Abstract
This article provides practical recommendations developed from the International Society of Gynecological Pathologists Endometrial Carcinoma Project to address 4 issues that may arise in the diagnosis of uterine corpus low-grade endometrioid carcinoma: (1) The distinction between atypical hyperplasia and low-grade endometrioid carcinoma. (2) The distinction between low-grade endometrioid carcinoma and serous carcinoma. (3) The distinction between corded and hyalinized or spindle cell variants of low-grade endometrioid carcinoma and carcinosarcoma. (4) The diagnostic criteria for mixed endometrial carcinomas, a rare entity that should be diagnosed only after exclusion of a spectrum of tumors including morphologic variants of endometrioid carcinoma, dedifferentiated endometrial carcinoma, carcinosarcoma, and endometrial carcinomas with ambiguous morphology.
Highlights
Presented in part at the International Society of Gynecological Pathologist’s Companion Society Symposium at the Annual Meeting of the United States and Canadian Academy of Pathology, March 2018, San Antonio, TX
80% of endometrial carcinomas are of endometrioid type and most of these are morphologically low grade (International Federation of Gynecology and Obstetrics [FIGO] grade 1 or 2)
A variety of problems may occur in the diagnosis of low-grade endometrioid carcinomas; some of these
Summary
The definition of mixed endometrial carcinoma has evolved as the overall classification scheme for endometrial carcinomas has been refined. Immunohistochemistry is recommended to help confirm the subtype of each component, using the suggested markers (positive and negative) for each individual subtype This strategy mitigates against misinterpreting morphologic variations of endometrioid carcinoma, such as those with villoglandular, papillary, or clear cell features, as a separate component of serous or clear cell carcinoma. It is advised that any amount of serous carcinoma or clear cell carcinoma that can be confidently recognized to coexist with endometrioid carcinoma qualifies as a mixed epithelial carcinoma This strategy differs slightly from the WHO criterion which recommends that the serous or clear cell carcinoma component must comprise at least 5% of the overall tumor. Two other endometrial carcinomas that contain spatially distinct components of tumor types are dedifferentiated endometrial carcinoma and carcinosarcoma. Carcinosarcoma is a distinct tumor type and should not be classified as mixed endometrial carcinoma
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