CARCINOMA OF ENDOMETRIUM (endometrioiod and serous carcinoma of uterine corpus).pptx
- 1. CARCINOMA OF ENDOMETRIUM Dr. Sizan Thapa MD Pathology
- 2. Lesson Plan Introduction Types Defination Epidemiology Etiopathogenesis Morphology Clinical Features
- 3. Most common invasive carcinoma of the female genital tract - esp advanced world Increase in incidence due to early detection and treatment of Cervical carcinoma Types 2 main types along with other less frequent types
- 4. Types Endometrioid carcinoma Serous carcinoma Clear cell carcinoma Mixed Mullerian tumor (Carcinosarcoma)
- 5. ENDOMETRIAL ENDOMETRIOID CARCINOMA DEFINATION Malignant epithelial neoplasm displaying varying proportions of glandular, papillary and solid architecture, with the neoplastic cells showing endometrioid differentiation.
- 6. EPIDEMIOLOGY Seventh most common tumor in females Second most common tumor of female genital tracts Incidence is higher in countries with high HDI than those with low HDI Varies from 1 - 25/ 100000 person Age: Perimenopausal women Percursor lesions Endometrial hyperplasia with atypia
- 7. PATHOGENESIS Estrogen excess in the setting of endometrial hyperplasia in perimenopausal women Associated with conditions leading to excess estrogen Obesity Estrogen secreting ovarian tumors Exogenous estrogen
- 8. Mutations in mismatch repair genes and PTEN (tumor supressor genes Early events in the development Mostly somatic mutations Women with germline mutation in PTEN (Cowden syndrome) and mismatch repair genes (Lynch syndrome) are at high risk TP53 mutations are seen but rare and late event Mutation --> increased signalling through PI3K/AKT pathway.
- 9. Increased expression of estrogen receptor dependent target genes in endometrial cells. Leads to tumor development and progression Mismatch repair genes mutations lead to rapid accumulation of mutations that may alter the cancer genes --> Derive tumor development
- 10. MORPHOLOGY Gross features Exophytic or diffusely infiltrative Varying degree of hemorrhage and necrosis Some may arise in lower uterine segment Spread by myometrial invasion then direct extension into adjacent structures Metastasis to regional lymph nodes and distant organs occurs late
- 11. Microscopic features 3 grades based on differentiation Mostly well differentiated Villoglandular architecture resembling proliferative endometrium Columnar cells with pseudostratified nuclei Nuclear atypia: mild to moderate Nucleoli: inconspicious Cytplasm: eosinophilic and granular
- 13. Grading FIGO system Grade I : < 5% solid part Grade II : 6-50 % solid part Grade III :> 50% solid part
- 14. CLINICAL FEATURES Abnormal uterine bleeding Postmenopausal bleeding Advanced disease : abdominal symptoms resembling those of Ovarian carcinoma.
- 15. SEROUS CARCINOMA OF ENDOMETRIUM DEFINATION Malignant carcinoma with diffuse, marked nuclear pleomorphism, typically exhibiting papillary and/or glandular growth patterns
- 16. EPIDEMIOLOGY 10% of all endometrial carcinomas Higher in black women High risk: multiparity, history of breast cancer, tamoxifen use, pelvic irradiation Age : elderly post menopausal women
- 17. PATHOGENESIS Arise in a setting of atrophic endometrium or endometrial polyp Precursor lesion : Serous endometrial intraepithelial carcinoma (SEIC) Majority exhibit TP53 mutation-->Altered p53 function
- 18. MORPHOLOGY Gross Features Variable May look overtly invasive into myometrium Polyp may be present
- 19. Microscopic Features Complex papillary and/or glandular architecture Glands are typically elongated, irregular with slit like lumen High grade cytology with marked nuclear pleomorphism, macronucleoli and mitosis Multinucleated tumor giant cells and psammomatous calcifications may be seen IHC : diffuse staining for p53
- 22. CLINICAL FEATURES Presents with post menopausal bleeding May present with features of lymph node metastasis or distant metastasis to other organs
- 23. Thank you