Endometrial carcinoma: molecular subtypes, precursors and the role of pathology in early diagnosis

Abstract

Endometrial carcinoma (EC) is classified into a wide range of morphological variants; this list has expanded over the past decade with the inclusion of mesonephric‐like and dedifferentiated carcinoma as EC variants in the fifth edition of the WHO Classification of Female Genital Tumours, and recognition that carcinosarcoma is a biphasic carcinoma rather than a sarcoma. Each EC variant has distinct molecular abnormalities, including TCGA‐based molecular subtypes, allowing further subclassification and adding complexity. In contrast to this rapid progress in understanding EC, there are only two recognized EC precursor lesions: endometrial atypical hyperplasia/endometrioid intraepithelial neoplasia (EAH/EIN) and serous intraepithelial carcinoma, a situation that has not changed for many years. Diagnosis of EC precursors is a cornerstone of surgical pathology practice, with early diagnosis contributing to the relatively favorable prognosis of EC. In this review we relate the precursor lesions to each of the EC morphological variants and molecular subtypes, discuss how successful early diagnosis is for each variant/molecular subtype and how it might be improved, and identify knowledge gaps where there is insufficient understanding of EC histogenesis. © 2020 The Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.

Identification of risk factors for the prognosis of Chinese patients with endometrial carcinoma

“…About 69% of endometrial cancer patients can be diagnosed when the tumor is confined to the uterus, so the overall survival rate is high. [ 1 ] Endometrial carcinoma: molecular subtypes, precursors, and the role of pathology in early diagnosis.…”

Molecular Basis of Endometriosis and Endometrial Cancer: Current Knowledge and Future Perspectives

“…According to genomic characteristics of 373 endometrial carcinomas, The Cancer Genome Atlas (TCGA) classified EC into four molecular subtypes [178,179], which differ a lot from the molecular point, underlying risk factors, clinical and pathological features, treatment modalities, and prognosis [180][181][182]. These four distinct prognostic groups are POLE ultramutated, microsatellite instability/hypermutated, copy number-low microsatellite stable, and copy number-high/serous like.…”

New Trends in the Detection of Gynecological Precancerous Lesions and Early-Stage Cancers

“…Nevertheless, different types of EC derive from different precursor lesions. Type I EC typically develops from atypical hyperplasia or EIN, depending on the classification system [ 102 ]. It was shown that the risk of progression to carcinoma in women with non-atypical endometrial hyperplasia was <5%, while almost 30% of women with atypical endometrial hyperplasia were diagnosed with EC [ 103 ].…”