Carcinoma dediferenciado do endométrio: Uma revisão da literatura / Dedifferentiated endometrial carcinoma: A literature review

"O Carcinoma Dediferenciado do Endométrio (DDEC) é uma neoplasia constituída por dois componentes histológicos morfologicamente distintos (diferenciado e indiferenciado). O componente diferenciado corresponde a um carcinoma endometrioide de baixo grau (I ou II), enquanto o componente indiferenciado é caracterizado por células epiteliais homogêneas de tamanho médio, sem qualquer tipo de diferenciação ou padrão morfológico arquitetural. Esta neoplasia foi descrita inicialmente em 2006, mas somente em 2014 foi incluída na classificação dos tumores da Organização Mundial de Saúde (OMS). Por ser uma entidade relativamente nova e ainda desconhecida por parte de alguns patologistas, estimase que o DDEC seja subdiagnosticado. O componente indiferenciado pode ser confundido com área sólida de um carcinoma endometrioide grau III ou mesmo com outras entidades tais como tumores neuroendócrinos, sarcomas ou linfomas. O estudo imuno-histoquímico e molecular contribui para confirmação do diagnóstico. Este trabalho tem como objetivo revisar a literatura recente do DDEC para melhor caracterização dos seus aspectos clínicopatológicos, já que esta neoplasia tem um pior prognóstico quando comparado com os carcinomas endometrioides e serosos uterinos."(AU)

"Dedifferentiated Endometrial Carcinoma (DDEC) is a neoplasm consisting of two morphologically distinct histological components (differentiated and undifferentiated). The differentiated component corresponds to a low grade endometrioid carcinoma (I or II), while the undifferentiated component is characterized by homogeneous epithelial cells of medium size, without any kind of differentiation or architectural morphological pattern. This neoplasm was first described in 2006, but only in 2014 it was included in the World Health Organization (WHO) classification of tumors. Because it is a relatively new entity and still unknown to some pathologists, it is estimated that DDEC is underdiagnosed. The undifferentiated component can be confused with the solid area of a grade III endometrioid carcinoma or even with other entities such as neuroendocrine tumors, sarcomas or lymphomas, and immunohistochemical and molecular study contribute to confirmation of the diagnosis. This paper aims to review the recent literature of DDEC to better characterize its clinical and pathological aspects, since this neoplasia has a worse prognosis when compared to endometrioid and serous uterine carcinomas"(AU)

Dedifferentiated carcinoma of the ovary. A case report.

We report the case of a 54-year-old female with dedifferentiated carcinoma of the ovary. Grossly, both ovaries were affected by a tumor of up to 25 mm (right ovary) and 220 mm (left ovary) in diameter. Microscopically, the tumors of both ovaries showed features of well differentiated endometrioid carcinoma with mucinous differentiation. Moreover, in the left ovary there was an undifferentiated solid component consisting of larger cells. Immunohistochemically, the undifferentiated component showed diffuse vimentin positivity and focal expression of cytokeratin 18. Other markers examined including PAX8, estrogen receptors and progesterone receptors were all negative. Dedifferentiated carcinomas consist of an undifferentiated epithelial component and a component of endometrioid carcinoma of FIGO grade 1 or 2. Clinically, they represent aggressive tumors with unfavorable prognosis mostly occurring in the endometrium. To the best of our knowledge, thus far only 6 cases arising in the ovary have been reported in the literature.

Low-grade endometrioid carcinoma of the ovary associated with undifferentiated carcinoma: case report and review of the literature.

The association of low-grade endometrioid carcinoma with undifferentiated carcinoma (UC) was first reported in endometrium carcinoma, termed with dedifferentiated carcinoma (DC). However, the coexistence of low-grade endometrioid carcinoma (LGEC) or serous carcinoma (LGSC) with UC has received minimal attention in ovary, and the behavior of this kind of neoplasm remains at further discussion. In this study, we reported a case of low-grade ovarian endometrioid carcinoma associated with UC and reviewed another four cases previously reported. We found a histological continuity between the LGEC and UC components in H&E section, which suggested a dedifferentiation from LGEC to UC components. In summary, this kind of pathological type has aggressive behavior and these patients have very poor prognosis regardless of the amount of undifferentiated carcinoma.

Sentinel lymph node mapping with pathologic ultrastaging: a valuable tool for assessing nodal metastasis in low-grade endometrial cancer with superficial myoinvasion.

OBJECTIVE: To report the incidence of nodal metastases in patients presenting with presumed low-grade endometrioid adenocarcinomas using a sentinel lymph node (SLN) mapping protocol including pathologic ultrastaging. METHODS: All patients from 9/2005 to 12/2011 who underwent endometrial cancer staging surgery with attempted SLN mapping for preoperative grade 1 (G1) or grade 2 (G2) tumors with <50% invasion on final pathology, were included. All lymph nodes were examined with hematoxylin and eosin (H&E). Negative SLNs were further examined using an ultrastaging protocol to detect micrometastases and isolated tumor cells. RESULTS: Of 425 patients, lymph node metastasis was found in 25 patients (5.9%) on final pathology-13 cases on routine H&E, 12 cases after ultrastaging. Patients whose tumors had a DMI <50% were more likely to have positive SLNs on routine H&E (p<0.005) or after ultrastaging (p=0.01) compared to those without myoinvasion. CONCLUSIONS: Applying a standardized SLN mapping algorithm with ultrastaging allows for the detection of nodal disease in a presumably low-risk group of patients who in some practices may not undergo any nodal evaluation. Ultrastaging of SLNs can likely be eliminated in endometrioid adenocarcinoma with no myoinvasion. The long-term clinical significance of ultrastage-detected nodal disease requires further investigation as recurrences were noted in some of these cases.