstract
In this article, the authors briefly review the historical evolution of the various putative precursor lesions for Type II endometrial cancers, with an emphasis on the newly defined "Endometrial Glandular Dysplasia (EmGD)". The evidentiary basis for delineating serous EmGD as the most probable precursor lesions to endometrial serous carcinoma is reviewed in detail. An argument is advanced for the discontinuation of the term serous "endometrial intraepithelial carcinoma (EIC)" as a descriptor for a supposedly intraepithelial, precancerous lesion. Preliminary evidence is also presented that suggests that there is a morphologically recognizable "clear cell EmGD" that probably represents a precancerous lesion to endometrial clear cell carcinomas.
Highlights
Endometrial cancers are the most frequently diagnosed malignancies of the female genital tract in the United States, with 39,080 new cases projected for 2007 [1]
Endometrial carcinomas are remarkably diverse in their biologic behavior
The present nomenclature for putative precursor lesions of endometrial cancers describes an incoherent amalgam that encompasses a lesion with very little malignancy risk, and on the other end of the "spectrum", serous endometrial intraepithelial carcinoma (EIC), a lesion with inherent potential malignancy
Summary
Endometrial cancers are the most frequently diagnosed malignancies of the female genital tract in the United States, with 39,080 new cases projected for 2007 [1]. The distinction between serous EIC (as presently defined) and small "stromal-invasive" (stage 1A) ESC is a rather artificial one that is largely devoid of clinical significance and whose validity is questionable Both are lined by identical, cytologically malignant cells [32,66,67,70], http://www.diagnosticpathology.org/content/3/1/6 both may show extrauterine disease [68,76,95,96], and both require comprehensive surgical staging [68,76,81,95,96]. Given their high rate of association with carcinomas having a clear cell component, their lack thereof in the control group of endometrioid cancers, their frequent occurrence in otherwise benign endometria and their aforementioned phenotype, we hypothesized that these lesions represent the precursor lesions of ECCC [87] It is acknowledged, that significantly more research is required to define the full clinicopathologic spectrum of these distinctive lesions and to establish their precancerous nature according to NCI criteria [33]
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