2. Basic data
• IC number : Pb80129
• Gender : female
• Age : 52
• Allergy : no know drug allergy
3. Past history
• Past medical history : 1. dyslipidemia 2.knee
osteoarthtritis (left)
• Menstrual history : menopause for the past 2
years
• Past OB/GYN history : Previous 2 Lower
Segment Caesarean Section
5. Physical examination
• Alert and comfortable
• Vital sign stable
• Heart : S1,S2 no murmurs
• Lung : clear
• Abdomen : soft no tender
6. • Total hysterectomy and bilateral salpingo-
oophrectomy
• Endometrial curettage : complex atypical
endometrial hyperplasia with areas consistent
with endometrioid adenocarcinoma
7. • Indication for op : complex with areas
consistent with endometrioid
adenocarcinoma
• Post op : patient well and stable on discharge
on 2014.2.14
8. Gross description
• Total hysterectomy and bilateral salpingo-
oophrectomy speciman
• Uterus : reveals a polypoidal lesion occupying the
entire endometrial cavity measuring 4.5*4.2*2cm
• Cervix : 3cm*3cm, no tumor
• Right ovary : 2.3*2.2*0.5cm No tumor
• Left ovary : 2.2*1.5*0.7 No tumor
• Tubes : unremarkable, No tumor
9. Microscopic description
• Tumor type : adenocarcinoma of
endometrium, endometrioid type
• Histologic grade : FIGO grade I
• Nuclear grade : nuclear grade 1-2
10. Depth of tumor invasion
• Tumor is limited to the endometrium
• Invasive tumor is confined to the
endometrium with an irregular endometrial
junction
• Lymphocytic infiltrate is seen around the
tumor
• Suspicious for superficial myometrial
invasion(A14)
11. • Endocervical invasion : no invasion is
identified
• Vascular invasion : no invasion is identified
• Uterine serosal involvement : no
• Adnexal involvement : no
• Vaginal involvement : not assessable
• Parametrial involvement : no
12. • Myometrium : foci of adenomyosis is seen
• Cervix : A8&A23 show squamous metaplasia
as well as a hemorrhagic and denuded
endocervical region, without malignancy
• Adnexae : corpus luteum cyst is noted in left
ovary ; corpora albicantes and follicular cyst at
both ovaries
13. Diagnosis
• Endometrial endometrioid adenocarcinoma,
FIGO I , tumor predominately confined to the
endometrium , lymphovascular invasion
identified
14. 80% accounts for endometrial carcinoma
Endometrioid carcinoma
Arise from endometrioid hyperplasia
Well differentiated (tomaxifen affect)
Prior pelvic radiation increase the risk
HNPCC increase 40~60% in endometrial cancer
16. Patterns of endometrial invasion
Myoinvasion
Glands, Nets, Cords, Single tumor cells
Irregular border with the myometrium
Pushing border with myometrium
Well-circumscribed, expansile
17. Change in therapy
• Radiation-induced changes : complete
disappearance of the tumor, necrotic tumor,
increased volume, vacuolation of cytoplasm,
bizarre, pyknotic, karyorrhectic nuclei,
enlarged nucleoli
18. Effects
• Cytologic changes : Decreased N:C ratio
• An increased amount of eosinophilic
cytoplasm and a decrease in nuclear size
21. Introduction
• Mutations in AT-rich interactive domain 1A
(ARID1A) have been detected in a wide variety
of human cancers, most frequently in
endometrium-related carcinomas
• ARIDA1 encodes BAF250A is a member of
SWI/SNF complex
Neoplasia (2012) 14, 986–993
23. Inactivation on SWI/SNF system
• Inactivation of several components of this
complex had can be associated with certain
type of cancer
Inactivation INI1
Rhabdoid tumor ,atypical
teratoid/rhabdoid tumor
Inactivation BRG1
and BRM
15%-20% primary non-small cell
lung cancers
Mutation in ARID1A
43%-57% ovarian clear cell
carcinomas
30% ovarian endometrioid
carcinomas
J Gynecol Oncol Vol. 24, No. 4:376-381
24. Inactivating mutations of ARID1A in
gynecologic tumors
• ARID1A has a tumor suppressor role
• Mutation in ARID1A cause Breast carcinoma
Esophageal adenocarcinoma
Gastric carcinoma
Pancreatic carcinoma
Hepatocellular carcinoma
Prostate carcinoma
Neuroblastoma/Medulloblastoma
Uterine/ovarian tumor
Burkitt lymphoma
Transitional cell carcinoma
25. AR1DA1 as tumor suppressor
Siliencing/deleted of ARIDA1
Expression of ARIDA1
Enhance proliferation
Suppress proliferation
Neoplasia (2012) 14, 986–993
26. Different appearance of ARID1A
• ARID1A is a nucleocytoplasmic protein whose
stability depends on its subcellular localization
Stable
Unstable ubiquitin-proteasome system
27. Alteration of ARID1A in ovarian tumors
Ovarian endometrioid carcinoma (30%)
Ovarian clear cell carcinoma (43%-57%)
Loss of ARIDA1
Cystic type (43%)
Adenofibromatous type (61%)
28. Inactivation of ARID1A occurs in the
early stages of tumor development
Borderline ovarian tumors (43%-57%)
Loss of ARIDA1
Endocervical-type mucinous
borderline tumors (33%)
borderline endometrioid tumor
(13%)
29. Alteration of ARID1A in uterine carcinomas
• ARID1A mutations frequently co-occurs with
other mutations
• Loss of ARID1A is associated with mismatch
repair deficiency
Endometrioid carcinoma
Mutation (40%)
Loss of expression in low-grade (26%-29%)
Loss of expression in high-grade (39%)
30. Clonal loss in ARIDA1
16% complex atypical hyperplasia
24% low-grade endometrioid carcinoma
10% high-grade endometrioid carcinoma
Complete loss in ARIDA1
0% complex atypical hyperplasia
25% low-grade endometrioid carcinoma
43% high-grade endometrioid carcinoma
31. ARID1A plays important role not only in tumor
initiation, but also in tumor progression.
Negative Low-grade PositiveLow-gradePositiveHigh -grade
32. Conclusion
• High prevalence of somatic mutations in
ovarian and endometrial cancers indicates a
pivotal role of ARID1A in their development
• Understanding the roles of ARID1A in the
pathogenesis of endometrium-derived tumors
is fundamental for future translational studies
40. Classification
• Grade 1 tumors have 95% or more of the
cancerous tissue forming glands.
• Grade 2 tumors have between 50% and 94%
of the cancerous tissue forming glands.
• Grade 3 tumors have less than half of the
cancerous tissue forming glands. Grade 3
cancers are called "high-grade."
