1. High-grade Endometrial Carcinomas: Morphologic and Immunohistochemical Features, Diagnostic Challenges and Recommendations
- Author
-
Colin J.R. Stewart, Vinita Parkash, Joanne K. Rutgers, Christopher P. Crum, Julie A. Irving, Khush Mittal, Ben Davidson, Robert A. Soslow, Anais Malpica, C. Blake Gilks, Carmen Tornos, Oluwole Fadare, Xavier Matias-Guiu, Paul N. Staats, Rajmohan Murali, Esther Oliva, Joseph A. Carlson, and W. Glenn McCluggage
- Subjects
0301 basic medicine ,Pathology ,medicine.medical_specialty ,endocrine system diseases ,Serous carcinoma ,Pathology and Forensic Medicine ,Endometrium ,03 medical and health sciences ,0302 clinical medicine ,High grade ,Diagnòstic ,Endometrial cancer ,Carcinosarcoma ,Diagnosis ,Biomarkers, Tumor ,medicine ,Carcinoma ,Humans ,Societies, Medical ,Clear cell carcinoma ,Undifferentiated carcinoma ,business.industry ,Endometrioid carcinoma ,Obstetrics and Gynecology ,Dedifferentiated carcinoma ,Articles ,medicine.disease ,Immunohistochemistry ,female genital diseases and pregnancy complications ,Endometrial Neoplasms ,3. Good health ,Serous fluid ,030104 developmental biology ,Càncer d'endometri ,030220 oncology & carcinogenesis ,Practice Guidelines as Topic ,Female ,FIGO Grade 3 ,Neoplasm Grading ,PAX8 ,business ,Carcinoma, Endometrioid ,Clear cell - Abstract
This review of challenging diagnostic issues concerning high-grade endometrial carcinomasisderivedfromtheauthors’ reviewoftheliteraturefollowedbydiscussionsatthe Endometrial Cancer Workshop sponsored by the International Society of Gynecological Pathologists in 2016. Recommendations presented are evidence-based, insofar as this is possible,giventhatthelevelsofevidenceareweakormoderateduetosmallsamplesizesand nonuniform diagnostic criteria used in many studies. High-grade endometrioid carcinomas include FIGO grade 3 endometrioid carcinomas, serous carcinomas, clear cell carcinomas, undifferentiated carcinomas, and carcinosarcomas. FIGO grade 3 endometrioid carcinoma is diagnosed when an endometrioid carcinoma exhibits >50% solid architecture (excluding squamousareas), orwhenan architecturallyFIGOgrade2endometrioid carcinomaexhibits marked cytologic atypia, provided that a glandular variant of serous carcinoma has been excluded. The most useful immunohistochemical studies to make the distinction between these 2 histotypes are p53, p16, DNA mismatch repair proteins, PTEN, and ARID1A. Endometrial clear cell carcinomas must display prototypical architectural and cytologic features for diagnosis. Immunohistochemical stains, including, Napsin A and p504s can be used as ancillary diagnostic tools; p53 expression is aberrant in a minority of clear cell carcinomas. Of note, clear cells are found in all types of high-grade endometrial carcinomas, leading to a tendency to overdiagnose clear cell carcinoma. Undifferentiated carcinoma (which when associated with a component of low-grade endometrioid carcinoma is termed “dedifferentiated carcinoma”) is composed of sheets of monotonous, typically dyscohesive cells, which can have a rhabdoid appearance; they often exhibit limited expression of cytokeratins and epithelial membrane antigen, are usually negative for PAX8 and hormone receptors, lack membranous e-cadherin and commonly demonstrate loss of expression of DNA mismatch repair proteins and SWI-SNF chromatin remodeling proteins. Carcinosarcomas must show unequivocal morphologic evidence of malignant epithelial and mesenchymal differentiation. This work was funded in part through the NIH/NCI Cancer Center Support Grant P30 CA008748.
- Published
- 2019