2. • 51 year old post menopausal female presented at R.I.M.S
gynaecology outpatient department with the complain of
Menorrhagia with colicky abdominal pain.she is obese and
hypertensive,genaralised weakness and history of weight loss.
• On examination the patient was pale looking and her hemoglobin
was 8.6gm%, MCV was 72 fL.,Platelet count was 2.1 lakhs cell
/cmm, and peripheral smear shows Microcytic Hypochromic
anaemia.
• USG Transvaginal shows Hyper-echogenic endometrium with
Irregular outline, and endometrial thickness was 7.2 mm.
• After preoperative investigation the patient was subjected to total
abdominal hysterectomy with B/L Salpingo-oopharectomy and
sample sent to our department for histopathological examination.
3. Gross examination
• Uterus, cervix and ovarian mass sent in 2
pieces.
• 1st piece:- Uterus and cervix appears bulky
measuring 11x8x5 cms, cervical canal was
patent.
• 2nd piece:- Right ovary mass measuring
24x16x12 cms, grey white,firm and venous
congestion are seen.
4. Cut section
• In Uterus :- Endometrial growth are present
which is soft and friable.
• In Right Ovary :- loculated, filled with brown
colour material.
6. Microscopy
• On low power:-
• There is crowded,
complex branching
glands with cribriform
architecture and back
to back glands without
intervening stroma.
8. On high power:-
• There is loss of polarity.
Nuclei are large, round
with prominent
nucleoli.
• And There is Nuclear
membrane
condensation. Glands
are infiltrating into
stroma.
14. Endometrial carcinoma
• It is the carcinoma of endometrial lining.
• Predominantaly affacts perimenopausal and
post menopausal women.
• It is the 4th most common malignancy in
women (following breast, bowel and lungs).
• Majority are adenocarcinoma.
16. Protective Factors
• Any agent or factor that lower the level or
time of exposure to estrogen is protective
factor of endometrial carcinoma.
• I.e : Multiparity
• Smoking
• Physical activity.
18. Classification
1. Endometrioid Adenocarcinoma (most
common type, accounts for about 80%)
2. Adenosquamous carcinoma
3. Papillary serous carcinoma
4. Clear cell carcinoma of endometrium
5. Mixed mullerian tumor
19. Endometrioid Adenocarcinoma
• It is well-differentiated
(grade I ) Endometrioid
Adenocarcinoma with
preserved glandular
architecture but lack of
intervening stroma.
20. Endometrioid Adenocarcinoma
• It is Moderately
differentiated (grade II )
Endometrioid
Adenocarcinomawith
glandular architecture
admixed with solid
area.
21. Endometrioid Adenocarcinoma
• It is poorly
differentiated (grade III)
Endomerioid
Adenocarcinoma with a
predominantly solid
growth pattern.
22. 2. ADENOSQUAMOUS CARCINOMA
• Squamous differentiation
is charactererized by
intercellular bridges.
Sharp cell borders,opaque
eosinophilic cytoplasm
and squamous pearl
formation or
keratinization.
• Area of sqamous
differentiation are not
regarded as solid areas in
this grading.
23. 3. Papillary serous carcinoma
• Serous carcinoma of
endometrium with
papillary growth pattern
consisting of malignant
cells with marked
cytologic atypia
including high nuclear-
to-cytoplasmic ratio
with atypical mitotic
figures and
hyperchromasia.
24. 4. Clear cell carcinoma
• It is high grade tumor
(grade 2 or 3).
• Architecture may be
papillary, glandular,
solid, or mixed.
• There is pleomorphic
nuclei and Hobnail cells
(nuclei of atypical cells
protrude into the
glandular lumens).
25. 5. Malignant Mixed mullerian
tumor(MMMT)
• The tumor usually consist
of
adenocarcinoma(endome
trioid, serous, or clear
cell)mixed with the
malignant mesenchymal
(sarcomatous) elements.
• Metastases usually
contain only epithelial
component.
26. GRADING…
• Grading based on the degree of glandular diffrentiation
versus solid areas..
• GRADE 1:- Less than 5% of the tumor is composed of
solid area.
• GRADE 2:- 5% to 50% of the tumor is composed of
solid areas.
• GRADE 3:- Grater than 50% of the tumor is composed
of solid areas.
• Prominent nuclear atypia and mitotic figures increases
the grade by one (i.e.,grade 1 tumors with marked
atypia should be classified as grade 2).
27. STAGING….
• STAGE I:- Carcinoma is confined to corpus
uteri itself.
• STAGE II:- Carcinoma involves the corpus and
the cervix.
• STAGE III:- Carcinoma extends outside the
uretus but not outside the true pelvis.
• STAGE IV:- Carcinoma extends outside the true
pelvis or involves the mucosa of the bladder
or the rectum.
29. TREATMENT cont…
• Based on the tumor Grade and Depth of
myometrial Invasion.
• Surgical:- TAH +BSO and pelvic washing(+-) pelvic
and periaortic node dissection.
• Hormonal:- Progestin for recurrent disease.
• Chemotherapy:- In advanced, recurrent or
metastatic disease.
• Radiotherapy:- who medically unfit for surgery or
those having high risk of recurrence (stage III or
IV).
