Histopathologic Endometrium

1. Surgico-pathologic
Conference
DEPARTMENT OF OBSTERTICS AND GYNECOLOGY
PASAY CITY GENERAL HOSPITAL
P. Burgos St. Pasay City
Prayer: Dr. Cheska San Juan
Opening Remarks: Dr. Jeanette Bautista
Case Presenter: Dr. Arnie Gaile Flores
Closing Remarks: Dr. Olivia Jane Chua-Fernandez
Guest Reactors
Horacio A. Saguil Jr. MD, FPDP, MMHoA, PhD
John Alexander C. San Juan , MD, DPSP
Bernadette C. Yap-Abela MD,
FPOGS, DSGOP, FPSPCPC
Moderator
November 3, 2023, 10:00 AM

2. OPENING REMARKS
DRA. JEANETTE BAUTISTA

3. B.L.
65-year-old, single,
G3P3(3003)
Filipino
Roman Catholic
Married

4. Chief complaint
Vaginal Bleeding

5. History of Present Illness
Diagnostic hysteroscopy followed with endometrial curettage was done. Histopathologic
Diagnosis revealed,
Endometroid adenocarcinoma, moderately differentiated, FIGO grade II.
Patient consulted our OPD were she was examined and transvaginal
ultrasound was requested, revealing a thickened endometrium.
2 month prior to admission, (+) vaginal bleeding for 1 week using 2 pads moderately soaked. No
other associated symptoms such as hypogastric pain, dysuria, or change in bowel movement.

6. Obstetrical history
Pregnancy
Order
Year/
Hospital
Mode of
Delivery
AOG Sex Birth weight Pregnan
y
Outcome
Complications/
Abnormalities
G1 1981/
Ospital ng Maynila
NSD FT F 2500g Alive None
G2 1982/
Fabella Hospital
NSD FT F 2700g Alive None
G3 1990/
Fabella Hospital
NSD FT F 3100g Alive None

7. Menstrual history
 She had her Menarche at the age of 14-year-
old.
 Subsequent menses at regular monthly
intervals, 3-2days duration, using 3-4 pads
per day, moderately soaked, not associated
dysmenorrhea.
 Menopause at age 52 years old

8. Sexual history
 She had her first coitus at 20-year-old and had 1
sexual partners
 No foul-smelling vaginal discharge
 No post coital bleeding
 No contraceptive method use.

9. Past Medical History
 Patient has hypertension for 15 years
and on Losartan 50mg /Tab OD
 No diabetes mellitus, bronchial asthma,
thyroid disease, lung disease or heart
problem.
 She had no previous surgeries.

10. Family History
 (+) Hypertension- Maternal/ Paternal
 Patient had no other heredofamilial
disease such as diabetes mellitus,
bronchial asthma, thyroid disease, lung
disease, heart problem, Cancer

11. Personal and Social History
 A high school undergraduate,
housewife
 She is a non-smoker, non-alcohol
beverage drinker and denies any
illicit drug use.
 Presently, living in for 41 years to a
67-year-old Taxi driver.

12. Review of systems
GENERAL: Conscious, (-) generalized body weakness, (-) loss of weight
SKIN: (-) pallor, (-) rashes, (-) lesions
HEENT: (-) pale palpebral conjunctiva, (-)headache, (-) dizziness, (-)sore throat
RESPIRATORY: (-)cough, (-) colds
CARDIAC: (-)chest pain, (-)palpitations
GIT: (-) vomiting, (-) nausea, (-) constipation (-) Abdominal pain
GENITOURINARY: (-) dysuria, (-) hematuria, (-) vaginal bleeding, (-)watery vaginal discharge
HEMATOLOGY: (-) easy bruising ,(-) nose/ gum bleeding
ENDOCRINE: (-)polydipsia, (-)polyuria
NERVOUS SYSTEM: (-) seizure, (-)tremor (-) decreased sensorium

13. Physical Examination at the ER
 General Survey:
Conscious, coherent, ambulatory, not in cardiopulmonary distress
Vital Signs:
BP: 120/80 mmHg CR: 86 bpm
RR: 20 cpm Temp: 36.5C
Height: 158 Weight: 86kg
BMI: 30.3 kg/m2 Obesity class I

14. Physical Examination at the ER
 HEENT:
Pink palpebral conjunctiva, anicteric sclera, no anterior neck mass nor
cervical lymphadenopathy
 Chest and Lungs:
Symmetrical chest expansion, no retraction, clear breath sounds
Adynamic precordium, normal rate, regular rhythm, no murmur

15. Physical Examination at the ER
 Abdomen: Flabby, Soft, non tender
 Pelvic examination:
 External Genitalia: grossly normal, no lesion
 Speculum Exam: scanty whitish discharge non-foul smelling,
cervix pinkish, smooth with no lesion
 Internal Examination: cervix closed
 Extremities: no pitting edema

16. TRANSVAGINAL ULTRASOUND
Normal sized anteverted uterus with thickened endometrium
To consider endometrial pathology.
Endometrial thickness of 1.58cm, hyperechoic, (+) intracavitary fluid
Normal ovaries.
Cervix measures 3.03 x 3.05 x 3.66 cm.
Dilated Canal fluid-filled
No fluid in the cul de sac

17. HISTOPATHOLOGIC DIAGNOSIS
 S/P Diagnostic hysteroscopy followed with endometrial curettage
 -Endometrioid adenocarcinoma, moderately differentiated, FIGO grade II

18. NORMAL HISTOLOGY OF THE UTERUS

19. HISTOLOGY OF A MENSTRUAL CYCLE
EARLY SECRETORY

21. ENDOMETRIAL HYPERPLASIA
HYPERPLASIA WITHOUT ATYPIA HYPERPLASIA WITHOUT ATYPIA

23. ENDOMETRIOD ADENOCARCINOMA
FIGO GRADE

24. SPECIMEN SLIDE

25. HISTOPATHOLOGIC DIAGNOSIS
S/P Diagnostic hysteroscopy followed with endometrial
curettage
-Endometrioid adenocarcinoma, moderately
differentiated, FIGO grade II

26. PRE OPERATIVE DIAGNOSIS
G3P3(3003) AUB-M (Endometroid adenocarcinoma, moderately
differentiated, FIGO grade II)
Menopause for 13 years
Hypertension stage II
S/P Diagnostics hysteroscopy followed with endometrial
curettage (July 1, 2022, PCGH)

27. PLAN
For Exploratory laparotomy with peritoneal fluid cytology
followed with Extrafascial Hysterectomy with Bilateral
salpingo-oophorectomy followed with bilateral lymph node
dissection +/- Paraaortic lymph node dissection under spinal
under spinal epidural anesthesia

28. INTRAOPERATIVE FINDINGS
 No ascitic fluid was noted. On palpation, the cecum, right
pelvic gutter, ascending colon, peritoneum overlying the right
kidney, liver edge, gallbladder, subdiaphragm, small intestine,
transverse colon, spleen, peritoneum overlying the left kidney,
descending colon and left pelvic gutter were all smooth.
Retroperitoneal and paraaortic lymph nodes were all smooth.
 The uterus was not enlarged with pinkish smooth serosa

29. OPERATIVE FINDINGS

30. GROSS SPECIMEN

31. GROSS SPECIMEN

32. GROSS SPECIMEN

33. POST OPERATIVE

34. PROCEDURE
Exploratory laparotomy with peritoneal fluid
cytology followed with Extrafascial Hysterectomy
with Bilateral salpingo-oophorectomy followed
with bilateral lymph node dissection under spinal
under spinal epidural anesthesia

35. FINAL DIAGNOSIS
G3P3(3003) Endometroid adenocarcinoma FIGO grade II
Menopause for 13 years
Hypertension stage II
S/P Diagnostics hysteroscopy followed with endometrial curettage
(July 1, 2022, PCGH)
S/P Exploratory laparotomy with peritoneal fluid cytology followed with
Extrafascial Hysterectomy with Bilateral salpingoophorectomy followed with
bilateral lymph node dissection under spinal under spinal epidural anesthesia

36. FINAL HISTOPATHOLOGIC DIAGNOSIS
-Endometriod adenocarcinoma, FIGO histologic grade II
-Tumor invasion is more than fifty percent (>50%) of the myometrium
-Tumor size: 2.5 cm in widest dimension
-lymphovascular space invasion is not observed
-Negative for tumor involvement:
-bilateral ovaries
-bilateral fallopian tubes
-Cervix
-Parametrium
- All four (4) isolated lymph nodes, Specimen labeled “ Right Lymph nodes”
- All five (5) isolated lymph nodes, specimen labeled “ Left Lymph nodes”
-AJCC pathologic staging: pT1bN0Mx

37. FINAL HISTOPATHOLOGIC DIAGNOSIS
-Other findings:
-Chronic cervicitis with squamous metaplasia and Nabothian cysts
-Corpus Albicans, Bilateral ovaries
-Unremarkable Fallopian tubes, bilateral
-Peritoneal fluid cytology
-The international system of reporting serous fluid cytology: Negative for
malignancy

38. SPECIMEN: UTERUS
LOW POWER FIELD
SCANNER VIEW

39. SPECIMEN: CERVIX

40. CANCER OF THE ENDOMETRIUM:
2018 FIGO STAGING

42. MANAGEMENT
Stage I: Confined to the Corpus
Surgery: EHBSO, PFC, Lymph Node Dissection
Surgico-Pathologic Staging Adjuvant Treatment
IA G1, G2 No Adjuvant Treatment (Level IA)
G3 Vaginal Brachytherapy (Level IIB)
IB G1, G2 Vaginal Brachytherapy (Level IA)
G3 Pelvic EBRT (Level IA)
+/- Chemotherapy (Level IB)

43. FOLLOW UP
 For referral to Gynecologic Oncologist
• Follow up every 6 months for 2 years then annually thereafter
• Physical Exam including through speculum, Pelvic and Rectovaginal
exam every visit
• Elicit new symptoms associated with possible recurrence
• Whole Abdominal CT scan if there is a suspicion of recurrent disease