Carcinoma of the endometrium, or uterine cancer, is the most common pelvic malignancy in postmenopausal women in the United States and Eastern Europe. It is primarily caused by chronic unopposed estrogen excess and presents with abnormal bleeding. Endometrial hyperplasia is a precursor lesion associated with mutations in genes like PTEN. Endometrial carcinomas are usually adenocarcinomas that can be well-differentiated, moderately-differentiated, or poorly-differentiated depending on glandular patterns and cellular changes. Leiomyomas, or uterine fibroids, are common benign smooth muscle tumors that can cause symptoms but rarely become malignant. They appear as nodular masses microscop

1. ENDOMETRIAL
CARCINOMA
DR. ROOPAM JAIN
PROFESSOR & HEAD, PATHOLOGY

2. ENDOMETRIAL CARCINOMA
• Carcinoma of the endometrium, commonly called uterine cancer, is
the most common pelvic malignancy in females in the United States
and Eastern Europe
• It is primarily a disease of postmenopausal women, the peak
incidence at onset being 6th to 7th decades of life and is uncommon
below the age of 40 years.
• Th e most important presenting complaint is abnormal bleeding in
postmenopausal woman or excessive flow in the premenopausal
years

3. ETIOLOGY
• A few factors associated with increased frequency of its development are
as follows:
• 1. Chronic unopposed oestrogen excess
• 2. Obesity
• 3. Diabetes mellitus
• 4. Hypertension
• 5. Nulliparous state
• 6. Heredity.

4. PATHOGENESIS
• Endometrial hyperplasia is a forerunner of endometrioid cancer is
supported by mutated PTEN gene (located on chromosome 10). Other
gene mutations in these cases are hMLH, KRAS and beta-catenin
oncogenes.
• Papillary serous endometrial carcinoma is seen in a background of
atrophic endometrium and is associated with mutation in p53 tumour
suppressor gene.

5. MORPHOLOGIC FEATURES
Grossly
• endometrial carcinoma may have 2 patterns—localised polypoid tumour,
or a diff use tumour; the latter being more common (Fig.).
• The tumour protrudes into the endometrial cavity as irregular, friable
and grey-tan mass.
• Extension of the growth into the myometrium may be identified by the
presence of soft, friable and granular tissue in cut section.
• In advanced disease, the involvement may extend beyond the
physiologic limits—into the cervical canal, into the peritoneum, besides
lymphatic metastases and haematogenous metastases to distant sites
such as lungs, liver, bones and other organs.

6. Endometrial carcinoma.
A, B, Diagrammatic representation of the common gross patterns—localised
polypoid growth and diffuse growth.

7. Endometrial carcinoma.
C, The specimen of the
uterus and cervix shows
enlarged uterus and dilated
uterine cavity containing
irregular, grey-white, friable
growth arising from
endometrial mucosa and
invading the underlying
myometrium superfi cially

8. MORPHOLOGIC FEATURES
Histologically,
• most endometrial carcinomas are adenocarcinomas, commonly termed
endometrioid adeno-carcinomas due to their resemblance with normal
endometrium.
• Depending upon the pattern of glands and individual cell changes, these
may be
• well-differentiated,
• moderately-differentiated
• poorly-differentiated.

9. Endometrial carcinoma
The most common histologic pattern is well-differentiated
adenocarcinoma showing closely packed (backto-back) glands
with cytologic atypia

10. Carcinoma of the endometrium is categorised into four
stages as per FIGO classification

11. LEIOMYOMA
• Leiomyomas or fibromyomas, commonly called fibroids
• most common uterine tumours of smooth muscle origin, often admixed
with variable amount of fibrous tissue component.
• About 20% of women above the age of 30 years harbour uterine
myomas of varying size.
• Vast majority of them are benign and cause no symptoms.
• Malignant trans formation occurs in less than 0.5% of leiomyomas.

12. LEIOMYOMA
• Symptomatic cases may produce abnormal uterine bleeding, pain,
symptoms due to compression of surrounding structures and infertility.
• The cause of leiomyomas is unknown but the possible stimulus to their
proliferation is oestrogen.
• Th is is evidenced by increase in their size in pregnancy (Fig. 22.16,C)
and high dose oestrogen-therapy and their regression follow ing
menopause and castration. Other possible factors impli cated in its
etiology are human growth hormone and sterility.

13. LEIOMYOMA
MORPHOLOGIC FEATURES
• Leiomyomas are most frequently located in the uterus
• within the myometrium (intramural or inter stitial),
• the serosa (subserosal),
• or just underneath the endometrium (submucosal).
• Subserosal and sub mucosal leiomyomas may develop pedicles and
protrude as pedunculated myomas.
• Leiomyomas may involve the cervix or broad ligament.

14. LEIOMYOMA
MORPHOLOGIC FEATURES
• Grossly,
• irrespective of their location, leiomyomas are often multiple,
circumscribed, firm, nodular, grey-white masses of variable size.
• On cut section, they exhibit characteristic whorled pattern (Fig., A,B).

15. Leiomyomas
A, Diagrammatic
appearance of common
locations & characteristic
whorled appearance on
cut section

16. B, Sectioned surface of the uterus shows multiple circumscribed, firm
nodular masses of variable sizes—submucosal (white arrows) and
intramural (black arrows) in location having characteristic whorling.
C, The opened up uterine cavity shows an intrauterine gestation sac
with placenta (white arrow) & a single circumscribed, enlarged, firm
nodular mass in intramural location (black arrow)

17. LEIOMYOMA - Histologically
• They are essentially composed of 2 tissue elements —
• whorled bundles of smooth muscle cells
• admixed with variable amount of connective tissue.
• The pathologic appearance may be altered by secondary changes in the
leiomyomas; these include: hyaline degeneration, cystic degeneration,
infarction, calcification, infection and suppuration, necrosis, fatty change,
and rarely, sarcomatous change.

18. Leiomyoma uterus
Microscopy shows whorls of smooth muscle cells which are
spindle-shaped, having abundant cytoplasm and oval nuclei