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Pathology - Endometrial carcinoma
Definition: A malignant epithelial tumor originating in the endometrium.
Epidemiology • The predominant malignant neoplasm of the female reproductive system in civilized nations. • 85% are estrogen-dependent ('type 1') tumors, prevalent in women in their 50s and 60s. • 15% are estrogen-independent ('type 2') tumors, observed in older women in their 70s and 80s.
Aetiology • Oestrogen-dependent neoplasms are linked to diabetes, obesity, nulliparity, early menarche, late menopause, and polycystic ovarian syndrome. The etiology of estrogen-independent tumors is less defined.
Carcinogenesis • Estrogen-dependent tumors arise from a precursor lesion known as endometrial intraepithelial neoplasia (atypical hyperplasia) against a backdrop of (simple) endometrial hyperplasia. The loss of PTEN function is characteristic. • Oestrogen-independent tumors arise from a precursor lesion known as endometrial intraepithelial carcinoma against a backdrop of endometrial atrophy. The dysfunction of the TP53 gene is characteristic.
Presentation • The primary symptom is post-menopausal hemorrhage. Macroscopy • An exophytic, friable mass occupies the endometrial cavity and infiltrates to variable degrees into the underlying myometrium. • In advanced cases, the tumor may penetrate the serosal surface or infect the cervix.
Histopathology • Estrogen-dependent tumors are typically well-differentiated endometrioid adenocarcinomas characterized by malignant epithelial cells that create intricate villoglandular formations. Oestrogen-independent tumors are typically serous carcinomas or clear cell carcinomas, which closely resemble their ovarian equivalents. Both are high-grade neoplasms with widespread dissemination at the time of presentation.
Prognosis: Oestrogen-dependent tumors typically have a favorable prognosis. Oestrogen-independent tumors exhibit great aggressiveness and are typically lethal.
Definition: A malignant epithelial tumor originating in the endometrium.
Epidemiology • The predominant malignant neoplasm of the female reproductive system in civilized nations. • 85% are estrogen-dependent ('type 1') tumors, prevalent in women in their 50s and 60s. • 15% are estrogen-independent ('type 2') tumors, observed in older women in their 70s and 80s.
Aetiology • Oestrogen-dependent neoplasms are linked to diabetes, obesity, nulliparity, early menarche, late menopause, and polycystic ovarian syndrome. The etiology of estrogen-independent tumors is less defined.
Carcinogenesis • Estrogen-dependent tumors arise from a precursor lesion known as endometrial intraepithelial neoplasia (atypical hyperplasia) against a backdrop of (simple) endometrial hyperplasia. The loss of PTEN function is characteristic. • Oestrogen-independent tumors arise from a precursor lesion known as endometrial intraepithelial carcinoma against a backdrop of endometrial atrophy. The dysfunction of the TP53 gene is characteristic.
Presentation • The primary symptom is post-menopausal hemorrhage. Macroscopy • An exophytic, friable mass occupies the endometrial cavity and infiltrates to variable degrees into the underlying myometrium. • In advanced cases, the tumor may penetrate the serosal surface or infect the cervix.
Histopathology • Estrogen-dependent tumors are typically well-differentiated endometrioid adenocarcinomas characterized by malignant epithelial cells that create intricate villoglandular formations. Oestrogen-independent tumors are typically serous carcinomas or clear cell carcinomas, which closely resemble their ovarian equivalents. Both are high-grade neoplasms with widespread dissemination at the time of presentation.
Prognosis: Oestrogen-dependent tumors typically have a favorable prognosis. Oestrogen-independent tumors exhibit great aggressiveness and are typically lethal.
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