Endometrioid adenocarcinoma with proliferated stromal cells, hyalinization and cord-like formations: A case report / 北京大学学报(医学版)

Corded and hyalinized endometrioid carcinoma (CHEC) is a morphologic variant of endo-metrioid adenocarcinoma. The tumor exhibits a biphasic appearance with areas of traditional low-grade adenocarcinoma merging directly with areas of diffuse growth composed of epithelioid or spindled tumor cells forming cords, small clusters, or dispersed single cells. It is crucial to distinguish CHEC from its morphological mimics, such as malignant mixed mullerian tumor (MMMT), because CHECs are usually low stage, and are associated with a good post-hysterectomy prognosis in most cases while the latter portends a poor prognosis. The patient reported in this article was a 54-year-old woman who presented with postmenopausal vaginal bleeding for 2 months. The ultrasound image showed a thickened uneven echo endometrium of approximately 12.2 mm and a detectable blood flow signal. Magnetic resonance imaging revealed an abnormal endometrial signal, considered endometrial carcinoma (Stage Ⅰ B). On hysterectomy specimen, there was an exophytic mass in the uterine cavity with myometrium infiltrating. Microscopically, most component of the tumor was well to moderately differentiated endometrioid carcinoma. Some oval and spindle stromal cells proliferated on the superficial surface of the tumor with a bundle or sheet like growth pattern. In the endometrial curettage specimen, the proliferation of these stromal cells was more obvious, and some of the surrounding stroma was hyalinized and chondromyxoid, which made the stromal cells form a cord-like arrangement. Immunostains were done and both the endometrioid carcinoma and the proliferating stroma cells showed loss of expression of DNA mismatch repair protein MLH1/PMS2 and wild-type p53 protein. Molecular testing demonstrated that this patient had a microsatellite unstable (MSI) endometrial carcinoma. The patient was followed up for 6 months, and there was no recurrence. We diagnosed this case as CHEC, a variant of endometrioid carcinoma, although this case did not show specific β-catenin nuclear expression that was reported in previous researches. The striking low-grade biphasic appearance without TP53 mutation confirmed by immunohistochemistry and molecular testing supported the diagnosis of CHEC. This special morphology, which is usually distributed in the superficial part of the tumor, may result in differences between curettage and surgical specimens. Recent studies have documented an aggressive clinical course in a significant proportion of cases. More cases are needed to establish the clinical behaviors, pathologic features, and molecular profiles of CHECs. Recognition of the relevant characteristics is the prerequisite for pathologists to make correct diagnoses and acquire comprehensive interpretation.

Endometrioid adenocarcinoma of the rectovaginal septum: A case report / 中南大学学报(医学版)

Primary endometrioid adenocarcinoma of the rectovaginal septum is rare. Its pathogenesis is not clear and there is no standard treatment. One patient with endometrioid adenocarcinoma of the rectovaginal septum arising from deep infiltrative endometriosis was admitted to Qingdao Municipal Hospital. The patient presented with incessant menstruation and abdominal distension. She had bilateral ovarian endometriotic cystectomy 6 years ago. Imaging findings suggested a pelvic mass which might invade the rectovaginal septum. Pathological results of primary surgery confirmed endometrioid carcinoma of the pelvic mass arising from the rectovaginal septum. Then she had a comprehensive staged surgery. Postoperative chemotherapy was given 6 times. No recurrence or metastasis was found during the 2-year follow-up. The possibility of deep infiltrating endometriosis and its malignant transformation should be considered in the differential diagnosis of a new extragonadal pelvic lesion in a patient with a history of endometriosis, which would avoid misdiagnosis and missed diagnosis.

Incidencia, mortalidad y supervivencia por cáncer de endometrio en Manizales, Colombia 2003-2017 / Incidence, mortality and survival of endometrial cancer in Manizales, Colombia 2003-2017

RESUMEN Objetivo. Estimar la incidencia, mortalidad y supervivencia a cinco años por carcinoma endometrial en Manizales, para el periodo 2003-2017. Materiales y métodos. Estudio observacional, retrospectivo, de base poblacional, con alcance descriptivo. Se ajustaron tasas de incidencia y mortalidad mediante el método directo usando la población mundial Segi como referencia. Se realizó seguimiento pasivo y activo de los casos hasta completar 60 meses o hasta la fecha de cierre de seguimiento. La supervivencia fue estimada mediante funciones de Kaplan-Meier y modelos de regresión de Cox. Resultados. Se observaron 210 casos incidentes en una población de 214 928 mujeres. La edad promedio al diagnóstico fue de 61 años. El tipo histológico más frecuente fue el endometrioide, bien diferenciado. La mayoría de las pacientes estaban afiliadas al régimen contributivo y pertenecían al nivel socioeconómico medio. La tasa de incidencia ajustada por edad fue de 5,7 casos nuevos por cada 100 000 mujeres-año. Se identificaron 75 defunciones con mayor mortalidad entre los 64 y los 79 años. La supervivencia global fue de 95,1% a los 12 meses y de 83,8% a los 60 meses. Se encontraron diferencias estadísticamente significativas en la supervivencia a favor de la histología epitelial, los estadios tempranos al momento del diagnóstico y la edad al diagnóstico menor a 60 años. Conclusiones. La mortalidad es similar a la reportada en otros países de la región. En Manizales, la sobrevida al cáncer de endometrio fue mayor en pacientes con diagnóstico temprano, con edad menor de 60 años y con histología endometrioide.

ABSTRACT Objective. To estimate the incidence, mortality and five-year survival of endometrial carcinoma in Manizales for the period 2003-2017. Materials and methods. Observational, retrospective, population-based study, descriptive in scope. Incidence and mortality rates were adjusted by the direct method using the Segi world population as reference. Passive and active follow-up of the cases was carried out until completing 60 months or until the follow-up closing date. Survival was estimated using Kaplan-Meier functions and Cox models. Results. 210 incident cases were observed in a population of 214.928 women. The average age at diagnosis was 61 years. The most frequent histological type was endometrioid, well differentiated. Most of the patients were affiliated to the contributory health insurance scheme and belonged to the middle socioeconomic level. The age-adjusted incidence rate was 5.7 new cases per 100,000 woman-years. Seventy-five deaths were identified, with greater mortality between 65-69 and 75-79 age groups. Overall survival was 95.1% at 12 months and 83.8% at 60 months. Statistically significant differences were found in survival in favor of epithelial histology, early stages at the time of diagnosis, and age at diagnosis less than 60 years. Conclusions. Manizales follows the global pattern of rise in the age-adjusted incidence rate. Mortality is like that reported in other countries in the region. In Manizales, endometrial cancer survival was higher in patients with early diagnosis, less than 60 years of age, and with endometrioid histology.

Analysis on related factors of lymph node metastasis and ovary involvement in endometrioid adenocarcinoma / 中华疾病控制杂志

Objective To investigate the related factors of lymph node metastasis and ovary involvement in endometrioid adenocarcinoma. Methods The clinicopathological data of endometrioid adenocarcinoma patients who underwent surgical treatment at the first affiliated hospital of university of science and technology of China from January 2011 to January 2018 were analyzed retrospectively. A total of 189 endometrioid adenocarcinoma were retrieved in the study. Results In the univariate analysis, D-dimer, preoperative plasma fibrinogen and CA125 levels could be elevated in endometrioid adenocarcinoma patients with ovary involvement (all P<0.05). Endometroid adenocarcinoma patients with lymph node metastasis had lower body mass index (BMI) (t=2.133, P=0.040), preoperative plasma fibrinogen, D-dimer, CA125 levels and BMI were higher in patients with lymph node metastasis (all P<0.05). In Logistic regression analysis, D-dimer levels(OR=1.448, 95% CI:1.105-1.898) and preoperative plasma fibrinogen(OR=1.925, 95% CI:1.018-3.640) were elevated in endometrioid adenocarcinoma patients with ovary involvement; Multiparity was the protective factor(OR=0.498, 95% CI: 0.253-0.982) for endometrioid adenocarcinoma patients with lymph node metastasis, but elevated preoperative plasma fibrinogen (OR=2.191, 95% CI: 1.085-4.422) was the risk factor among the patients. Conclusion Increased preoperative plasma fibrinogen or D-dimer levels could be predictors of lymph node metastasis or ovary involvement in endometrioid adenocarcinoma.

Clinical comparison between neuroendocrine and endometrioid type carcinoma of the uterine corpus / 부인종양

OBJECTIVE: To compare the clinicopathologic features and survival outcomes of neuroendocrine tumor of the uterine corpus (NET-U) to endometrioid type endometrial carcinoma (EC). METHODS: From 1993 to 2012, the Surveillance, Epidemiology and End Results cancer registry was queried for women diagnosed with EC or NET-U. Data regarding stage, grade, presence of extra-uterine disease, lymph node metastasis, receipt of adjuvant radiation, surgical intervention and overall survival (OS) was extracted. Chi-square tests, t-tests and Kaplan Meir curves were used for statistical analysis. RESULTS: A total of 98,363 patients were identified: 98,245 with EC and 118 with NET-U. The mean age at diagnosis for EC was 61.7 years and 64.8 years for NET-U (p=0.01). NET-U cases were more likely to be poorly differentiated (97.0% vs. 15.6%; p≤0.01) and have nodal metastasis (56.4% vs. 11.1%; p≤0.01) when compared to EC. Presence of extrapelvic disease at the time of diagnosis was observed more frequently in NET-U compared to EC, 49.1% vs. 4.8%, respectively (odds ratio=18; 95% confidence interval=13.1–27.2; p≤0.01). Significant improvement in OS was observed in NET-U patient who received radiation (OS: 7.7 vs. 3.3 years; p≤0.01) or underwent surgical management (5.6 vs. 0.9 years; p≤0.01). The OS for EC was 14.4 vs. 4.6 years for NET-U (p≤0.01). CONCLUSION: NET-U represents an aggressive form of uterine malignancy. When compared to EC, patients with NET-U present at more advanced stage, have more frequent extra-uterine disease and lower OS.

The factors analysis on pregnant outcomes between well-differentiated endometrial cancer and atypical endometrial hyperplasia after conservative treat ment / 实用肿瘤学杂志

Objective To identify factors that might affect establishing pregnancy following conservative treatment by medroxyprogesterone acetate ( MPA)for well -differentiated endometrioid adenocarcinoma ( EC) or a-typical endometrial hyperplasia(AEH).Methods A retrospective study of 65 patients with EC/AEH were divid-ed into a pregnancy group ( n=34 ) and a non -pregnancy group ( n=31 ) .The influent factors on establishing pregnancy were detected by statistical analysis .Results There was no significant difference in clinical character-istics between pregnancy group and non -pregnancy group .There were significantly different between pregnancy group and non-pregnancy in the duration of MPA administration ,the time to disappearance of lesions ,the age of pregnancy permission ,the number of D&C procedures performed ,and endometrial thickness during ovulation ( P<0.05).The multivariate logistic regression analysis identified that the recurrence (OR=2.323,P=0.015),endo-metrial thickness during ovulation (OR=0.283,P <0.001),and age of pregnancy permission (OR=2.524,P=0.039) were significant factors affecting pregnancy outcomes .Conclusion Recurrence, endometrial thickness during ovulation ,and the age of the pregnancy permission were considered to affect pregnant establishment follow -ing conservative treatment with MPA .Assisted reproductive technology immediately after achieving tumor disap-pearance by MPA would therefore be beneficial for patients with disease recurrence ,thin endometrium ,or a higher age of pregnancy permission .

Expression of mismatch repair gene in endometrioid adenocarcinoma and its prognostic significance / 肿瘤研究与临床

Objective To explore the expression of mismatch repair gene (MMR) (MLH1,MSH2,PMS2 and MSH6) in endometrioid adenocarcinoma,and to analyze its clinical pathological significance.Methods Inmunohistochemical EnVision method was used to detect the expressions of DNA mismatch repair proteins (MLH1,MSH2,PMS2 and MSH6) in 101 cases of endometrial adenocarcinoma.The phenotypes of tumor microsatellite instability (MSI) and microsatellite stable were determined,and its relationship with onset age,differentiation,depth of myometrial invasion,lymphatic metastasis and prognosis of tumor were analyzed.Results There were 67 cases of hysterectomy and 34 cases of endometrial biopsy in 101 cases of endometrial adenocarcinoma.52 cases of surgical specimens and 14 cases of biopsy specimens were included in 66 cases that had complete follow-up data.Rates of negative expression were as follows:MLH1 31.6 ％ (32/101),MSH228.7 ％ (29/101),PMS2 16.8 ％ (17/101),MSH6 8.9 ％ (9/101).MSI phenotype 53.5 ％ (54/101),MSS phenotype 46.5 ％ (47/101).Univariate analysis showed that prognoses of MSI-L&MSS group (34 cases) were better than those of MSI-H group (18 cases) in hysterectomy organization (P =0.041).The differences between depth of myometrial invasion,degree of differentiation,age and prognosis of endometrial adenocarcinoma were statistically significant (P ＜0.05).Cox multivariate analysis showed that differences between depth of myometrial invasion,age and prognosis of endometrial adenocarcinoma were statistically significant (P =0.034,P =0.009),while there was no significant difference between MSI-L&MSS group and MSI-H group in prognosis (P ＞ 0.05).Conclusions MSI is one of the molecular events that occur in the endometrioid adenocarcinoma.Age and depth of tumor invasion are independent prognostic factors of endometrioid adenocarcinoma.In view of inconsistency between univariate analysis and multivariate analysis,whether MSI can be used as deterministic accordance for endometrioid adenocarcinoma prognostic evaluation requires further verification.

Intestinal Endometriosis: Clinicopathologic Analysis of 15 Cases Including a Case of Endometrioid Adenocarcinoma

BACKGROUND: Since many patients with intestinal endometriosis present with gastrointestinal symptoms without a history of endometriosis, endoscopic examination of the intestinal tract is initially performed, often leading to a misdiagnosis. METHODS: We reviewed the clinicopathologic findings of 18 samples from 15 patients with intestinal endometriosis who underwent endoscopic biopsy and/or surgical resection to identify diagnostically helpful findings. RESULTS: All 7 biopsy specimens displayed relatively well-defined submucosal lesions, with non-mucinous glands lined by ciliated epithelium and surrounding cellular stroma containing spiral arteriole-like blood vessels. The stroma was immunopositive for CD10 in all cases. All but one specimen exhibited immunopositivity for ER and PR in both glandular and stromal components. In contrast to the overlying normal colonic mucosa, glandular epithelium with endometriosis was immunopositive for cytokeratin (CK) 7, but immunonegative for CK20 in all cases. Three cases were associated with adenocarcinoma in the same or different segments; specifically, two primary rectal adenocarcinomas and one endometrioid adenocarcinoma arising from endometriosis. CONCLUSIONS: The characteristic features of endometrial glands and stroma, including non-mucinous glands without goblet cells, ciliated columnar epithelium, and cellular stroma with spiral arterioles, facilitate the accurate diagnosis of intestinal endometriosis, which can be confirmed by immunohistochemical staining.

Ovarian Endometrioid Adenocarcinoma with a Yolk Sac Tumor Component

Ovarian endometrioid adenocarcinoma (EAC) with a yolk sac tumor (YST) component is extremely rare. Only twelve cases have been reported in the English literature. We report here two additional cases of this rare tumor. The YST component showed classic microscopic features, and immunohistochemically stained positive for alpha-fetoprotein (AFP), but negative for cytokeratin 7 (CK7), epithelial membrane antigen (EMA), estrogen receptor (ER) and progesterone receptor (PR). The EAC appeared to blend into the YST in several areas and immunohistochemically stained positive for CK7, EMA, ER, and PR, but negative for AFP.

Minimal Deviation Endometrioid Adenocarcinoma of the Uterine Cervix: A Case Report

We describe here a case of minimal deviation endometrioid adenocarcinoma (MDEA) of the uterine cervix that was initially suspected according to the abnormal cytologic findings in a 39-year-old woman. The Papanicolaou (pap) smear showed many neoplastic glandular cells in monolayered sheets, rosettes, and clusters with palisading and feathering borders. The tumor cells had oval, hyperchromatic nuclei, with chromatin clumping and small nucleoli. Histologic examination disclosed endometrial-type glands with a bland, isolated, mainly rounded appearance and these glands were widely scattered deep into the cervical stroma with only scant stromal reaction. An association of MDEA with tubo-endometrioid metaplasia or cervical endometriosis has been suggested by identifying the tubo-endometrioid glands in the vicinity of the MDEA.

A Multiinstitutional Consensus Study on the Pathologic Diagnosis of Endometrial Hyperplasia and Carcinoma

BACKGROUND: The purpose of this study was to examine the reproducibility of both the diagnosis of endometrial hyperplasia (EH) or adenocarcinoma, and the histologic grading (HG) of endometrioid adenocarcinoma (EC). METHODS: Ninety-three cases of EH or adenocarcinomas were reviewed independently by 21 pathologists of the Gynecologic Pathology Study Group. A consensus diagnosis was defined as agreement among more than two thirds of the 21 pathologists. RESULTS: There was no agreement on the diagnosis in 13 cases (14.0%). According to the consensus review, six of the 11 EH cases (54.5%) were diagnosed as EH, 48 of the 57 EC cases (84.2%) were EC, and 5 of the 6 serous carcinomas (SC) (83.3%) were SC. There was no consensus for the 6 atypical EH (AEH) cases. On the HG of EC, there was no agreement in 2 cases (3.5%). According to the consensus review, 30 of the 33 G1 cases (90.9%) were G1, 11 of the 18 G2 cases (61.1%) were G2, and 4 of the 4 G3 cases (100.0%) were G3. CONCLUSIONS: The consensus study showed high agreement for both EC and SC, but there was no consensus for AEH. The reproducibility for the HG of G2 was poor. We suggest that simplification of the classification of EH and a two-tiered grading system for EC will be necessary.

Malignant mixed mllerian tumor of the ovary: a case report preoperatively diagnosed as endometrioid adenocarcinoma by MR imaging / 대한산부인과학회잡지

Malignant mixed mllerian tumors (MMMTs) are unusual neoplasms occurring mostly in the endometrium. In the ovary, they are very rare and represent less than 1% of all ovarian malignancies. They are highly aggressive neoplasms comprising histologically of both epithelial and mesenchymal components. The cell type cannot be determined on the basis of appearance at magnetic resonance (MR) imaging, computed tomography (CT), or ultrasonography (US) but we diagnosed this case as endometrioid adenocarcinoma by MR imaging. Although the pathologic evaluation revealed the ovarian MMMT, mesenchymal components was very minute in the background of endometrioid adenocarcinoma components. The patient received the screening tests of ovarian carcinoma including transvaginal ultrasonography only 3months ago and she got negative results. During the exploration, a 15-cm sized mass looked like it has rapidly grown and ruptured spontaneously preoperatively. Herein we report a case of ovarian MMMT, which was diagnosed preoperatively as endometrioid adenocarcinoma by MR imaging with review of literatures.