MALIGNANT

TUMORS OF
ENDOMETRIU
M
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• CARCINOMA OF ENDOMETRIUM

• MALIGNANT MIXED MULLERIAN

TUMORS

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 • Most common gynecologic malignancy!!!
and accounts for 7% of all invasive cancer in
women!

• 39,000 new cases / year

• occurs most often in postmenopausal

women(peak incidence 55-65 yrs)
accounting for up to 80 ％ of cases with less
than 5 ％ diagnosed under 40 years of age ．

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• HISTOLOGIC TYPES

– Endometrioid
– Adenosquamous
– Papillary Serous
– Clear Cell
– Mucinous
– Other

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• TYPES:

• Type I carcinomas
• Type II carcinomas

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 TYPE I CARCINOMAS
• Most common(>80% of cases) (55-65yr)
• Morphology:
“ENDOMETRIOID CA”
-Well differentiated
-Mimic proliferative endometrial glands
• Precursor:
Hyperplasia
• Associated with:
1.obesity
2.diabetes
3.hypertension
4.infertility
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(cont.)

• Molecular genetics:
Mutations in:
• PTEN(tumor suppressor gene)
• PIK3CA
• KRAS
• MSI
• beta-catenin
• p-53

• Behavior:
indolent
spreads via lymphatics
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• Morphology:
-GROSS:
Can be:
= localized polyploid tumor
= diffuse tumor involving endometrial surface

- Spread occurs by direct myometrial

invasion with eventual extension to the
periuterine structures by direct continuity.
- Spread into the broad ligaments may
cause a palpable mass.
- eventually,regional lymphadenopathy
- in late stages:metastsizes to lung, liver,
bones and other organs.
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-MICROSCOPIC:
most are “endometrioid adenocarcinomas”

Graded as:
-G1 / Stage 1- well-differentiated(<5% solid growth)
with easily recognizable glandular patterns
-G2 / Stage 2- moderately differentiated(<50% solid growth)
showing well-formed glands mixed with
solid sheets of malignant cells
-G3 / Stage 3- poorly differentiated(>50% solid gorwth)
characterized by solid sheets of cells with
barely recognizable glands and a general
degree of nuclear atypia and mitotic activity.
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 TYPE II CARCINOMAS
• Occur in women a decade later than type I and usually
arise in the setting of endometrial atrophy(65-75 yr)
• Account for 15% cases of endometrial CA.
• Morphology:
-serous(MOST COMMON)
-clear cell
-mixed mullerian tumor
• Precursor:
endometrial intraepithelial carcinoma(EIC)
• Associated with:
-atrophy
-thin physique
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• Molecular genetics:
Mutations in:
-p53
-aneuploidy
-PIK3CA
• Behavior:
Aggressive
Intraperitoneal and lymphatic spread

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• Morphology:

-GROSS:
Arise in small atrophic uteri and
are often large bulky tumors
or deeply invasive into the myometrium

(cont.)

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-MICROSCOPIC:
• Precursor lesion,EIC, consist of:
-malignant cells identical to those of serous CA
-but remain contained to gland surface without
stromal inavsion
• Invasive lesion may have a:
- papillary growth pattern composed of :
cells with marked atypia,
high nuclear to cytoplasmic ratio
atypical mitotic figure,
hetrochromasia and
prominent nucleoli
-However can have predominant glandular growth
pattern.

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Malignant mixed mullerian tumors

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 MMMTs (previously carcinosarcomas)
•Consist of adenocarcinomas with malignant
changes in the stroma

•Occur in postmenopausal women and present

with postmenopausal bleeding

•Vast majority of these tumors are carcinomas with

sarcomatous differentiation.

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• THE STROMA:

differentiates into variety of malignant

mesodermal components:
– muscle
– cartilage
– osteoid

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• Morphology:
GROSS:
- fleshier than adenocarcinomas
- may be bulky and polypoid
- sometime protrude through the cervical os
MICROSCOPIC:
- tumor consist of
adenocarcinoma(endometrioid,serous or
clear cell)
- mixed with malignant mesenchymal
elements
-alternatively the tumor may contain two distinct and
separate epithelial and mesenchymal components
(cont.)
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-sarcomatous components may also mimic extrauterine
tissues
-metastasis usually contain only epithelial components

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• Staging:
Stage I:
carcinoma is confined to the corpus uteri itself
Stage II:
carcinoma involves corpus and the cervix
Stage III:
carcinoma extends outside the uterus but not outside the
true pelvis
Stage IV:
carcinoma extends outside the true pelvis or involves the
mucosa of the bladder or the rectum.

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 Thank
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