Proposed Criteria for the Diagnosis of Well-Differentiated Endometrial Carcinoma

Longacre, Teri A.; Chung, Marilda H.; Jensen, Debra N.; Hendrickson, Michael

doi:10.1097/00000478-199504000-00001

Cited by 89 publications

(36 citation statements)

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“…[19][20][21][22] The risk of associated malignancy in mucinous changes has been reported significant 2 and lesions with complex architectural patterns may carry the same prognostic significance as conventional atypical endometrial hyperplasia. 23,24 It has been proposed that mucinous metaplasia may represent a clonal alteration of endometrial glandular epithelium. 25 Histological classifications of mucinous metaplasia were attempted in the past to predict subsequent risk of developing endometrial malignancy by various cytological and histological parameters.…”

Section: Discussionmentioning

confidence: 99%

Frequent KRAS mutation in complex mucinous epithelial lesions of the endometrium

et al. 2014

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KRAS mutation correlates with mucinous differentiation in various human cancers, and recently, was found in a high proportion of a small cohort of papillary mucinous lesions of the endometrium. In this study, a large number of endometrial mucinous lesions were analyzed for the presence of KRAS mutation along with clinical progression. A total of 45 endometrial biopsy/curettage cases were included in the study and classified into the following categories: simple mucinous change (5 cases), complex mucinous change (33 cases) and mucinous adenocarcinoma (7 cases). Follow-up hysterectomy specimens were available in 14 of 33 patients (42%) with complex mucinous lesions, of which 9 cases (64%) showed atypical complex hyperplasia with an average interval of 21 weeks. None of the 5 cases of simple mucinous change showed KRAS mutation. KRAS mutation was observed in 18 of 33 patients with complex mucinous lesions (55%) and in 6 of 7 cases of mucinous adenocarcinoma (86%). Overall, KRAS mutation has a positive predictive value (PPV) of 88% (7/8 cases) for complex atypical hyperplasia or adenocarcinoma in the follow-up hysterectomy. In conclusion, the current data further emphasizes the architectural complexity as an important prognostic indicator for patients with mucinous endometrial lesions. The presence of KRAS mutation in both mucinous adenocarcinoma and complex mucinous changes indicates that KRAS mutational activation is implicated in the pathogenesis of a significant subset of endometrial mucinous carcinoma. With a high PPV, KRAS mutation analysis may offer an additional discriminatory power to refine risk stratification algorithm for patients with endometrial mucinous lesions.

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Section: Discussionmentioning

confidence: 99%

Frequent KRAS mutation in complex mucinous epithelial lesions of the endometrium

et al. 2014

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“…10 -17 A group of gynecologic pathologists at Stanford University, for example, proposed a classification algorithm for predicting clinically significant endometrial lesions. 18 That algorithm was predicated on the use of 1 architectural measure combined with 2 cytologic parameters, and it had 99.5% specificity and 57% sensitivity for detecting myoinvasion based on a set of clinical specimens that were obtained at community hospitals. The WHO endorsed a classification system for endometrial hyperplasia in 1975 that was revised in 1994 and again in 2003.…”

Section: Discussionmentioning

confidence: 99%

Concurrent endometrial carcinoma in women with a biopsy diagnosis of atypical endometrial hyperplasia

Trimble

Kauderer

Zaino

et al. 2006

Cancer

539

301

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BACKGROUNDAdenocarcinoma of the endometrium is the most common gynecologic malignancy in the United States, accounting for approximately 36,000 diagnoses of invasive carcinoma annually. The most common histologic type, endometrioid adenocarcinoma (EC), accounts for 75–80% of patients. The objective of this work was to estimate the prevalence of concurrent carcinoma in women with a biopsy diagnosis of the precursor lesion, atypical endometrial hyperplasia (AEH).METHODSThis prospective cohort study included women who had a community diagnosis of AEH. Diagnostic biopsy specimens were reviewed independently by three gynecologic pathologists who used International Society of Gynecologic Pathologists/World Health Organization criteria. Study participants underwent hysterectomy within 12 weeks of entry onto protocol without interval treatment. The hysterectomy slides also were reviewed by the study pathologists, and their findings were used in the subsequent analyses.RESULTSBetween November 1998 and June 2003, 306 women were enrolled on the study. Of these, 17 women were not included in the analysis: Two patients had unreadable slides because of poor processing or insufficient tissue, 2 patients had only slides that were not endometrial, the slides for 5 patients were not available for review, and 8 of the hysterectomy specimens were excluded because they showed evidence of interval intervention, either progestin effect or ablation. In total, 289 patients were included in the current analysis. The study panel review of the AEH biopsy specimens was interpreted as follows: 74 of 289 specimens (25.6%) were diagnosed as less than AEH, 115 of 289 specimens (39.8%) were diagnosed as AEH, and 84 of 289 specimens (29.1%) were diagnosed as endometrial carcinoma. In 5.5% (16 of 289 specimens), there was no consensus on the biopsy diagnosis. The rate of concurrent endometrial carcinoma for analyzed specimens was 42.6% (123 of 289 specimens). Of these, 30.9% (38 of 123 specimens) were myoinvasive, and 10.6% (13 of 123 specimens) involved the outer 50% of the myometrium. Among the women who had hysterectomy specimens with carcinoma, 14 of 74 women (18.9%) had a study panel biopsy consensus diagnosis of less than AEH, 45 of 115 women (39.1%) had a study panel biopsy consensus diagnosis of AEH, and 54 of 84 women (64.3%) had a study panel diagnosis of carcinoma. Among women who had no consensus in their biopsy diagnosis, 10 of 16 women (62.5%) had carcinoma in their hysterectomy specimens.CONCLUSIONSThe prevalence of endometrial carcinoma in patients who had a community hospital biopsy diagnosis of AEH was high (42.6%). When considering management strategies for women who have a biopsy diagnosis of AEH, clinicians and patients should take into account the considerable rate of concurrent carcinoma. Cancer 2006. © 2006 American Cancer Society.

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“…1,2,17 We report here the clinicopathologic features of all stage I, grades 1 and 2 endometrioid adenocarcinomas and mucinous ovarian adenocarcinomas well staged at MSKCC during a 20-year period. We used the most recently proposed criteria, 1,2,17 supplemented with those of Longacre et al 21 for distinguishing these from borderline tumors and have designed the study to elucidate the significance of destructive stromal invasion with respect to outcome. In the context of invasion patterns, we confirm that all stage I endometrioid adenocarcinomas and mucinous ovarian adenocarcinomas show mostly expansile invasion and that only a subpopulation contain expansile invasion in addition to destructive stromal invasion, the latter of which was almost always microscopic in extent.…”

Section: Discussionmentioning

confidence: 99%

Invasion patterns in stage I endometrioid and mucinous ovarian carcinomas: a clinicopathologic analysis emphasizing favorable outcomes in carcinomas without destructive stromal invasion and the occasional malignant course of carcinomas with limited destructive stromal invasion

et al. 2005

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Stage I, low-grade endometrioid and mucinous ovarian carcinomas have an excellent prognosis. Published data have suggested that destructive stromal invasion, a relatively uncommon finding in these tumors, is a poor prognostic factor. We investigated this by studying all FIGO stage I, grades 1 and 2 (of 3) endometrioid and mucinous ovarian carcinomas that were surgically staged at the Memorial Sloan-Kettering Cancer Center from 1980 to 2000. We undertook a careful review of all available slides using current diagnostic criteria and correlated histopathologic indices with clinical outcome data. Cases studied included 13 endometrioid ovarian carcinomas (stage IA, eight; stage IC, five) and six intestinal mucinous ovarian carcinomas (stage IA, three; stage IC, three). All of the tumors contained areas of expansile invasion, greater than that acceptable for microinvasion, and were thus diagnosed as carcinomas instead of borderline tumors. Nevertheless, nearly all demonstrated borderline tumor (noninvasive) components. Six tumors contained at least one focus of destructive stromal invasion (two endometrioid and four mucinous ovarian carcinomas). Four additional cases showed a focus suspicious for but not diagnostic of destructive invasion ('indeterminate for destructive invasion') (two endometrioid and two mucinous ovarian carcinomas). Follow-up data were available for 17 patients. The median follow-up was 81 months (range, 9-161 months). In all, 14 patients were alive with no evidence of disease (expansile invasion alone, eight; destructive stromal invasion, four; and indeterminate for destructive invasion, two). Three patients died of their disease (destructive stromal invasion, two; and indeterminate for destructive invasion, one). The size, number, and nuclear grade of destructive stromal invasion foci did not appear to have an impact on survival in this relatively limited number of patients. Outcome data in patients with stage I, low-grade endometrioid and mucinous ovarian carcinomas without destructive stromal invasion indicate that these tumors have a very limited malignant potential. The literature has not documented recurrences in this setting when the staging has been complete, the sampling adequate, and the cytologic features no more than grade 2, and metastasis to the ovary has been excluded. In contrast, carcinomas harboring even limited foci of destructive stromal invasion, although frequently cured surgically, can pursue a malignant clinical course. Modern Pathology (2005) 18, 903-911.

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Proposed Criteria for the Diagnosis of Well-Differentiated Endometrial Carcinoma

Cited by 89 publications

References 0 publications

Frequent KRAS mutation in complex mucinous epithelial lesions of the endometrium

Frequent KRAS mutation in complex mucinous epithelial lesions of the endometrium

Concurrent endometrial carcinoma in women with a biopsy diagnosis of atypical endometrial hyperplasia

Invasion patterns in stage I endometrioid and mucinous ovarian carcinomas: a clinicopathologic analysis emphasizing favorable outcomes in carcinomas without destructive stromal invasion and the occasional malignant course of carcinomas with limited destructive stromal invasion

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