Patterns of Myometrial Invasion in Endometrial Adenocarcinoma with Emphasizing on Microcystic, Elongated and Fragmented (MELF) Glands Pattern: A Narrative Review of the Literature

Svetlana Mateva,Margarita Nikolova,Angel Yordanov

doi:10.3390/diagnostics11091707

Svetlana Mateva, Margarita Nikolova + Show 1 more

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https://doi.org/10.3390/diagnostics11091707

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Journal: Diagnostics	Publication Date: Sep 18, 2021
Citations: 3	License type: CC BY 4.0

Affiliation: Medical University Pleven

Abstract

Endometrioid endometrial adenocarcinoma (EEC) is the most common malignancy of the female genital tract. According to the 2009 FIGO staging system, the depth of myometrial invasion (MI), and tumor spread to adjacent organs or tissues are the staging criteria for endometrial carcinoma (EC). Therefore, assessment of the depth of MI is of great importance. There is a spectrum of morphological patterns of MI. Still, their number and features vary according to the scientific literature, with a certain overlap that creates difficulties and controversies in the precise assessment of MI depth. The purpose of this review is to present and discuss the most important and recent information about patterns of MI, focusing on the more aggressive and the elongated and fragmented glands (MELF) pattern in particular. Assessment of MI depth and correct staging of EC is possible only after the precise recognition of each MI pattern.

Highlights

Giuseppe RicciEndometrial adenocarcinoma (EC) is the most frequent gynecological malignancy in developed countries with an overall good prognosis [1,2,3]
It is associated with an increased expression of cancer stem cells (CSCs) markers—CD44 and CD133 and with a loss of estrogen receptors (ER), progesterone receptors (PR), and decreased
Several markers have emerged as useful for the identification of CSCs—and the expression of CD44 and CD133 was closely associated with disease progression and poor prognosis [17]

Summary

Introduction

Endometrial adenocarcinoma (EC) is the most frequent gynecological malignancy in developed countries with an overall good prognosis [1,2,3] Many factors, such as age, histological type and grade, depth of myometrial invasion (MI), lymphovascular invasion (LVI), tumor size, and metastases in pelvic and lumbar-aortic lymph nodes, have a proven prognostic value [4,5]. The majority of the patients are classified as per Soslow et al as low-grade tumors (G 1 and 2) [7], low-stage (IA-II, as defined by Sadowski et al.) [8] These EEC have a favorable prognosis [5,9,10,11], but a small number of them may eventually develop unpredictable recurrence leading to an adverse prognosis [10,12,13]. According to the 2009 FIGO staging system, the depth of MI and the tumor spread to adjacent organs or tissues are the current

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