Adenocarcinoma Of Endometrioid Type Research Articles

Endometrioid type adenocarcinoma in situ as a potential precursor lesion for extremely rare invasive endometrioid type adenocarcinoma of the cervix

HPV-independent in situ adenocarcinomas have been only recently added to the WHO 2020 classification. To date, little information has been published about HPVindependent precursor lesions. In particular, regardiong the extremely rare cervical endometrioid type adenocarcinoma thought to arise in the setting of cervical endometriosis, a premalignant lesion is still not well defined. In this short communication we describe a possible precursor to invasive cervical endometrioid type adenocarcinoma in a 39-yr-old patient, with a previous history of breast cancer.

Evaluation of immunohistochemically expression of GLUT-1 in benign proliferative, hyperplastic endometrium and endometriosis adenocarcinoma

Objectives: The aim of this study is to evaluate the GLUT-1 expression in benign proliferative, hyperplastic, and malignant endometrial tissues, to evaluate the usefulness of GLUT-1 expression in endometrial hyperplasia, and to determine its role in the neoplastic progression to endometrioid type adenocarcinoma. We also aimed to analyze some prognostic clinical parameters (age, stage, grade).
 Methods: This cross sectional study was carried out on paraffin embedded surgical specimens of endometrial tissue. Applying the immune histochemical techniques by using the GLUT-1 as a primary antibody, statistical analysis was done and the correlation with different clinical and pathological parameters were assessed.
 Results: 98 cases of endomertial tissue, 17.4% disordered proliferative endometrium, 22.4% endometrial hyperplasia without atypia, 18.4% endometrial hyperplasia with atypia, 41.8% endometrioid adenocarcinoma, 56.1% were GLUT-1 positive. Significant correlation was found between GLUT-1 expression and increasing degree of atypia as it was negative in benign proliferative and hyperplasia without atypia meanwhile positive in hyperplasia with atypia and endometrioid carcinoma. Significant correlation with grade of carcinoma, patient age, no correlation was found with ovarian and cervical metastasis, no significant correlation was found with tumor stage.
 Conclusions: GLUT-1 immunostaining may be useful in distinguishing hyperplasia without atypia from hyperplasia with atypia; GLUT-1 overexpression is a consistent feature of endometrioid adenocarcinoma.

Demographic and Clinical Characteristics of Endometrial Cancer in Northwestern Iran, Urmia: A Ten-Year Cross-Sectional Study

Background: endometrial cancer is the most frequent genital cancer in women in the developing nation. The purpose of this study was to investigate on the demographic and clinical aspects of endometrial cancer, or to explain its epidemiology in patients admitted to Urmia's Kosar Hospital.
 Methods: From 2006 to 2016, the medical records of 179 hospitalized women with an initial diagnosis of endometrial cancer were analyzed in this cross-sectional research. The patients’ clinical and demographic information, including age, menstrual age, first visit reason, number of deliveries, menstrual pattern, history of previous disease in patients and their relatives, disease stage, clinical parameters (including WBC, Hb, and MCV), pathology type, and the presence or absence of metastasis was extracted from their medical records and analyzed.
 Results: The patients in our research had a mean age of more than 50 years. Nearly 80% of the patients were menopausal, and approximately 90% of the patients presented with bleeding complaints. Patients with endometrioid type adenocarcinoma had the highest frequency of pathology.
 Conclusion: Our findings show a high proportion of bleeding complaints among the patients evaluated, which might reflect the importance of this finding and help to guide the disease’s diagnosis and therapy. However, further research is needed to establish the epidemiology of this condition in the country.

Magnetic Resonance Imaging (MRI) Staging in Women with Endometrial Cancer: A Correlation with Histopathology

Background & Objective: Endometrial cancer is the most frequent genitourinary tract malignancy in women. Women with endometrial cancer mostly refer at early stages of the disease which leads to good prognosis. Magnetic resonance imaging (MRI) has a crucial role in staging of the cancer. As there are little studies regarding the correlation between histopathology and International Federation of Gynecology and Obstetrics (FIGO) staging in Iranian women with endometrial cancer, we designed this study to assess the relationship between histopathology and FIGO staging with MRI in Iranian women with endometrial cancer.Materials & Methods: This retrospective study was conducted in Imam Khomeini hospital complex between January 2015 and January 2018. All MRIs were performed on a 3T system. All imaging was done in Imam Hospital under observation of attending Radiologists with 10 and 20 years of work experience in women’s imaging who conducted this research. Obtained surgical specimens were assessed by an expert pathologist in the field of cancer and type of cancers were determined.Results: Thirty two women with proved endometrial cancer (D&C or endometrial biopsy) were enrolled. Mean age was 55.2±10.7 years and all women referred to our clinic with vaginal bleeding. The most common FIGO staging was IA (14, 43.75%) and the most frequent pathology was endometrioid type adenocarcinoma (30, 93.7%) (60% well differentiated, 13.3% moderately differentiated, and 26.6% poorly differentiated). Most cases with endometrioid type poorly differentiated referred with IIIC1 stage of cancer, most patients with endometrioid type well differentiated referred with stage IA, a patient with clear cell cancer referred with stage IIIB, and patients with sarcoma referred with stages IB, and IV.Conclusion: Patients with poor differentiated endometrial cancer referred with higher stages of the cancer.

Oncogenic c-terminal cyclin D1 (CCND1) mutations are enriched in endometrioid endometrial adenocarcinomas.

Cyclin D1 (CCND1) is a core cell cycle regulator and is frequently overexpressed in human cancers, often via amplification, translocation or post-transcription regulation. Accumulating evidence suggests that mutations of the CCND1 gene that result in nuclear retention and constitutive activation of CDK4/6 kinases are oncogenic drivers in cancer. However, the spectrum of CCND1 mutations across human cancers has not been systematically investigated. Here, we retrospectively mined whole-exome sequencing data from 124 published studies representing up to 29,432 cases from diverse cancer types and sites of origin, including carcinoma, melanoma, sarcoma and lymphoma/leukemia, via online tools to determine the frequency and spectrum of CCND1 mutations in human cancers and their associated clinico-pathological characteristics. Overall, in contrast to gene amplification, which occurred at a frequency of 4.8% (1,419 of 28,769 cases), CCND1 mutations were of very low frequency (0.5%, 151 of 29,432 cases) across all cancers, but were predominantly enriched in uterine endometrioid-type adenocarcinoma (6.5%, 30 of 458 cases) in both primary tumors and in advanced, metastatic endometrial cancer samples. CCND1 mutations in endometrial endometrioid adenocarcinoma occurred most commonly in the c-terminus of cyclin D1, as putative driver mutations, in a region thought to result in oncogenic activation of cyclin D1 via inhibition of Thr-286 phosphorylation and nuclear export, thereby resulting in nuclear retention and protein overexpression. Our findings implicate oncogenic c-terminal mutations of CCND1 in the pathogenesis of a subset of human cancers and provide a key resource to guide future preclinical and clinical investigations.

Serum HE4 is correlated to prognostic factors and survival in patients with endometrial cancer.

The extent of surgery and the decision for adjuvant treatment in patients with endometrial cancer (EC) depend on the presence of risk factors for lymph node metastases and disease recurrence. Postoperative markers such as myometrial infiltration and specific mutations can select patients for adjuvant treatment but will not influence surgical planning. A biomarker stratifying patients into low-risk and high-risk groups before surgery could identify patients who benefit from more extensive surgery. Therefore, we evaluated the correlation of serum biomarker HE4 with clinical and recently identified prognostic pathological variables and survival. Patients treated for endometrial cancer between 1994 and 2014 were included. Serum HE4 concentration was measured in preoperatively obtained samples. A total of 88 patients were eligible for analysis. The majority (64%) was diagnosed with endometrioid-type adenocarcinoma. Serum HE4 concentration is significantly associated with stage of disease (p=0.001), deep myometrial invasion (p<0.001), exact depth of myometrial invasion (≥4mm) (p=0.01), tumour-free distance to serosa (≤7mm) (p<0.001), extensive lymph vascular space invasion (p=0.04) and cervical involvement (p=0.001). HE4 concentration and nodal involvement were correlated, although not significant (p=0.17). Serum HE4 is an independent prognostic factor for recurrence-free survival (HR 5.12 per 10-fold increase in HE4, 95% CI 1.54-17.1) and overall survival (HR 7.48 per 10-fold increase in HE4, 95% CI 1.76-31.7). HE4 is a prognostic marker in endometrial cancer and is helpful in addition to other variables for the preoperative risk stratification of patients with endometrial cancer.

GLUT-1 Expression in Proliferative Endometrium, Endometrial Hyperplasia, Endometrial Adenocarcinoma and the Relationship Between GLUT-1 Expression and Prognostic Parameters in Endometrial Adenocarcinoma.

Malignant cells show increased glucose uptake in in vitro and in vivo studies. This uptake is mediated by glucose transporter proteins. GLUT-1 is the most common transporter protein, and its expression is reported to be increase in many human cancers. The aim of this study is to determine the GLUT-1 overexpression in benign, hyperplastic, and malignant endometrial tissues, to evaluate the usefulness of GLUT-1 expression in endometrial hyperplasia, and to determine its role in the neoplastic progression to endometrioid type adenocarcinoma. We also aimed to analyze prognostic clinical parameters, predict prognosis, and survival. We examined immunohistochemical expression of GLUT-1 in 91 cases of endometrial hyperplasia, 100 cases of endometrioid type adenocarcinoma, and 10 proliferative endometrial tissues. The percentage of positive cells and staining intensity were assessed in a semi quantitative fashion and scored (1+ to 3+). GLUT-1 immunoreactivity was not present in proliferative endometrium. Twenty-nine (31.9%) of 91 endometrial hyperplasia cases showed positive immunoreactivity, of which only six were cases of hyperplasia without atypia while 23 of them were cases with atypia. We found GLUT-1 positivity of 95% in endometrioid type adenocarcinoma. GLUT-1 overexpression was not significantly correlated with any of the clinicopathological parameters except histological grade in endometrioid adenocarcinoma; the survival was not found to be correlated with GLUT-1 expression. GLUT-1 immunostaining may be useful in distinguishing hyperplasia without atypia from hyperplasia with atypia; GLUT-1 overexpression is a consistent feature of endometrioid adenocarcinoma. A correlation between GLUT -1 expression and tumor grade has been found, although other prognostic parameters and survival has no meaningful correlation.

A histopathologic review of nonsquamous cell malignancies of the cervix in Kano, Nigeria

Background: Although recent studies suggest that there is rising proportion of cervical adenocarcinoma in most part of the world, there has been no formal study in our setting. We therefore undertook this review to document and evaluate the pattern in Kano, Northern Nigeria. Patients and Methods: This was a 10 year retrospective study from 2 nd January, 2002 to 31 st December, 2011 of all non-squamous cell malignancies diagnosed at the pathology department of Aminu Kano Teaching Hospital, Kano, Nigeria. Where necessary, new sections were made from formalin fixed, paraffin embedded blocks. Results: During the ten year study period, a total of 545 cervical cancers were diagnosed. Of these, 448 (82.2%) were squamous cell carcinomas and 17.8% were non-squamous malignancies. Out of the 97 non-squamous malignancies, adenocarcinoma was by far the most common. 52 (53.6%) were endometrioid type adenocarcinomas, while clear cell and mucinous variants comprised 12 (12.4%) and 6 (6.2%) respectively. Other carcinomas in this series were adenosquamous (10 cases), small cell (6 cases), adenoid cystic {3 cases}, undifferentiated (3 cases) and metastatic (1 case). There was only one sarcoma - a leiomyosarcoma. Patients ranged from 20 to 80 years (mean 48.30 ± SD 12.61 years) with the highest occurence in the 4 th –6 th decade age group. Conclusion: Non-squamous malignancies of the cervix comprised 17.8% of all invasive cervical cancers in Kano and adenocarcinomas were overwhelmingly preponderant. The study findings were consistent with most published reports in Nigeria and elsewhere. These malignancies were associated with high morbidity and mortality which necessitates data for health planning and policy decisions.

Cutaneous Metastases of the Synchronous Primary Endometrial and Bilateral Ovarian Cancer: An Infrequent Presentation and Literature Review.

There are limited data about the cutaneous metastases of gynecological malignancies in the literature. Based on this limited number of studies, cutaneous metastases from gynecological malignancies are uncommon occurrences. Cutaneous metastases from the synchronous endometrioid carcinoma of the uterine corpus and bilateral ovaries arising from endometriosis are extremely rare. Herein, we report a 51-year-old woman with FIGO Stage 1A Grade 1 endometrial endometrioid-type adenocarcinoma and synchronous bilateral Stage 1B ovarian endometrioid-type adenocarcinoma who presented 34 months following total abdominal hysterectomy and bilateral salpingo-oophorectomy with skin metastases. After the patient underwent an excisional biopsy, we applied a palliative radiotherapy. The patient received the combination therapy with cisplatin and doxorubicin after the completion of radiotherapy but the disease evolution was rapidly fatal and the patient died 4 months after her admission to our department due to widely disseminated disease.

Fallopian Tube Carcinoma Presenting As Preterm Labour at 31 Weeks Gestation Woman

Primary Fallopian tube carcinoma (PFTC) is a rare tumour accounting for less than 2% of all female genital malignancies. The true incidence of PFTC is underestimated due to difficulty to diagnose it as primary disease and is often mistaken for metastases from ovarian cancer. A 37-year-old woman presented with pre-term contractions in her 31st week of gestation. Ultrasound scan confirmed a left ovarian mass and ascites. The Ca125 was 2450 IU/l. Planned Caesarean section was performed at 34 weeks and a live female infant was born in good condition. At the same time she underwent a total abdominal hysterectomy, bilateral salpingo-oophorectomy, omentectomy and biopsy of pelvic peritoneum and appendices epiploicae. Over 6L ascites was drained. The histology confirmed Stage IIB adenocarcinoma of endometrioid type arising from the left fallopian tube with metastases to ovaries, peritoneum.

A Benign Ovarian Tumour developing an Endometrial Cancer? Sertoliform Ovarian Cystoadenoma getting together with an Endometrioid Adenocarcinoma

Introduction: Sertoli cells tumours are neoplasms with a very low incidence, being sertoliform cystoadenomae extremely unusual. Its first description was made on 1982 by Young and Roth, with very few cases published after them. This is a neoplasm only described on postmenopausal women, with an average age of presentation of 68 year old, and they could suffer virilization symptoms in different degrees. Histologically, it is a well differentiated neoplasm, with a low malignancy degree, and good prognosis if it is confined to ovaries. In other way, the finding of this ovarian tumour getting together with an endometrioid adenocarcinoma is an extremely rare case. Medical Case: A 66 year old woman, who attended our office relating postmenopausal metrorrhage, is presented. The patient had a medical history of diabetes mellitus type II, arterial hypertension, dyslipidemia, liver steatosis, glaucoma and appendectomy. She got three deliveries and had her menopause at the age of 53. An outpatient hysteroscopy was carried on, finding three endometrial polyps, two of them appeared as normal, and the bigger one had a glandular appearance with atypical vascularization, taking biopsy of it that was informed as endometrioid type adenocarcinoma with mucus-secreting pattern. Ultrasoud scanning, magnetic resonance and serum Ca 125 were carried on, finding a 2,5cm left ovarian nodule with negative Ca 125. An abdominal total hysterectomy with double adnexectomy, was carried on, with intraoperative biopsy, informed as a borderline tumour. Due to this finding, the operation was completed with omentectomy, lymphadenectomy and peritoneal washing. Last histological analysis identifies the ovarian tumour as sertoliform adenoma from rete ovarii, with hepatocyte multifocal metaplasia. This tumour is suspected of being estrogenic functioning one, probably was the inductor of low degree and moderatedly differentiated G2 endometrioid adenocarcinoma. There was no lymphatic or omental metastases. FIGO staging IA, TNM staging T1aN0M0. Conclusions: Sertoliform cystoadenoma is a very rare finding, with only few cases reported. It could be an estrogenic functioning tumour and due to this characteristic could induce endometrial hyperplasia, and at last, could be the reason for appearance of low malignancy degree endometrial neoplasms.

Endometrial cancer and microsatellite instability status.

Microsatellite instability (MSI) is an important factor in the development of various cancers as an identifier of a defective DNA mismatch repair system. The objective of our study was to define the association between microsatellite instability status and traditional clinicopathologic characteristics of endometrioid type adenocarcinoma.Material and methodsMSI status of endometrial cancer was examined by employing the Promega MSI Analysis System. This system uses 5 mononucleotide markers to identify MSI in tumour and normal tissue DNA (BAT-25, BAT-26, NR-21, NR-24, and MONO-27), and 2 pentanucleotide markers (Penta C and Penta D) for specimen identification. In this study, we investigated MSI status in 109 endometrial carcinomas.Results and conclusionsOne hundred (92%) of 109 endometrial cancers showed endometrioid type histology and only 9 (8%) non-endometrioid type. MSI-high was found in 17% (17/100) of endometrioid type adenocarcinomas, in 0% (0/9) of non-endometrioid carcinomas. Selected clinicopathologic parameters for endometrioid type adenocarcinomas were compared to the MSI status which was separated into two groups – MSI-high and MSI stable. The results showed that MSI-high status was related to clinicopathologic parameters such as deep myometrial invasion and higher histologic grade in endometrioid type adenocarcinomas.

Endometrioid adenocarcinoma of the ovary mimicking serous borderline tumor: report of a series of cases.

Ovarian endometrioid adenocarcinomas may have an extremely variable morphologic appearance and mimic a number of other epithelial malignancies as well as nonepithelial tumors. We report the clinicopathologic features of a small series of ovarian endometrioid adenocarcinomas (n=5), 4 of which were received in consultation, which were originally diagnosed as or were suspected to represent serous borderline tumor, with or without a component of low-grade serous adenocarcinoma. The patients were aged between 47 and 74 yr (mean, 60 yr), and all tumors were unilateral and Stage 1C. Serous borderline tumor was suspected on the basis of the predominant architectural pattern with prominent papillary formations consisting of rather bland epithelial cells covering stromal cores which projected into cystic spaces. In all cases, there were areas of typical endometrioid adenocarcinoma, although these foci were minor. Features useful in confirming an endometrioid neoplasm, not all of which were present in every case, were a monomorphous cell population, areas of cytoplasmic clearing, areas of more pronounced nuclear atypia, and mitotic activity than is typical of low-grade serous neoplasms, squamous elements, endometriosis and absent or only focal WT1 immunohistochemical staining. The close mimicry of a serous borderline tumor by an endometrioid adenocarcinoma is a diagnostic pitfall which has not been reported in the literature and represents yet another example of the propensity for ovarian endometrioid adenocarcinomas to mimic other neoplasms. Pathologists should consider an endometrioid adenocarcinoma when faced with a presumed serous borderline tumor with any of the features listed above. Extensive sampling may be of value in revealing more typical areas of endometrioid neoplasia and negative staining with WT1 of use in excluding a serous neoplasm.

Clinical significance of benign endometrial cells found in papanicolaou tests of Turkish women aged 40 years and older

Background:Spontaneously exfoliated benign-appearing endometrial cells (BEC) on a Papanicolaou smear might indicate endometrial pathology in postmenopausal women, necessitating further investigation. A cut-off age of 40 years was included in the Bethesda System 2001 based on studies of clinical significance of endometrial cells in Pap smears in Western countries.Aims:The purpose of this study was to determine the significance of age subgroup for women with a cytological diagnosis of BEC, regardless of menopausal status, in a retrospective cohort of Turkish women.Materials and Methods:Between October 2006 and November 2011, 41 patients with a BEC diagnosis and 64 patients with a cytological diagnosis of normal smear (NS) were enrolled; regardless of menopausal status, these women were 40 years and older and for whom follow-up endometrial biopsies had been performed.Results:On subsequent histopathologic evaluation, no malignant lesion was detected in women aged 40-50 years compared to three endometrioid-type adenocarcinomas in women older than 50 years with cytological diagnosis of BEC. There was a significant difference between women older than 50 years with cytologic diagnosis of BEC and NS in relation to premalignant lesions on histopathologic evaluation; however, this was not the case for women aged 40-50 years.Conclusions:According to our study, reporting BEC for women aged between 40 and 50 years has minor clinical significance but is significant for women older than 50 years, regardless of menopausal status. Larger sample size would be appropriate to confirm the results of the current study.

Mesonephric adenocarcinoma (endometrioid type) of endocervix with diffuse mesonephric hyperplasia involving cervical wall and myometrium: An unusual case report

Malignant mesonephric tumors are rare variants of cervical adenocarcinoma, derived from remnants of mesonephric ducts and are associated with mesonephric remnants and/or mesonephric hyperplasia. Few cases have been described in literature. We report an unusual case of cervical mesonephric adenocarcinoma of endometrioid type with squamous morules in association with diffuse mesonephric hyperplasia involving the cervical walls and extending into the myometrium.

Endometrial Adenocarcinoma and Mucocele of the Appendix: An Unusual Coexistence

Appendiceal mucocele is a rare clinical entity, which is however quite often associated with mucinous ovarian tumor. The coexistence of mucinous cystadenoma of the appendix and endometrial adenocarcinoma has not been reported before. A 49-year-old woman presented to our clinic with postmenopausal bleeding and no other symptom. Endometrial biopsy revealed endometrial adenocarcinoma of endometrioid type (grade I). Preoperative CT scanning revealed an appendiceal mucocele, and a colonoscopy confirmed the diagnosis. The patient underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy and appendectomy. The final histopathological examination showed a mucinous cystadenoma of the appendix and confirmed the diagnosis of endometrioid endometrial adenocarcinoma. The coexistence of appendiceal mucocele and female genital tract pathology is rare. However, gynecologists should keep a high level of suspicion for such possible coexistence. Both the diagnostic approach and the therapeutic management should be multidisciplinary, most importantly with the involvement of general surgeons.

The dichotomy in the histogenesis of endometriosis-associated ovarian cancer: clear cell-type versus endometrioid-type adenocarcinoma.

The histogenesis of endometriosis and endometriosis-associated ovarian cancer is one of the most mysterious aspects of pathology. To better understand the histogenesis of endometriosis and endometriosis-associated ovarian cancer, we analyzed the possibility of a link of endometrium, ovarian surface epithelium, and a cortical inclusion cyst to ovarian endometriosis and endometriosis-associated ovarian cancer by immunohistochemistry using the epithelial membrane antigen (an epithelial marker), calretinin (a mesothelial marker), and hepatocyte nuclear factor (HNF)-1β (a clear cell carcinoma-specific transcription factor). During ovarian surface epithelium invagination, cortical inclusion cyst epithelial cells may, in some cases, undergo mesothelial-epithelial transition and subsequently differentiate into endometriosis. This case of endometriosis that has undergone Müllerian metaplasia arises from the HNF-1β-negative cells. The remaining endometriosis may develop from the late secretory and menstrual endometria, with HNF-1β-positive staining, by retrograde menstruation. Endometrioid adenocarcinoma and clear cell carcinoma arise from the HNF-1β-negative and HNF-1β-positive epithelial cells of endometriosis, respectively. It has been proposed that clear cell and endometrioid-type adenocarcinomas arise from distinct types of endometriosis with different cells of origin.

Expression pattern of PAX2 in hyperplastic and malignant endometrium

PAX2 is a member of paired box gene family and expressed during development of urogenital system. This study aimed to evaluate PAX2 expression pattern in hyperplastic and malignant endometrial tissues in comparison to non-pathological endometrial changes and to investigate the presence of any correlation between the PAX2 expression and tumor behavior. The study was performed on the archival material of 121 endometrial tissues including complex hyperplasia (n = 18), complex atypical hyperplasia (n = 20), and endometrioid type adenocarcinoma (n = 47) as study groups, and proliferative endometrium (n = 21) and atrophic endometrium (n = 16) as control groups. One representative block for each case was selected for immunohistochemical evaluation. Sections with 4μm thickness were cut from the blocks and incubated with PAX2 rabbit anti-human polyclonal antibody. PAX2 nuclear staining was detected in all of the endometrial tissues. The mean percentages of PAX2 staining cells were 80.8, 96.7, 88.6, 92.7, and 99.2% with proliferative endometrium, atrophic endometrium, complex hyperplasia, complex atypical hyperplasia, and adenocarcinoma, respectively (Kruskal-Wallis; P < 0.001). The frequency of PAX2 staining increased as the pathology progressed in the manner of complex hyperplasia → complex atypical hyperplasia → adenocarcinoma. In cancer cases, there was no correlation between PAX2 expression levels and the stage, histological grade, myometrial invasion, and lymph node status. PAX2 is expressed in hyperplastic and malignant endometrium as well as proliferative and atrophic endometrium. As the neoplastic lesion progresses from a premalignant state to endometrial cancer, PAX2 expression increases. These findings suggest that PAX2 may contribute to the development of endometrial cancer.

The sensitivity and specificity of a new formula to distinguish endometrioid type endometrial carcinoma from ovarian endometrial carcinoma

Objectives Endometrioid type adenocarcinoma sometimes occupies both endometrium and ovary and in some cases the origin cannot be determined. Study design In this study, we established a formula to distinguish ovarian endometrioid cancer (EOC) from endometrioid type endometrial cancer (EEC), based on our previous report of cyclin and KI67 expression pattern by immunohistochemistry of 36 EECc and 37 OECc by the logistic regression. We calculated the diagnostic accuracy using 92 test samples retrospectively and finally could diagnose the origin of 16 cases in whom endometrioid type adenocarcinoma arose in both ovary and endometrium and could be determined by Scully's criteria, and 15 cases in whom endometrioid type adenocarcinoma arose in both ovary and endometrium and Scully's criteria were not usuful retrospectively. Results The estimated formula is as follows: Logit(Prob(EOC)) = −1.1437 − 0.0853 CNA + 0.0423 CNB + 0.173 CND1 + 0.0129 CNE + 0.0224 CNF + 0.0508 KI67, where Prob(EOC) is the probability that a clinical sample is EOC. If Prob(EOC) is larger than 0.5, the diagnosis is ovarian cancer; if less than 0.5 it is endometrial cancer. Finally, using the formula, 37 of 48 EECs (77.1%) and 33 of 44 EOCs (75.0%) were correctly classified, with an accuracy of 76.1% ( p < 0.0001), retrospectively. In 12 of the 16 cases (75%) who could be determined by Scully's criteria, the origin determined by Scully's criteria was concordant with the origin determined by the formula retrospectively. In the other 15 cases, 12 cases were judged as ovary/ovary, 2 cases were judged as uterus/uterus and 1 case was judged as uterus/ovary. Conclusion The formula we established was thought to be useful to distinguish the origin of the cases in whom endometrioid type adenocarcinoma arises in both ovary and endometrium.

MELF pattern invasion in endometrial carcinoma: association with low grade, myoinvasive endometrioid tumours, focal mucinous differentiation and vascular invasion

To investigate the frequency of microcystic, elongated and fragmented (MELF) pattern invasion in endometrial carcinoma and its association with other pathological findings. The histology slides from 170 consecutively accessioned endometrial malignancies were reviewed to identify cases showing MELF type invasion. Histological subtype, tumour grade, presence of squamous and mucinous differentiation, and frequency of lymphovascular space invasion (LVSI) were compared in MELF positive and negative cases. Additional stains for cytokeratin and stromal mucin were performed in the MELF positive tumours and immunohistochemistry to demonstrate vascular endothelium was performed in 12 selected cases. There were 133 endometrioid adenocarcinomas (EEC) and 37 non-endometrioid carcinomas. MELF type invasion was identified in 27 cases (15.9%) all of which were FIGO grade 1 or 2 myoinvasive adenocarcinomas of endometrioid type. The histochemical and immunohistochemical stains were useful in demonstrating the relatively subtle invasive foci in some tumours. MELF positive cases more frequently showed focal mucinous differentiation and LVSI. MELF type invasion appears restricted to low grade, myoinvasive carcinomas of endometrioid type and is more common in tumours exhibiting focal mucinous differentiation. These associations suggest that MELF changes represent a specific tumour-stromal interaction rather than a degenerative process. Tumours exhibiting MELF pattern invasion should be carefully examined for LVSI. Ancillary techniques, in particular cytokeratin immunohistochemistry, are useful in diagnostic assessment.