Recent Developments in Surgical Pathology of the Uterine Corpus

Abstract

There have been several updates recently on the classification of uterine tumors. Endometrial carcinomas have traditionally been divided into 2 types, but some are difficult to classify and do not fit readily into either of the currently recognized categories. The Cancer Genome Atlas Research Network has recently defined 4 new categories of endometrial cancer on the basis of mutational spectra, copy number alteration, and microsatellite instability, which might provide independent prognostic information beyond established risk factors. The Society of Gynecologic Oncology, moreover, now recommends systematic screening of every patient with endometrial cancer for Lynch syndrome. The new definition of high-grade endometrial stromal sarcoma disregards the number of mitotic figures as a primary diagnostic criterion and instead specifies moderate atypia still resembling stromal origin but lacking the pleomorphism of undifferentiated uterine sarcoma; these tumors also harbor a JAZF1-SUZ12 gene rearrangement. Mitotic count, atypia, and coagulative necrosis are the main histologic criteria that define leiomyosarcoma. Determining the type of necrosis can be very challenging in patients receiving various treatment modalities for symptomatic fibroids before myomectomy, since key histologic features of ischemic-type necrosis are often absent. Ancillary stains including p16, p53, MIB-1, trichrome, and reticulin may be helpful in tumors harboring necrosis that is difficult to classify. Minimally invasive gynecologic surgeries have introduced histologic artifacts that complicate the diagnosis. It is essential to recognize these as procedure-related artifacts to avoid upstaging tumors and triggering unnecessary adjuvant treatment.

Uterine sarcoma – current perspectives

“…The distinction between uterine sarcomas and other uterine tumors is clinically difficult and is reliant on histological and imaging features. 6 , 7 Uterine tumors are rare mesenchymal tumors: the commonest are leiomyomas and their variants usually occur in women between the ages of 40 and 50 years. Distinction between leiomyoma and leiomyosarcoma is made with conventional morphological criteria (mitosis, atypia and necrosis).…”

Management of uterine sarcomas and prognostic indicators: real world data from a single-institution

“…However, its use has not been generalized as a prognostic tool for uterine sarcomas [7]. Apart from their common origin, these tumors present with distinct biological and molecular profiles that may also determine their behavior under treatment [8]. Several different pathways with oncogenic importance are implicated in the evolution of these sarcomas [9].…”

A Study on Endometrial Biopsies in Gynaecological Specimen: A 2 Years Retrospective Study

“…Various types of hyperplasias were classified as per WHO classification (2014), 10 polyps and the tumours were classified according to WHO classification (2014). 11,12 Data were then analysed using tables, figures and charts.…”

“…WHO 2014 classifies endometrial stromal sarcomas into 12 :  Low-grade stromal sarcoma-Cells resembling benign endometrial stromal cells with low/ high mitotic activity.  High-grade stromal sarcoma-Cells are atypical resembling endometrial stromal cells but less atypical and pleomorphic than undifferentiated stromal sarcoma.…”