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    Endometrial Carcinoma (INTRO)

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    jijani
    Carcinoma of the endometrium is the fourth most common cancer in women worldwide. The main risk factors are nulliparity, tamoxifen use, and hereditary non-polyposis colorectal cancer. Endometrial carcinoma is classified into Type I (estrogen-dependent) and Type II (not estrogen-dependent and more aggressive). Adenocarcinoma is the most common type, accounting for 80% of cases. Other variants include serous carcinoma, clear cell carcinoma, and squamous carcinoma. Staging is based on tumor grade, depth of myometrial invasion, and spread to lymph nodes or other organs.

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    Endometrial Carcinoma (INTRO)

    Uploaded by

    jijani
    124 views35 pages
    Carcinoma of the endometrium is the fourth most common cancer in women worldwide. The main risk factors are nulliparity, tamoxifen use, and hereditary non-polyposis colorectal cancer. Endometrial carcinoma is classified into Type I (estrogen-dependent) and Type II (not estrogen-dependent and more aggressive). Adenocarcinoma is the most common type, accounting for 80% of cases. Other variants include serous carcinoma, clear cell carcinoma, and squamous carcinoma. Staging is based on tumor grade, depth of myometrial invasion, and spread to lymph nodes or other organs.

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    Carcinoma of the endometrium is the fourth most common cancer in women worldwide. The main risk factors are nulliparity, tamoxifen use, and hereditary non-polyposis colorectal cancer. Endometrial carcinoma is classified into Type I (estrogen-dependent) and Type II (not estrogen-dependent and more aggressive). Adenocarcinoma is the most common type, accounting for 80% of cases. Other variants include serous carcinoma, clear cell carcinoma, and squamous carcinoma. Staging is based on tumor grade, depth of myometrial invasion, and spread to lymph nodes or other organs.

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    124 views35 pages

    Endometrial Carcinoma (INTRO)

    Uploaded by

    jijani
    Carcinoma of the endometrium is the fourth most common cancer in women worldwide. The main risk factors are nulliparity, tamoxifen use, and hereditary non-polyposis colorectal cancer. Endometrial carcinoma is classified into Type I (estrogen-dependent) and Type II (not estrogen-dependent and more aggressive). Adenocarcinoma is the most common type, accounting for 80% of cases. Other variants include serous carcinoma, clear cell carcinoma, and squamous carcinoma. Staging is based on tumor grade, depth of myometrial invasion, and spread to lymph nodes or other organs.

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    of 35

    END OMET RIA L

    C A RCI NOMA

    By
    A.Charumathy
    Final yr mbbs
    ll unit KGH
    Madras medical college

    EPIDEMIOLOGY
    In

    India, incidence is 5-7%.Cervical cancer


    remains the most common gynecological
    malignancy.
    4TH leading cancer in incidence but only 8th
    leading cause of death from malignancy among
    women.
    More frequently occuring gynecological
    cancer(20-25%) in developed countries.

    7 times

    more common in North Americans


    than Chinese counterparts.
    Mostly occurs in 6th&7th decade of life.
    20-25% - perimenopausal women
    5% - below 45yrs of age
    Overall 5 year survival rate is
    75% - Adenocarcinoma
    50% - clear cell & serous CA
    Mostly sporadic,10% is hereditary.

    RISK FACTORS
    Nulliparity

    Tamoxifen

    FACTORS REDUCING
    RISK
    Progesterone-2%
    Early
    menopause Pills-40-50%
    Oral Contraceptive

    PATHOLOGY
    NORMAL
    ENDOMETRIUM

    PROLIFERATIVE
    PHASE

    SECRETORY PHASE

    ENDOMETRIAL
    HYPERPLASIA
    It is an

    increased proliferation of the


    endometrial glands relative to the stroma,
    resulting in an increased gland-to-stroma
    ratio when compared with normal
    proliferative endometrium.
    Evolves in the background of proliferative
    endometrium due to protracted oestrogen
    stimulation in the absence of progestin.

    CLASSIFICATION

    GROSS MORPHOLOGY

    HISTOPATHOLOGY

    ATYPICAL HYPERPLASIA
    Atypical
    Large

    features-:

    nuclei of variable size & shape


    Loss of polarity
    Increase in nuclear to cytoplasmic ratio
    Prominent nucleoli
    Irregularly clumped chromatin with
    parachromatin clearing

    Theendometrial glands are highly irregular in size and shape


    and show frequent outpouchings.Theatypiaischaracterized
    byenlarged round nuclei, irregular chromatin distribution, and
    prominent nucleoli.

    ENDOMETRIAL
    CARCINOMA
    Endometrial

    cancer is a biologically and


    histologically diverse group of neoplasms
    characterized by a dualistic model of
    pathogenesis.
    Type I endometrioid adenocarcinomas
    comprise 75 percent of all cases. They are
    estrogen dependent, low grade, and
    derived from atypical endometrial
    hyperplasia.

    In

    contrast, type II cancers usually have


    serous or clear cell histology, no
    precursor lesion, and a more aggressive
    clinical course

    Feature

    Type I

    Type II

    CLASSIFICATION

    ADENOCARCINOMA
    Also

    called endometroid carcinoma


    80% of endometrial carcinoma
    Tumour is composed of Glands resembling normal endometrial
    glands,
    Columnar cells with basally oriented nuclei ,
    Little or no intracytoplasmic mucin

    Features of

    carninoma
    Desmoplastic reaction
    Back to back glands without intervening
    stroma
    Extensive papillary pattern
    Squamous epithelial differentiation

    GROSS MORPHOLOGY

    HISTOPATHOLOGY

    GRADING (FIGO)
    Based on

    differentiation,glandular
    architecture and nuclear features
    tumours are graded into following
    GRADE I - < 5% SOLID GROWTH
    GRADE II - 6-50% SOLIDGROWTH
    GRADE III - > 50% SOLID GROWTH
    PRESENCEOFNUCLEARATYPIA
    INCREASESGRADEBY1IRRESPECTIVEOF
    ARCHITECTURALGRADING.

    GRADE I

    GRADE II

    GRADE III

    VARIANTS
    With areas

    of squamous differentiation
    Benign
    -Adenocanthoma
    Malignant -Adenosquamous
    Carcinoma
    Villoglandular differentiation
    -Well differentiated
    -Tumour cells arranged along
    fibrovascular stalks
    Secretory carcinoma
    -Rare variant,excellent prognosis

    SECRETORY CARCINOMA

    Theneoplasticglandscontainlargesubnuclear vacuoles impartinga


    piano key appearance.

    MUCINOUS CARCINOMA
    5% of endometrial carcinoma.
    Good prognosis
    Behaves as normal

    endometroid tumour
    >1/2 of tumour composed of cells with
    intracytoplasmic mucin

    Abundantmucinisfillingthecytoplasmofneoplastic cells.alsopresentin
    luminalspaces

    SEROUS CARCINOMA
    3-4% of endometrial carcinoma
    Aggressive

    tumour with poor prognosis


    Similar to serous carcinoma of ovary &
    fallopian tube
    Also called uterine papillary serous
    carcinoma
    Tumour is composed of fibrovascular stalks
    lined by highly atypical cells with tufted
    stratification.

    Psammoma

    bodies are seen.


    High rate of reccurence.
    Serous carcinoma have lymphovascular
    and deep myometrial invasion.

    Theimageshowspapillary clustersofhigh-grade neoplastic cells.


    Numerousmitotic figurescanbeseen.Otherfeaturesthatarefrequentlyseen
    includenecrosis, psammoma bodies,andinvasion of the myometrium.

    CLEAR CELL
    CARCINOMA
    <5% of endometrial carcinoma
    Occurs

    in older women.
    Aggressive tumour with poor prognosis.
    Mixed histologic pattern
    (papillary,tubulocyctic, glandular &
    solid types).
    Cells have hobnail configuration arranged in
    papillae with hyanilized stalk

    Thetumoriscomposedofpolygonal cellswithabundant clear


    cytoplasm(duetoglycogencontent).Ithasdistinct cytoplasmic
    bordersandmoderatecytologicatypia.

    SQUAMOUS CARCINOMA
    Rare

    variant, especially the pure


    variety.Often glands are present.
    Often associated with cervical stenosis,
    chronic inflammation, pyometra at the time of
    diagnosis
    It has a very poor prognosis with 36%
    survival rate.

    SPREAD
    Contiguous spread to endometrium
    Myometrium invasion
    Deeper invasion

    of lymphatic & vascular

    space
    Direct spread to para aortic nodes.
    Cervical involvement
    Metastasis

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