endometrial carcinoma (intro)
TRANSCRIPT
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ENDOMETRIAL
CARCINOMA
ByA.CharumathyFinal yr mbbs
ll unit KGHMadras medical college
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EPIDEMIOLOGY
In India, incidence is 5-7%.Cervical cancerremains the most common gynecologicalmalignancy.
4THleading cancer in incidence but only 8thleading cause o death rom malignancy among!omen.
"ore re#uently occuring gynecologicalcancer$&-5%' in develo(ed countries.
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7 times more common in )orth *mericansthan Chinese counter(arts.
"ostly occurs in +th7thdecade o lie.
&-5% - (erimeno(ausal !omen
5% - belo! 45yrs o age
verall 5 year survival rate is
75% - *denocarcinoma
5&% - clear cell serous C*"ostly s(oradic,&% is hereditary.
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/I01 2*CT/0)ulli(arity
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Tamo3ien
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FACTORS REDUCINGRISK
ral Contrace(tive ills-4&-5&%rogesterone-%arly meno(ause
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PATHOLOGY
)/"*6)"T/I"
PROLIFERATIVEPHASE
SECRETORY PHASE
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ENDOMETRIAL
HYPERPLASIAIt is an increased (rolieration o theendometrial glands relative to the stroma,resulting in an increased gland-to-stroma
ratio !hen com(ared !ith normal(rolierative endometrium.
volves in the bac9ground o (rolierativeendometrium due to (rotracted oestrogenstimulation in the absence o (rogestin.
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C6*00I2IC*TI)
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GROSS MORPHOLOGY
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HISTOPATHOLOGY
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ATYPICAL HYPERPLASIA
*ty(ical eatures-:
6arge nuclei o variable si;e sha(e
6oss o (olarityIncrease in nuclear to cyto(lasmic ratio
rominent nucleoli
Irregularly clum(ed chromatin !ith
(arachromatin clearing
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The endometrial glands are highly irregular in size and shaeand sho! "re#uent outou$hings. The atypia is characterized
by enlarged round nu$lei% irregular $hromatin distri&ution% androminent nu$leoli.
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ENDOMETRIAL
CARCINOMAndometrial cancer is a biologically andhistologically diverse grou( o neo(lasmscharacteri;ed by a dualistic model o
(athogenesis.Ty(e I endometrioid adenocarcinomascom(rise 75 (ercent o all cases. They areestrogen deendent% lo! grade% and
deri'ed "rom atyi$al endometrialhyerlasia(
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In contrast, ty(e II cancers usually haveserous or $lear $ell histology% nore$ursor lesion% and a more aggressiveclinical course
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Feature Tye I Tye II
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CLASSIFICATION
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ADENOCARCINOMA
*lso called lands resembling normal endometrialglands,
Columnar cells !ith basally oriented nuclei ,
6ittle or no intracyto(lasmic mucin
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2eatures o carninoma ?
esmo(lastic reaction@ac9 to bac9 glands !ithout intervening
stroma
3tensive (a(illary (attern
0#uamous e(ithelial dierentiation
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GROSS MORPHOLOGY
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HISTOPATHOLOGY
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GRADING (FIGO)
@ased on di""erentiation%glandularar$hite$ture and nu$lear "eaturestumours are graded into ollo!ing
>/* I - A 5% 06I >/BTH>/* II - +-5&% 06I>/BTH
>/* III - 5&% 06I >/BTH
PRESENCE OF NUCLEAR ATYPIAINCREASES GRAE !Y " IRRESPECTI#E OFARC$ITECTURAL GRAING.%
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>/* II >/* III
>/* I
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VARIANTS
Bith areas o s#uamous dierentiation@enign -*denocanthoma
"alignant -*denos#uamous
CarcinomaDilloglandular dierentiation
-Bell dierentiated
-Tumour cells arranged alongibrovascular stal9s
0ecretory carcinoma
-/are variant,e3cellent (rognosis
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SECRETORY CARCINOMA
The &e'p(astic )(a&ds c'&tai& (ar)e su&nu$lear 'a$uoles i*parti&) a+iano )ey* appeara&ce.
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MUCINOUS CARCINOMA
5% o endometrial carcinoma.
>ood (rognosis
@ehaves as normal endometroid tumour
E o tumour com(osed o cells !ithintracyto(lasmic mucin
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Ab,&da&t mu$inis -i((i&) the cyt'p(as* '- neolasti$ $ells(a(s' prese&t i&(,*i&a( spaces
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SEROUS CARCINOMA
F-4% o endometrial carcinoma
*ggressive tumour !ith (oor (rognosis
0imilar to serous carcinoma o ovary
allo(ian tube*lso called
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Psammoma &odies are seen.
High rate o reccurence.
0erous carcinoma have lymho'as$ular
and dee myometrial in'asion(
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The i*a)e sh'saillary $lusters'- high,grade neolasti$ $ells.N,*er',s mitoti$ "iguresca& be see&. Other -eat,res that are -re/,e&t(y see&
i&c(,de ne$rosis% sammoma &odies0 a&d in'asion o" the myometrium.
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CLEAR CELL
CARCINOMAA5% o endometrial carcinoma
ccurs in older !omen.
*ggressive tumour !ith (oor (rognosis.
"i3ed histologic (attern$aillary%tu&ulo$y$ti$% glandular -solid tyes.(
Cells have hobnail coniguration arranged in(a(illae !ith hyanili;ed stal9
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The t,*'r is c'*p'sed '-olygonal $ellsith a&undant $lear$ytolasm1d,e t' )(yc')e& c'&te&t2. It has distin$t $ytolasmi$
&ordersa&d *'derate cyt'(')ic atypia.
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SQUAMOUS CARCINOMA
/are variant, es(ecially the (urevariety.ten glands are (resent.
ten associated !ith cervical stenosis,chronic inlammation, (yometra at the time odiagnosis
It has a very (oor (rognosis !ith F+%survival rate.
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SPREAD
Contiguous s(read to endometrium
"yometrium invasion
ee(er invasion o lym(hatic vascular
s(aceirect s(read to (ara aortic nodes.
Cervical involvement
"etastasis
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