Multiple confluent nodules, measuring 5.1 cm in maximum gross dimension. **No clinically malignant, pathologically benign (group E) cases were identified in the current series. DOD indicates died of disease; ETE, extratesticular extension; LVI, lymphovascular invasion; MF, mitotic figures per 10 HPF; NED, no evidence of disease; RPLN, retroperitoneal lymph node; S/P, status post.

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Endometrial carcinomas (ECs) are the most common gynecologic cancers in the western world. The impact of androgen receptor (AR) on clinicopathologic parameters of EC is not well studied. The aim of our study is to assess the role of AR expression in ECs and correlate its expression with estrogen (ER) and progesterone (PR). A retrospective review of 261 EC was conducted. H&E slides were reviewed and clinicopathologic parameters were analyzed. Immunohistochemical stains for AR, ER, and PR were performed on a tissue microarray. The hormonal expression was evaluated and the data were analyzed using the Fisher exact test and Kaplan-Meier survival analysis. Patients' age ranged from 31 to 91 (median=65 y). Type I EC included 202 endometrioid and 7 mucinous carcinoma, whereas type II included 34 serous, 16 carcinosarcoma, and 2 clear cell carcinoma. Although not significant, AR expression showed more frequent association with type I EC, early tumor stage (I-II), and low FIGO grade (1-2) EC. AR expression significantly correlated with absence of lymphovascular invasion (P=0.041) and decreased LN involvement (P=0.048). Patients with AR expression showed increased disease-free survival (208 vs. 165 mo, P=0.008) and late disease recurrence (P=0.009). AR expression had a positive significant correlation with PR (P<0.001) and ER (P=0.037) expression. AR might play a role as a prognostic marker for ECs.

Context Low interobserver diagnostic agreement exists among high-grade endometrial carcinomas. Objective Evaluate diagnostic variability in FIGO grade 3 endometrioid adenocarcinoma (G3EC) in two different sign-out practices. Design Sixty-six G3EC cases were identified from pathology archives of Wayne State University, Detroit, MI (WSU) (general surgical pathology sign-out) and 65 from Memorial Sloan Kettering Cancer Center, New york, NY (MSK) (gynecologic pathology focused sign-out). Each case was reviewed together by two gynecologic pathologists, one from each institution, and classified into G3EC group or reclassified group. Clinicopathological parameters were compared. Results Twenty-five (38%) WSU cases were reclassified as undifferentiated (2), serous (4), mixed endometrioid and serous (12) carcinomas, and FIGO grade 2 endometrioid (G2EC) with focal marked nuclear atypia (7). Eleven (17 %) MSK cases were reclassified as undifferentiated (5), serous (1), mixed endometrioid and serous (4), mixed endometrioid and clear cell (1) carcinomas. Agreement rate between original and review diagnosis was 83% (54 of 65) at MSK and 62% (41 of 66) at WSU (P= .01) with overall rate of 73% (95 of 131). Undifferentiated carcinomas were higher at MSK than WSU (46 %, 5 of 11 vs. 8%, 2 of 25; P= .02). G2EC with focal marked nuclear atypia was higher in WSU (28%, 7 of 25) than MSK (0%) (P= .03). Mixed endometrioid and serous carcinoma was the most common misclassified subtype (44%, 16 of 36). Conclusions Moderate interobserver variability exists in the diagnosis of G3EC with significantly higher diagnostic agreement rate in gynecologic pathology focused sign-out than general sign-out practice.

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Uterine carcinosarcomas are rare aggressive biphasic neoplasms. Because of its rarity, limited data are available on potential prognostic parameters. While several studies support that carcinomatous components predict outcomes, others do not. In this study, we evaluated the clinical and histopathologic features of 196 uterine carcinosarcomas to identify potential prognostic factors. Patients' ages ranged from 34 to 95 yr (median, 68 yr). Seventy-three (38%) patients experienced tumor recurrence during follow-up. Tumors ≥5 cm, outer half myometrial invasion, lymphovascular invasion, lymph node metastasis, advanced stage (International Federation of Gynecology and Obstetrics stages III-IV), sarcomatous component on recurrence, sarcoma dominance, and positive cytology were significantly associated with shorter disease-free interval (P<0.05). In addition, serous histology and rhabdomyoblastic differentiation was significantly associated with worse 3-yr overall survival. Our data supports that both carcinomatous and sarcomatous components play a role in tumor progression and survival of uterine carcinosarcoma patients, suggesting their equal importance in guiding management decisions.

The incidence of endometrial cancers diagnosed on biopsy that have no residual cancer identified at hysterectomy is not well studied. The aim of our study was to determine the incidence and long-term follow-up of this "vanishing cancer" phenomenon. All slides from the initial biopsy/curettage and hysterectomy specimens were reviewed and the diagnosis confirmed by a gynecologic pathologist. The entire endometrium was serially sectioned and submitted for histologic examination. Clinical and pathologic variables were analyzed, including patient demographics, tumor histologic type and grade, stage, biopsy method, adjuvant therapy, surgical procedure, recurrence, and disease-specific survival. We identified 23 biopsy-proven cases of endometrial cancer with no residual disease on hysterectomy specimen. Of the 23 patients, 15 (65.2%) were diagnosed as endometrioid, 6 (26%) serous, 1 clear cell (4.3%), and 1 (4.3%) serous intraepithelial carcinoma. Seventeen underwent dilatation and curettage, and 6 had endometrial biopsy as the primary procedure. The median follow-up was 8.8 years (range, 1.2 to 17 y). Only 2 cases with serous carcinoma underwent adjuvant chemotherapy, and none received radiation therapy. Only 1 patient died of disease after 27 months and was diagnosed as FIGO grade II endometrioid carcinoma on dilatation and curettage. The inability to identify cancer in a hysterectomy specimen for biopsy-confirmed carcinoma does not indicate technical failure. Although there is no specific standard treatment for patients with "vanishing endometrial cancer," the prognosis is excellent; however, close follow-up is suggested.

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