Most common invasive cancer of the

female genital tract Arise mainly in Postmenopausal Women Uncommon in women younger than 40 years of age Peak Incidence: 55-65 year old women

Characteristics Age Clinical Setting

Morphology

Type I 55-65 yr Unopposed estrogen Obesity Hypertension Diabetes Endometrioid

Type II

65-75 Atrophy Thin physique

Serous Clear Cell Mixed Mullerian Tumor

Characteristics Precursor

Type I Hyperplasia

Molecular genetics PTEN PIK3CA KRAS MSI B-catenin P53

Type II Endometrial intraepithelial carcinoma P53 Aneuploidy PIK3CA

Characteristics Behavior

Type I Indolent Spreads via lymphatics

Type II Agrgressive Intraperitoneal and lymphatic spread

Localized as polypoid tumor or diffuse tumor involving endometrial surface Spread generally by Direct myometrial invasion with eventual extension to the periuterine structures by direct continuity

Localized as polypoid tumor or diffuse tumor involving endometrial surface Spread generally by Direct myometrial invasion with eventual extension to the periuterine structures by direct continuity

Spread into broad ligaments Palpable Mass Dissemination to the regional lymph nodes May metastasize to the lungs, liver, bones and other organs

ENDOMETRIOID ADENOCARCINOMA
85% of Endometrial Carcinomas Gland Patterns resembling normal endometrial epithelium

COMPLEX ATYPICAL HYPERPLASIA- very closely packed irregular-shaped endometrial gland separated by hyperplastic endometrial stroma

ENDOMETRIOID CARCINOMA

Dilated irregular glands

Grade I. Well Differentiated adenocarcinoma, less than 5% solid growth

Grade II. Moderately differentiated adenocarcinoma with partly (less than 50%) solid growth

Grade III. Poorly differentiated adenocarcinoma with predominantly solid growth (greater than 50%)

SEROUS CARCINOMA most common

subtype

Clear cell carcinoma and Malignant Mixed Mullerian Tumor

confluent glandular pattern cribriform pattern

Papillary pattern

Infiltration of glands

Arise from small uteri Often bulky tumors Deeply invasive into myometrium Precursor lesion: ENDOMETRIAL INTRAEPITHELIAL CARCINOMA Invasive lesions Papillary Growth Pattern
Cells with marked atypia (high nuclear to

cytoplasmic ratio, atypical figures, heterochromasia and prominent nucleoli.

What are the important features identified on the hysterectomy specimen in evaluating prognosis?

The prognosis depend heavily on the clinical stage of the disease and its histologic grade and type Hysterectomy specimens with endometrial carcinoma are often submitted for frozen section to determine the depth on invasion.

Clinicians ask for the involvement of the cervix uteri and the ovaries.

The pathologic examination of the uterus and adnexa is necessary for final staging on the postoperative specimen

In that process, the ff are taken: weight and the size of the uterus and adnexa appearance of the serosal surface, the myometrium, and the uninvolved endometrium The uterine tumor should be described

location 3-dimensional size distance from the margins and from the external oa descriptive characteristics (eg, exophytic, necroses, color) estimated depth of infiltration into the myometrium, and its infiltration of the cervix

What is the relationship of parity, age, exogenous estrogen administration to the development of the endometrium?

Clinicopathologic and epidemiologic studies have supported the malignant of endometrial hyperplasia and the concept of a continuum of proliferative glandular lesions culminating in some cases, in carcinoma.

Furthermore, molecular studies have confirmed that endometrial hyperplasia and carcinoma have specific molecular genetic alterations.

Therefore, since the following factors mentioned (parity, age, exogenous estrogen administration ) are also closely related to endometrial hyperplasia, its safe to say that this factors can also contribute to endometrial carcinoma.

Why did this patient receive internal radium radiation

THANK YOU!

A malignant mixed Mllerian tumor, also known as malignant mixed mesodermal tumor, MMMT and carcinosarcoma, is a malignant neoplasm found in the uterus , the ovaries, the fallopian tubes and other parts of the body that contains both carcinomatous (epithelial tissue) and sarcomatous (connective tissue) components. It is divided into two types, homologous (in which the sarcomatous component is made of tissues found in the uterus such as endometrial, fibrous and/or smooth muscle tissues) and a heterologous type (made up of tissues not found in the uterus, such as cartilage, skeletal muscle and/or bone).