Endometrioid adenocarcinoma


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  • Clinical

    • postmenopausal bleeding, unopposed estrogen
    • likes to metastasize to lungs, abdominal structures

  • Gross

    • shaggy endometrium or nodule, invasion as tan discoloration into myometrium

  • Histology

    • architecture
      • back to back glands with no stroma, only desmoplasia
      • cribriforming, papillary (villoglandular), solid (high grade)
      • smooth luminal gland borders
    • cytology
      • columnar cells (in low grade)
      • eosinophilic cytoplasm (may be clear or mucinous in metaplasias)
    • squamous morules

  • Variants

    • villoglandular adenocarcinoma
    • secretory variant adenocarcinoma
    • ciliated cell variant adenocarcinoma
    • endometrioid adenocarcinoma with squamous differentiation

  • Grading (FIGO)

    • nuclear
      • 1 = oval, even chromatin
      • 2 = in between
      • 3 = pleomorphic, nucleoli
    • architecture
      • 1-3, with cutoffs being 5 and 50% solid structures
    • overall
      • use architecture grade
      • bump up by one if nuclear grade 3

  • Stains

    • ER+, PR+ (partial loss in higher grades)
    • p16 patchy at most
      • vs endocervical adenocarcinoma (diffuse p16 due to E6, 7 HPV protein)
    • p53-/+
      • overexpression only in high grade
      • vs serous (prominent p53)
    • others: pancytokeratin+, EMA+, CA125+, Ber EP4+, B72.3+, CEA uncommon
    • CK7+, CK20-
    • CDX2+ in mucinous variants
    • vimentin+ unlike other adenocarcinomas

  • Molecular

    • MSI/MMR testing
    • PTEN mutation
    		•