DOCSLIB.ORG

Diagnostic Immunohistochemistry in Gynaecological Neoplasia: a Brief Survey of the Most Common Scenarios Elisabetta Kuhn,1,2,3 Ayse Ayhan4,5

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Diagnostic Immunohistochemistry in Gynaecological Neoplasia: a Brief Survey of the Most Common Scenarios Elisabetta Kuhn,1,2,3 Ayse Ayhan4,5 Best practice J Clin Pathol: first published as 10.1136/jclinpath-2017-204787 on 28 November 2017. Downloaded from Diagnostic immunohistochemistry in gynaecological neoplasia: a brief survey of the most common scenarios Elisabetta Kuhn,1,2,3 Ayse Ayhan4,5 1Pathology Unit, Arcispedale ABSTRact of gynaecological malignancies and enriched the Santa Maria Nuova–IRCCS, Immunohistochemistry is a valuable adjunct in routine portfolio of IHC markers useful in the differential Reggio Emilia, Italy 2 diagnosis of gynaecological diseases. Accordingly, Department of Morphology, gynaecological pathology. The molecular revolution Surgery and Experimental has redesigned knowledge of gynaecological cancers IHC represents a solid adjunct for the classifica- Medicine, University of Ferrara, and refined histological classification. The direct tion of gynaecological malignancies that improves Ferrara, Italy 1 3 consequence has been the progressive introduction of interobserver reproducibility and has the poten- Laboratory of Technology for new immunostainings for diagnostic and classification tial of revealing unexpected features. However, Advanced Therapies (LTTA), University of Ferrara, Ferrara, purposes. Hence, we review the routine diagnostic use interpretation in the light of knowledge-based Italy of immunohistochemistry in the field of gynaecological specificity of each single marker along with histo- 4Departments of Pathology, neoplasia. We reviewed the immunomarkers useful pathology expertise and stringency is still the sine Hamamatsu and Hiroshima in gynaecological pathology according to literature qua non. A satisfactory IHC must localise cells and Universities Schools of Medicine, Seirei Mikatahara Hospital, revision, our personal experience and research findings. tissue targets, clearly and specifically, keeping the Hamamatsu, Japan We discuss the application of immunohistochemistry to non-specific background to a minimum level. 5Department of Pathology, reach the most accurate diagnosis in morphologically Here, we will describe the panels of IHC markers Johns Hopkins University equivocal cases of gynaecological pathology and used in the most common scenarios of differential School of Medicine, Baltimore, present the appropriate panel of immunomarkers in the diagnosis seen in routine gynaecological pathology, Maryland, USA most common scenarios of gynaecological pathology. along with their rationale. Though beyond the Correspondence to This short review provides an updated overview of the scope of this paper, clinical information and macro- Dr Elisabetta Kuhn, Department essential immunohistochemical markers currently used scopical and microscopical features will be outlined of Morphology, Surgery and in the diagnostics of gynaecological malignancies along at times since they still represent a keystone for Experimental Medicine and with their molecular rationale. the correct diagnosis and characterisation of many Laboratory of Technology for pathological entities. Advanced Therapies Centre, University of Ferrara, Ferrara 44121, Italy; elisabettakuhn@ hotmail. it and Professor INTRODUCTION LOOKING at THE OVARY Ayse Ayhan, Department Immunohistochemistry (IHC) combines micro- Primary ovarian tumours are summarised in three of Pathology, Hamamatsu scopic morphology with accurate molecular iden- main subgroups with well-defined clinicopatho- http://jcp.bmj.com/ University School of Medicine, tification and allows in situ visualisation of any logical characteristics: epithelial, germ-cell and Handayama 1-20-1, 431- 2 3192 Hamamatsu, Japan; specific protein antigen. The introduction of IHC sex-cord stromal tumours (table 1). However, ayseayhanjp@ gmail. com in diagnostic pathology has revolutionised routine metastatic tumours and primary tumours derived practice, and IHC studies have significantly contrib- from non-ovarian-specific lymphoid or stromal EK and AA contributed equally. uted to a better understanding and subtyping of cells (ie, lymphomas, leukaemias and soft-tissue Received 12 September 2017 many malignancies, initially lymphoid neoplasms. tumours) should not be ignored since they repre- on November 6, 2020 by guest. Protected copyright. Revised 2 November 2017 Furthermore, IHC has become an integral part of sent a large proportion of ovarian malignancies. Accepted 3 November 2017 the definition of the majority of solid tumours and Currently, PAX8 is emerging as the most specific Published Online First is progressively gaining a foothold in guiding anti- marker to distinguish a primary ovarian carcinoma 7 December 2017 cancer therapy. Among other examples, HER2/neu from a metastasis, but it lacks sensibility as it is and oestrogen receptor (ER) expression is routinely also expressed in metastasis from the endocervix, used to identify patients with breast cancer eligible kidney and thyroid (see figure 1 and table 2).1 The to trastuzumab and tamoxifen, respectively. most common malignancy of the ovary is high- With the boost and consequential widespread use grade serous carcinoma (HGSC) that together with of advanced technologies, molecular studies that other serous tumours of the adnexa (low-grade claim to have discovered novel candidate makers serous carcinoma and borderline serous tumour) with diagnostic, predictive, prognostic or thera- are now thought to derive from the fallopian tube peutic value are published daily. In this context, the epithelium.3 4 Coherently, these tumours demon- responsibility of the pathologist is increasing. Besides strate consistent nuclear expression of Müllerian making tissue diagnosis, they are also in charge of marker WT1, which is highly expressed in the (1) guaranteeing the adequacy of samples used for normal tubal epithelium.3 WT1 is the most sensitive diagnostic tests, which will be translated into ther- and specific marker for serous histotype and can be apeutic decisions, (2) performing IHC biomarker used to discriminate serous tumours from all other To cite: Kuhn E, analysis and (3) assisting the development of novel histotypes. Ayhan A. J Clin Pathol tissue biomarkers. Over the last decade, molecular Recently, a practical approach to the use of IHC 2018;71:98–109. studies have unveiled the molecular genetic pathway in the classification of primary ovarian carcinomas 98 Kuhn E, Ayhan A. J Clin Pathol 2018;71:98–109. doi:10.1136/jclinpath-2017-204787 Kuhn E, Ayhan A. Ayhan A. Kuhn E, J Clin Pathol Table 1 Clinicopathological characteristics of ovarian tumours Laterality 5-year Differential 2018; Frequency Mean age (mean size) Stage Macro Micro Grade Chemoresponse survival diagnosis 71 Primary ovarian malignancies :98–109. doi:10.1136/jclinpath-2017-204787 :98–109. HGSC 70% 63 Bilateral III–IV Papillary, solid-cystic with necrosis and Solid, papillary and glandular growth of large cells with pleomorphic nuclei High Good 30% EMC, CCC, TCC, LGSC haemorrhage and prominent nucleoli. Brisk mitotic activity LGSC 3%–5% 53 Bilateral III Cystic, papillary with calcifications Small nest or micropapillae of uniform cells with mild–moderate atypia within Low Moderate 85% HGSC, CCC, SBT stroma. Psammoma bodies. Associated with SBT EMC 10%–15% 58 Unilateral I Solid or Solid-cystic Back-to-back tubular or cribriform glands, focally mucinous, secretory or Low Good 78% MC, HGSC, metastasis (15 cm) squamoid endometriosis CCC 5%–10% 55 Unilateral I Solid-cystic Tubulocystic, papillary and solid growth, clear cuboidal cells, sometimes High Poor 75% HGSC, mixed HGSC/ (15 cm) eosinophilic, papillae hyalinised stroma, with endometriosis EMC, LGSC, YST MC 3% 45 Unilateral I Solid-cystic Variably atypical cells with expansile or destructive invasive pattern. Low Poor >90% Metastasis (>12 cm) Heterogeneous tumours with benign, MBT and carcinoma features SMC Rare 40–50 Bilateral I Solid or solid-cystic Mixture of Müllerian cell phenotypes associated with SMBT Low NA Poor HGSC, EMC MMMT 2% 60 Unilateral III Solid with necrosis and haemorrhage HGSC or EMC component plus sarcomatous component, either non-specific or High Moderate 15%–30% HGSC, EMC with (14 cm) heterologous (chondro, rhabdomyo, osteo, lipo) spindle elements GCT 1% 53 Unilateral I Solid-cystic Diffuse, trabecular, insular or microfollicular growth pattern of uniform small Low Moderate 60% HGSC, SCC-HT (10 cm) cells with round to oval nuclei, rare grooves and scant pale cytoplasm SCC-HT Rare 20 Unilateral III Solid-cystic, pale with necrosis and Diffuse pattern with follicle-like spaces, small homogeneous hyperchromatic High Moderate 40% HGSC, GCT (15 cm) haemorrhage cells, mitotically active, sometimes with intermingled larger eosinophilic cells with large nuclei and prominent nuclei Metastatic adenocarcinoma* Colorectal Common 70 Bilateral IV Solid, friable with necrosis and haemorrhage Small or large glands, often cribriform, composed of non-mucinous atypical High NA Poor MC (12 cm) cells with central dirty necrosis Biliopancreatic Rare 60 Bilateral IV Solid-cystic Small or large glands into desmoplastic stroma or scarce stroma Variable NA Poor MC, MBLT Mammary Common 49 Bilateral IV Solid Ductal or lobular carcinoma High NA Poor EMC (<5 cm) (with a 3:1 proportion) Appendiceal Rare 45 Bilateral IV Multicystic and mucoid or solid and firm Low-grade mucinous neoplasm with abundant mucin or mucinous Low/high NA Good or MC, MBLT (15/11 cm) adenocarcinoma, that is, goblet cell carcinoid, signet ring carcinoma or poor intestinal-type adenocarcinoma Gastric Common 43 Bilateral IV Solid, firm, oedematous Signet ring cells arranged in tubules or sheets
Load more

Recommended publications
  • Diagnostic Immunochemistry in Gynaecological Neoplasia Guide to Diagnosis
    International Journal of Scientific and Research Publications, Volume 9, Issue 9, September 2019 356 ISSN 2250-3153 Diagnostic Immunochemistry in Gynaecological Neoplasia Guide to Diagnosis S.S Pattnaik, J.Parija,S.K Giri, L.Sarangi, Niranjan Rout, S. Samantray, N. Panda,B.L Nayak, J.J Mohapatra, M.R Mohapatra, A.K Padhy Presently Working As Senior Resident In Dept Of Gynaecology Oncology, At Ahrcc ,M.B.B.S , M.D (O&G) DOI: 10.29322/IJSRP.9.09.2019.p9346 http://dx.doi.org/10.29322/IJSRP.9.09.2019.p9346 Abstract- AIM AND OBJECTIVE - This short review provides an updated overview of the essential immunochemical markers currently used in the diagnostics of gynaecological malignancies along with their molecular rationale. The new molecular markers has revolutionized the field of IHC MATERIAL METHODS -We have reviewed the recent ihc markers according to literature revision and our experiencewe, have discussed the the use of ihc , CONCLUSION- The above facts will help reach at a diagnosis in morphologically equivocal cases of gynaecology oncology pathology, and guide us to use a specific the panel of ihc ,which will help us reach accurate diagnosis. I. INTRODUCTION HC combines microscopic morphology with accurate molecular identification and allows in situ visualisation of specific protein I antigen . IHC has definite role in guiding cancer therapy.The role of pathologist is increasing beside tissue diagnoses , to perfoming IHC biomarker analyse ,assisting the development of novel markers. Ihc markers are being in used in new perspective , in guiding anticancer therapy.ihc represents a solid adjunct for the classification of gynaecological malignancies that improves intraobserver reproducibility and has potential of revealing unexpected features(1) OVARIAN IHC: • PAX -8 is the most specific marker, emerging to diagnose primary ovarian cancer,but it lacks sensibility as it is also expressed in metastasis from endocervix ,kidney and thyroid.
    [Show full text]
  • Histopathology of Gynaecological Cancers
    1 Histopathology of gynaecological cancers Ovarian tumours Ovarian tumours are classified based on cell types, Classification of Tumours of the Ovary patterns of growth and, whenever possible, on Epithelial tumours (ET) histogenesis (WHO Classification 2014). Sex cord–stromal tumours (SCST) There are 3 major categories of primary ovarian tumour: Germ cell tumours (GCT) epithelial tumours (ETs), sex cord–stromal tumours Monodermal teratoma and somatic type tumours arising from dermoid cyst (SCSTs) and germ cell tumours (GCTs). Secondary Germ cell–sex cord stromal tumours tumours are not infrequent. Mesenchymal and mixed epithelial and mesenchymal tumours The incidence of malignant forms varies with age. Other rare tumours, tumour-like conditions Carcinomas, accounting for over 80%, peak at the 6th Lymphoid and myeloid tumours decade; SCSTs peak in the perimenopausal period; GCTs Secondary tumours peak in the first three decades. Prognosis is worse for WHO, 2014 carcinomas. Stage I: Tumour confined to ovaries or Fallopian tube(s) IA: Tumour limited to 1 ovary (capsule intact) or Fallopian tube; no tumour on ovarian or Fallopian tube surface; no malignant cells in the ascites or peritoneal The staging classification has been recently revised washings (FIGO 2013 Classification) and ovarian, Fallopian tube IB: Tumour limited to both ovaries (capsules intact) or Fallopian tubes; no and peritoneal cancer are classified together. tumour on ovarian or Fallopian tube surface; no malignant cells in the ascites or peritoneal washings Stage I cancer is confined to the ovaries or Fallopian IC: Tumour limited to 1 or both ovaries or Fallopian tubes, with any of the following: • IC1: Surgical spill tubes.
    [Show full text]
  • Prognostic Factors for Patients with Early-Stage Uterine Serous Carcinoma Without Adjuvant Therapy
    J Gynecol Oncol. 2018 May;29(3):e34 https://doi.org/10.3802/jgo.2018.29.e34 pISSN 2005-0380·eISSN 2005-0399 Original Article Prognostic factors for patients with early-stage uterine serous carcinoma without adjuvant therapy Keisei Tate ,1 Hiroshi Yoshida ,2 Mitsuya Ishikawa ,1 Takashi Uehara ,1 Shun-ichi Ikeda ,1 Nobuyoshi Hiraoka ,2 Tomoyasu Kato 1 1Department of Gynecology, National Cancer Center Hospital, Tokyo, Japan 2Department of Pathology and Clinical Laboratories, National Cancer Center Hospital, Tokyo, Japan Received: Nov 29, 2017 ABSTRACT Revised: Jan 15, 2018 Accepted: Jan 26, 2018 Objective: Uterine serous carcinoma (USC) is an aggressive type 2 endometrial cancer. Data Correspondence to on prognostic factors for patients with early-stage USC without adjuvant therapy are limited. Keisei Tate This study aims to assess the baseline recurrence risk of early-stage USC patients without Department of Gynecology, National Cancer adjuvant treatment and to identify prognostic factors and patients who need adjuvant therapy. Center Hospital, 5 Chome-1-1 Tsukiji, Chuo-ku, Methods: Sixty-eight patients with International Federation of Gynecology and Obstetrics Tokyo 104-0045, Japan. (FIGO) stage I–II USC between 1997 and 2016 were included. All the cases did not undergo E-mail: [email protected] adjuvant treatment as institutional practice. Clinicopathological features, recurrence Copyright © 2018. Asian Society of patterns, and survival outcomes were analyzed to determine prognostic factors. Gynecologic Oncology, Korean Society of Results: FIGO stages IA, IB, and II were observed in 42, 7, and 19 cases, respectively. Median Gynecologic Oncology follow-up time was 60 months. Five-year disease-free survival (DFS) and overall survival This is an Open Access article distributed under the terms of the Creative Commons (OS) rates for all cases were 73.9% and 78.0%, respectively.
    [Show full text]
  • Mixed Epithelial Carcinoma of the Endometrium: Recommendations for Diagnosis from the Isgyp Endometrial Carcinoma Project
    Mixed Epithelial Carcinoma of the Endometrium: Recommendations for Diagnosis from the ISGyP Endometrial Carcinoma Project Joseph Rabban MD MPH Pathology Department University of California San Francisco March 2017 Introduction The 2014 edition of the World Health Organization (WHO) Classification of Tumors of the Female Reproductive Organs recognizes mixed carcinoma (also called mixed cell adenocarcinoma by WHO) as a specific histologic category of epithelial endometrial cancer.(1) The 2014 WHO defines it as a tumor composed of “two or more different histological types of endometrial carcinoma, at least one of which is of the type II category.” The term “type II” category refers to non-endometrioid, non-mucinous types (e.g. serous carcinoma, clear cell carcinoma, carcinosarcoma). The rationale for recognizing this category stems largely from the adverse behavior of tumors that contain as little as 5% of a component of serous carcinoma admixed with endometrioid adenocarcinoma, with the implication that the type II tumor component should drive patient management. The International Society of Gynecologic Pathologists (ISGyP) Endometrial Carcinoma Project has reviewed this definition and identified areas that merit clarification and areas that remain controversial. This lecture will address practical recommendations for the diagnosis of mixed epithelial carcinoma of the endometrium and review the key entities in the differential diagnosis. Clinical Significance The literature on mixed epithelial carcinoma of the endometrium is composed of three kinds of studies: 1.) studies of endometrial serous carcinoma in which some of the cases are pure serous carcinoma and some are mixed with endometrioid adenocarcinoma; 2.) studies of endometrial clear cell carcinoma in which some cases are pure and some are mixed with other cancer types; 3.) studies specifically of mixed endometrial cancers.
    [Show full text]
  • A New Potential Serum Biomarker for Uterine Serous Papillary Cancer
    Imaging, Diagnosis, Prognosis HumanKallikrein6:ANewPotentialSerumBiomarkerforUterine Serous Papillary Cancer Alessandro D. Santin,1Eleftherios P.Diamandis,2 Stefania Bellone,1Antoninus Soosaipillai,2 Stefania Cane,1 Michela Palmieri,1Alexander Burnett,1Juan J. Roman,1 and Sergio Pecorelli3 Abstract Purpose:The discovery of novel biomarkers might greatly contribute to improve clinical manage- ment and outcomes in uterine serous papillary carcinoma (USPC), a highly aggressive variant of endometrial cancer. Experimental Design: Human kallikrein 6 (hK6) gene expression levels were evaluated in 29 snap-frozen endometrial biopsies, including13 USPC, 13 endometrioid carcinomas, and 3 normal endometrial cells by real-time PCR. Secretion of hK6 protein by 14 tumor cultures, including3 USPC, 3 endometrioid carcinoma, 5 ovarian serous papillary carcinoma, and 3 cervical cancers, was measured usinga sensitive ELISA. Finally, hK6 concentration in 79 serum and plasma sam- ples from 22 healthy women, 20 women with benign diseases, 20 women with endometrioid car- cinoma, and17USPC patients was studied. Results: hK6 gene expression levels were significantly higher in USPC when compared with endometrioid carcinoma (mean copy number by real-time PCR, 1,927 versus 239, USPC versus endometrioid carcinoma; P < 0.01). In vitro hK6 secretion was detected in all primary USPC cell lines tested (mean, 11.5 Ag/L) and the secretion levels were similar to those found in primary ovarian serous papillary carcinoma cultures (mean, 9.6 Ag/L). In contrast, no hK6 secretion was detectable in primary endometrioid carcinoma and cervical cancer cultures. hK6 serum and plasma concentrations (mean F SE) amongnormal healthy females (2.7 F 0.2 Ag/L), patients with benign diseases (2.4 F 0.2 Ag/L), and patients with endometrioid carcinoma (2.6 F 0.2 Ag/L) were not significantly different.
    [Show full text]
  • Education Licenses, Certification Principal
    Prepared: October 1, 2019 Name: Joseph T. Rabban III, MD, MPH Position: Professor of Clinical Pathology Pathology School of Medicine Address: UCSF Mission Bay Hospital 1825 4th Street, M-2359 Box 0102, Pathology Department San Francisco, CA 94158 353-2292 Fax: 353-1612 [email protected] EDUCATION 1988 - 1992 Brown University Sc.B. Biology 1992 - 1998 Harvard Medical School M.D. Medicine 1995 - 1996 Harvard School of Public Health M.P.H. Medicine 1998 - 1999 University Of California, San Francisco Intern General Surgery 1999 - 2001 University Of California, San Francisco Resident Anatomic Pathology 2001 - 2002 University Of California, San Francisco Fellow Surgical Pathology 2002 - 2003 University Of California, San Francisco Fellow Cytopathology 2003 - 2004 Harvard Medical School (Massachusetts Fellow Gynecologic General Hospital) and Breast Pathology LICENSES, CERTIFICATION 2000 Medical license 70912, State of California (active license) 2002 American Board of Pathology (Anatomic Pathology) 2003 American Board of Pathology (Cytopathology) PRINCIPAL POSITIONS HELD 2001 - 2002 University Of California, San Francisco Chief Resident 2003 - 2004 Massachusetts General Hospital Fellow / Graduate Assistant 2004 - 2008 University Of California, San Francisco Assistant Pathology Professor 2008 - 2013 University Of California, San Francisco Associate Pathology Professor 1 of 28 Prepared: October 1, 2019 2013 - present University Of California, San Francisco Professor Pathology OTHER POSITIONS HELD CONCURRENTLY 2004 - 2010 UCSF Medical Center
    [Show full text]
  • Serous Tubal Intraepithelial Carcinoma: a Concise Review for the Practicing Pathologist and Clinician
    diagnostics Review Serous Tubal Intraepithelial Carcinoma: A Concise Review for the Practicing Pathologist and Clinician S. Emily Bachert 1 , Anthony McDowell Jr. 2, Dava Piecoro 1 and Lauren Baldwin Branch 2,* 1 Department of Pathology and Laboratory Medicine, University of Kentucky College of Medicine, Lexington, KY 40536, USA; [email protected] (S.E.B.); [email protected] (D.P.) 2 Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Kentucky College of Medicine, Lexington, KY 40536, USA; [email protected] * Correspondence: [email protected] Received: 16 December 2019; Accepted: 8 February 2020; Published: 13 February 2020 Abstract: Ovarian cancer is the deadliest gynecologic malignancy, accounting for more than 14,000 deaths each year. With no established way to prevent or screen for it, the vast majority of cases are diagnosed as International Federation of Gynecology and Obstetrics (FIGO) stage III or higher. Individuals with germline BRCA mutations are at particularly high risk for epithelial ovarian cancer and have been the subject of many risk-reducing strategies. In the past ten years, studies looking at risk-reducing salpingo-oophorectomy (RRSO) in this population have uncovered an interesting association: up to 8% of women with BRCA1 or BRCA2 mutations who underwent RRSO had an associated serous tubal intraepithelial carcinoma (STIC). The importance of this finding is highlighted by the fact that up to 60% of ovarian cancer patients will also have an associated STIC. These studies have led to a paradigm shift that a subset of epithelial ovarian cancer originates not in the ovarian epithelium, but rather in the distal fallopian tube.
    [Show full text]
  • Analysis of the Outcome of Patients with Stage IV Uterine Serous Carcinoma Mimicking Ovarian Cancer
    medRxiv preprint doi: https://doi.org/10.1101/19002410; this version posted July 16, 2019. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. All rights reserved. No reuse allowed without permission. Analysis of the outcome of patients with stage IV uterine serous carcinoma mimicking ovarian cancer Murad Al-Aker1, Karen Sanday2, James Nicklin2 1Cancer Therapy Centre, Liverpool Hospital, Liverpool, NSW 2190 2Queensland Centre for Gynecological Cancer, Brisbane, Queensland, Australia Correspondence author: Dr Murad Al-Aker, MBBS, JBOG, CABOG, FACOG, FRANZCOG Staff Specialist Gynaecological Oncologist Cancer Therapy Centre| Liverpool Hospital Locked Bag 7103 |Liverpool BC| NSW|1871 T: 02 87385277| F: 02 87389819 |E: [email protected] 1 NOTE: This preprint reports new research that has not been certified by peer review and should not be used to guide clinical practice. medRxiv preprint doi: https://doi.org/10.1101/19002410; this version posted July 16, 2019. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. All rights reserved. No reuse allowed without permission. Primary objective: To analyse the clinicopathological factors that might influence the progression-free survival and overall survival in patients with stage IV uterine serous carcinoma treated at Queensland Centre for Gynecological cancer. Secondary objective: To compare the survival outcomes of patients with stage IV uterine serous carcinoma treated with neoadjuvant chemotherapy and interval cytoreduction, with those treated with primary cytoreductive surgery followed by adjuvant chemotherapy and patients who received palliative care only.
    [Show full text]
  • Endometrial Carcinoma
    10 Endometrial Carcinoma Important Issues in Interpretation of The tumors are often associated with hyper- Biopsies . 209 plasia and atypical hyperplasia, conditions that Criteria for the Diagnosis of result from unopposed estrogenic stimulation Well-Differentiated Endometrial such as anovulatory cycles that normally occur Adenocarcinoma . 209 at the time of menopause or in younger women Benign Changes that Mimic with the Stein–Leventhal syndrome (polycystic Carcinoma . 214 ovarian disease). Unopposed exogenous estro- Malignant Neoplasms—Classification, gen use as hormone replacement therapy in Grading, and Staging of the Tumor . 216 older women also predisposes to endometrial Classification . 216 carcinoma that tends to be low-grade. In hys- Grading . 216 Clinically Important Histologic terectomy specimens these low-grade tumors Subtypes . 221 generally show minimal myometrial invasion, Staging . 236 although deep invasion can occur in some Endometrial Versus Endocervical cases.5;6 The prognosis is generally good, with a Carcinoma . 237 5-year survival of 80% or better.3 Metastatic Carcinoma . 238 Type II neoplasms represent another, very Clinical Queries and Reporting . 239 different, form of endometrial carcinoma. They are high-grade neoplasms that do not appear to be related to sustained estrogen stimulation.1;2;4 Endometrial adenocarcinoma is the most com- Tumors in this group account for 15% to 20% mon malignant tumor of the female genital of all endometrial carcinomas. The prototypical tract in the United States. This neoplasm rep- type II neoplasm is serous carcinoma, but other resents a biologically and morphologically histologic subtypes include clear cell carcino- diverse group of tumors, with differing patho- mas and other carcinomas that show high-grade genesis.1–4 These tumors have two basic clinico- nuclear features.
    [Show full text]
  • Management of Women with Uterine Papillary Serous Cancer: a Society of Gynecologic Oncology (SGO) Review☆
    Gynecologic Oncology 115 (2009) 142–153 Contents lists available at ScienceDirect Gynecologic Oncology journal homepage: www.elsevier.com/locate/ygyno Review Management of women with uterine papillary serous cancer: A Society of Gynecologic Oncology (SGO) review☆ David M. Boruta II a,⁎, Paola A. Gehrig b, Amanda Nickles Fader c, Alexander B. Olawaiye d a Department of Obstetrics, Gynecology and Reproductive Biology, Division of Gynecologic Oncology, Massachusetts General Hospital, Boston, MA 02114, USA b Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA c Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Cleveland Clinic Foundation, Cleveland, OH 44195, USA d Department of Obstetrics, Gynecology, and Reproductive Sciences, Division of Gynecologic Oncology, University of Pittsburgh Medical Center, Magee-Women's Hospital, Pittsburgh, PA 15213, USA article info abstract Article history: Objective. Uterine papillary serous carcinoma (UPSC) is a clinically and pathologically distinct subtype of Received 7 May 2009 endometrial cancer. Although less common than its endometrioid carcinoma (EEC) counterpart, UPSC Available online 9 July 2009 accounts for a disproportionate number of endometrial cancer related deaths. To date, limited prospective trials exist from which evidence-based management can be developed. This review summarizes the Keywords: available literature concerning UPSC in an effort to provide the clinician with information pertinent to its Uterine papillary serous carcinoma management. Endometrial cancer Staging Methods. MEDLINE was searched for all research articles published in English between January 1, 1966 Radiotherapy and May 1, 2009 in which the studied population included women diagnosed with UPSC. Although Chemotherapy preference was given to prospective studies, studies were not limited by design or by numbers of subjects given the paucity of available reports.
    [Show full text]
  • A Case of Synchronous Serous Ovarian Cancer and Uterine Serous Endometrial Intraepithelial Carcinoma
    A Case of Synchronous Serous Ovarian Cancer and Uterine Serous Endometrial Intraepithelial Carcinoma Maho Shimizu Kobe University Graduate School of Medicine School of Medicine: Kobe Daigaku Daigakuin Igakukei Kenkyuka Igakubu https://orcid.org/0000-0002-3079-8303 Keitaro Yamanaka Kobe University Graduate School of Medicine School of Medicine: Kobe Daigaku Daigakuin Igakukei Kenkyuka Igakubu Maho Azumi Kobe University Graduate School of Medicine School of Medicine: Kobe Daigaku Daigakuin Igakukei Kenkyuka Igakubu Masako Tomimoto Kobe University Graduate School of Medicine School of Medicine: Kobe Daigaku Daigakuin Igakukei Kenkyuka Igakubu Keiichi Washio Kobe University Graduate School of Medicine School of Medicine: Kobe Daigaku Daigakuin Igakukei Kenkyuka Igakubu Ryosuke Takahashi Kobe University Graduate School of Medicine School of Medicine: Kobe Daigaku Daigakuin Igakukei Kenkyuka Igakubu Satoshi Nagamata Kobe University Graduate School of Medicine School of Medicine: Kobe Daigaku Daigakuin Igakukei Kenkyuka Igakubu Yuka Murata Kobe University Graduate School of Medicine School of Medicine: Kobe Daigaku Daigakuin Igakukei Kenkyuka Igakubu Yui Yamasaki Kobe University Graduate School of Medicine School of Medicine: Kobe Daigaku Daigakuin Igakukei Kenkyuka Igakubu Yoshito Terai ( [email protected] ) Department of Obstetrics and Gynecology, Kobe University Graduate School of Medicine 7-5-2 Kusunoki- cho, Chuo-ku, Kobe, Hyogo, 650-0017 Japan https://orcid.org/0000-0002-5581-8518 Page 1/12 Case report Keywords: Serous ovarian cancer, Serous endometrial intraepithelial carcinoma, SEIC Posted Date: May 10th, 2021 DOI: https://doi.org/10.21203/rs.3.rs-486209/v1 License: This work is licensed under a Creative Commons Attribution 4.0 International License. Read Full License Page 2/12 Abstract Background Serous endometrial intraepithelial carcinoma (SEIC) is now considered to represent an early stage of uterine serous carcinoma (USC).
    [Show full text]
  • Endometrial Carcinoma Associated with Ovarian Granulosa Cell Tumors – a Case Report
    ANTICANCER RESEARCH 35: 5547-5550 (2015) Endometrial Carcinoma Associated with Ovarian Granulosa Cell Tumors – A Case Report NICOLAE BACALBASA1, CLAUDIA STOICA2, ILEANA POPA3, GRATIELA MIREA2 and IRINA BALESCU4 1Obstetrics and Gynecology Department Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; 2General Surgery Department, Ilfov County Hospital, Bucharest, Romania; 3Pathology Department Coltea Clinical Hospital, Bucharest, Romania; 4General Surgery Department, Ponderas Hospital, Bucharest, Romania Abstract. Ovarian granulosa cell tumors represent patients, abnormal vaginal bleeding, abdominal swelling and uncommon neoplasms with estrogen-secreting capacity. Due even abnormal palpable masses in the lower abdomen can be to their association with persistently increased levels of seen (4). Most tumors are large, solid or cystic, with slow estrogen, modifications of the endometrial tissue ranging growth and tendency for late recurrence (1, 4, 6). When it from hyperplasia to malignant degeneration may be comes to their hormonal activity, estradiol has been encountered. We present the case of a 65-year-old patient advocated as a true tumor marker for these neoplasias (4, 7). who presented for post-menopausal vaginal bleeding. The However, the estradiol concentration is not a reliable marker endometrial biopsy raised the suspicion of an atypical of disease activity, no significant correlation has been endometrial hyperplasia and the patient was submitted to established between it and the presence of bulky disease (8, surgery. Histopathological studies of the specimen of total 9). Despite this, high hormonal levels can be associated with hysterectomy with bilateral adnexectomy revealed the other significant modifications of estrogen-sensitive tissues, presence of a well-differentiated endometrial carcinoma such as endometrial tissues.
    [Show full text]