Architectural versus nuclear atypia-defined FIGO grade 2 endometrial endometrioid adenocarcinoma (EEC): a clinicopathologic comparison of 154 cases with clinical follow-up.

International Federation of Gynecology and Obstetrics (FIGO) Grade 2 endometrial endometrioid adenocarcinoma carries a 88% 5-yr survival rate. They are defined by >5% but <50% solid epithelial component. A small subset may display <5% solid growth, but marked nuclear atypia and are designated Grade 2. We compared tumor characteristics, staging, and clinical outcome of patients with architectural versus atypia-defined Grade 2 endometrial endometrioid adenocarcinoma. A total of 154 Grade 2 endometrial endometrioid adenocarcinoma cases were reviewed to confirm grade; percent solid growth, and presence of atypia. Only marked atypia (significant nuclear pleomorphism identifiable at 10× or enlarged nuclei, 1.5 to 2× normal, with irregular nuclear contours, dispersed chromatin, and prominent nucleoli) increased the FIGO Grade 1 level. Depth of invasion, tumor stage, lymph node status, and clinical outcomes were then compared. A total of 154 cases were evaluated. Twenty-three were eliminated (6 Grade 3, 17 Grade 1). Of the 131 FIGO II cases, 19 (15%) were based on the presence of severe atypia and 112 (85%) met the architecturally defined criteria. Atypia-defined versus architecturally defined Grade 2 endometrial endometrioid adenocarcinoma's show no significant difference in stage and prognosis. An increase in grade based on presence of nuclear atypia stratifies patients at increased risk as 89% of these patients have myoinvasion at the time of hysterectomy which is in distinct contrast to our previous study (International Journal of Gynecologic Pathology. 2012 July; 31(4): 337-43), where 70% of Grade I cases were noninvasive. No significant correlation between percentage of solid component and risk of recurrence was identified in this study.

Smooth muscle neoplasms of the vulva masquerading as Bartholin gland duct cysts.

Smooth muscle neoplasms of the vulva can be mistaken for Bartholin duct cysts, which can lead to a delay in diagnosis. We present a case of vulvar leiomyoma and a case of leiomyosarcoma that clinically mimicked Bartholin duct cysts. Identification of leiomyosarcomas in this region is particularly important; due to the risk of recurrence, patients may need radiation and/or chemotherapy in addition to adequate surgical treatment and appropriate follow up. Prior series have shown that risk of recurrence is related to inadequate resection and not to the size or grade of tumor. It is critical that pathologists recognize smooth muscle tumors of the vulva and communicate to clinicians the importance of clear margins and wide local excision in cases of malignancy.