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
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
12.
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
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
20.
21.
22. • CLINICAL FEATURES
– Presents with post menopausal bleeding
– May present with features of lymph node metastasis or distant
metastasis to other organs
