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Definition
Endometrial cancer include epithelial malignant tumors, (endometrioid,
mucinous, serous, clear cell, mixed, and undifferentiated cancer) and
malignant mixed epithelial and mesenchymal tumor, i.e. carcinosarcoma
(malignant mixed Müllerian tumor).
Endometrial cancer (EC)
Macroscopic appearance
Figure 1a. Macroscopic appearance of a tumour originating in
the endometrium of the corpus uteri, infiltrating into the
myometrium
Macroscopic appearance
Figure 1b. Macrosocpic apperence of endometrial cancer that
originates in the lower uterine segment.
Lägg FIGO 2 kolla om
Lägg till Mucinous?
Adenosquamous?
Microscopic appearance
of endometrioid cancers
Figure 2 a-c
Lägg FIGO 3 kolla om
FIGO I och II är OK
Lägg till Mucinous?
Adenosquamous?
Endometrioid-FIGO 3,
Solid growth
Endometrioid with mucinous
differentiation
Microscopic appearance of the MELF
(Microcystic, Elongated structures or
Fragmented solid cells) - growth pattern
Figure 3: MELF growth pattern, associated with adverse prognosis
Microscopic appearance–
Non-endometrioid tumours
Figure 4b Figure 4c
Figure 4a
Assessment of endometrial gray-scale
morphology according to IETA
(Leone et al UOG 2010)
IRREGULAR INTERRUPTED
NON-UNIFORM ECHOGENICITY
ENDOMETRIAL – MYOMETRIAL JUNCTION
UNIFORM ECHOGENICITY
ENDOMETRIAL ECHOGENICITY
REGULAR
Figure 5a
Assessment of endometrial vascularity
according to IETA
(Leone et al UOG 2010)
VESSEL PATTERN
MULTIPLE FOCAL
MULTIPLE
MULTIFOCAL
1 2 3 4
COLOR SCORE
SINGLE
SINGLE
BRANCHING
SCATTERED CIRCULAR
Figure 5b
Sonographic vessel pattern may reflect
tumour growth pattern (Epstein et al UOG 2011)
Focal vessel-
pattern associated
with exophytic
growth
Multiple
multifocal vessel
pattern associated
with invasive
growth
Figure 6
Morphology of endometrioid endometrial
cancer (EEC) dependents on grade and
stage
(Epstein et al UOG 2018)
Stage 1A, grade 1 Stage 1A, grade 3 Stage 1B, grade 1 Stage II, grade 3
Low risk tumors High risk tumors
Figure 7
Ultrasound characteristics
LOW RISK CANCER
Regular endometrial-
myometrial junction
Uniform Echogenicity
Single branching, or
Multiple focal vessels
Sparse vascularization
Figure 8
Ultrasound characteristics
HIGH RISK CANCER
Irregular endometrial-
myometrial junction
Non-uniform echogenicity
Multiple, multifocal
vessel pattern
Color score 3-4
Figure 9
Endometrial Morphology –
non-endometroid tumours
(Epstein et al UOG 2018)
Non-endometrioid tumours are all high-risk tumours
Carcinosarcoma
Clear cell Mixed
Serous
Figure 10
VIDEO – typical case low risk
endometrial cancer
No cervical stromal invasion Myometrial invasion < 50%
Figure 11
VIDEO – Typical case high risk
endometrial cancer
Cervical stromal invasion present Myometrial invasion present
Figure 12
Differential diagnosis
Endometrial
Stromal
Sarcoma
Uterus completely
infiltrated by colorectal
cancer metastasis
Benign
Endometrial
polyp
Figure 13
Cervical cancer

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Endometrial cancer

  • 1. Definition Endometrial cancer include epithelial malignant tumors, (endometrioid, mucinous, serous, clear cell, mixed, and undifferentiated cancer) and malignant mixed epithelial and mesenchymal tumor, i.e. carcinosarcoma (malignant mixed Müllerian tumor). Endometrial cancer (EC)
  • 2. Macroscopic appearance Figure 1a. Macroscopic appearance of a tumour originating in the endometrium of the corpus uteri, infiltrating into the myometrium
  • 3. Macroscopic appearance Figure 1b. Macrosocpic apperence of endometrial cancer that originates in the lower uterine segment.
  • 4. Lägg FIGO 2 kolla om Lägg till Mucinous? Adenosquamous? Microscopic appearance of endometrioid cancers Figure 2 a-c Lägg FIGO 3 kolla om FIGO I och II är OK Lägg till Mucinous? Adenosquamous? Endometrioid-FIGO 3, Solid growth Endometrioid with mucinous differentiation
  • 5. Microscopic appearance of the MELF (Microcystic, Elongated structures or Fragmented solid cells) - growth pattern Figure 3: MELF growth pattern, associated with adverse prognosis
  • 7. Assessment of endometrial gray-scale morphology according to IETA (Leone et al UOG 2010) IRREGULAR INTERRUPTED NON-UNIFORM ECHOGENICITY ENDOMETRIAL – MYOMETRIAL JUNCTION UNIFORM ECHOGENICITY ENDOMETRIAL ECHOGENICITY REGULAR Figure 5a
  • 8. Assessment of endometrial vascularity according to IETA (Leone et al UOG 2010) VESSEL PATTERN MULTIPLE FOCAL MULTIPLE MULTIFOCAL 1 2 3 4 COLOR SCORE SINGLE SINGLE BRANCHING SCATTERED CIRCULAR Figure 5b
  • 9. Sonographic vessel pattern may reflect tumour growth pattern (Epstein et al UOG 2011) Focal vessel- pattern associated with exophytic growth Multiple multifocal vessel pattern associated with invasive growth Figure 6
  • 10. Morphology of endometrioid endometrial cancer (EEC) dependents on grade and stage (Epstein et al UOG 2018) Stage 1A, grade 1 Stage 1A, grade 3 Stage 1B, grade 1 Stage II, grade 3 Low risk tumors High risk tumors Figure 7
  • 11. Ultrasound characteristics LOW RISK CANCER Regular endometrial- myometrial junction Uniform Echogenicity Single branching, or Multiple focal vessels Sparse vascularization Figure 8
  • 12. Ultrasound characteristics HIGH RISK CANCER Irregular endometrial- myometrial junction Non-uniform echogenicity Multiple, multifocal vessel pattern Color score 3-4 Figure 9
  • 13. Endometrial Morphology – non-endometroid tumours (Epstein et al UOG 2018) Non-endometrioid tumours are all high-risk tumours Carcinosarcoma Clear cell Mixed Serous Figure 10
  • 14. VIDEO – typical case low risk endometrial cancer No cervical stromal invasion Myometrial invasion < 50% Figure 11
  • 15. VIDEO – Typical case high risk endometrial cancer Cervical stromal invasion present Myometrial invasion present Figure 12
  • 16. Differential diagnosis Endometrial Stromal Sarcoma Uterus completely infiltrated by colorectal cancer metastasis Benign Endometrial polyp Figure 13 Cervical cancer