Relationship between surgical‐pathological risk factors and outcome in clinical stage I and II carcinoma of the endometrium: A Gynecologic Oncology Group study

Cp, Morrow; Bundy, B.; Kurman, Rj.; Wt, Creasman; Heller, Paul B.; Homesley, H D; Graham, J.A.

doi:10.1016/0020-7292(91)90520-f

Cited by 221 publications

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“…Although various other grading schemata have been suggested for endometrioid adenocarcinomas (61,62), the almost universally accepted one discussed previously has been shown to be reproducible and an effective indicator of prognosis in many reported series (63)(64)(65). Indeed, the treatment of an endometrioid adenocarcinoma of the endometrium will generally depend on the pathologist's intraoperative or postoperative assessment of tumor grade and extent of myoinvasion (58,66,67).…”

Section: Grading Of Endometrioid Adenocarcinomasmentioning

confidence: 99%

Problems in the Differential Diagnosis of Endometrial Hyperplasia and Carcinoma

Silverberg

2000

Modern Pathology

138

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The differential diagnosis of endometrial hyperplasia and well-differentiated endometrioid adenocarcinoma is complicated not only by the resemblance of these lesions to each other, but also by their tendency to be overdiagnosed (particularly hyperplasia) on the background of polyps, endometritis, artifacts, and even normally cycling endometrium. Atypical hyperplasia may also be overdiagnosed when epithelial metaplastic changes occur in simple or complex hyperplasia without atypia. Lowgrade adenocarcinomas are best recognized by architectural evidence of stromal invasion, usually in the form of stromal disappearance, desmoplasia, necrosis, or combinations of these findings between adjacent glands. Endometrioid adenocarcinomas are usually Type 1 cancers associated with manifestations of endogenous or exogenous hyperestrogenic stimulation and a favorable prognosis. Subtypes include adenocarcinomas with squamous differentiation and secretory, ciliated cell and villoglandular variants. Rules and pitfalls in the grading of endometrioid adenocarcinomas and the estimation and reporting of myometrial invasion are presented.KEY WORDS: Differential diagnosis, Endometrial carcinoma, Endometrial hyperplasia, Grading, Myoinvasion. Mod Pathol 2000;13(3):309 -327The purpose of this article is to review the relationships between hyperplasia and adenocarcinoma of the endometrium, with an emphasis on the differential diagnostic problems both between these two lesions and between them and other entities that enter into the differential diagnostic picture. However, differential diagnosis is not the only relationship between endometrial hyperplasia and carcinoma. During the course of this review, we briefly consider the questions of the progression of endometrial hyperplasia (and specifically its atypical variant) to carcinoma, as well as the prognostic effect of the presence of endometrial hyperplasia in cases of endometrial carcinoma, and the biologic significance of carcinoma that arises in the presence or absence of hyperplasia. The last of these topics, however, is considered in much greater detail in the article by Sherman (1) in this issue.There are four possible approaches to making the differential diagnosis between atypical endometrial hyperplasia and well-differentiated endometrioid adenocarcinoma of the endometrium. These approaches may be summarized briefly as follows:(1) adenocarcinoma in situ, (2) endometrial intraepithelial neoplasia (EIN), (3) nonhistologic techniques, and (4) so-called "routine" light microscopy.The oldest of these approaches is the first, in which it is assumed that there must be an entity, conveniently named adenocarcinoma in situ, that is intermediate between the most severe atypical hyperplasia and the earliest focal change recognizable as invasive adenocarcinoma. Probably the most effective rebuttal of this concept for diagnostic purposes was made by Professor Harold Fox, who stated, "A true adenocarcinoma in situ of the endometrium is one in which the glands have undergone neoplastic change bu...

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Section: Grading Of Endometrioid Adenocarcinomasmentioning

confidence: 99%

Problems in the Differential Diagnosis of Endometrial Hyperplasia and Carcinoma

Silverberg

2000

Modern Pathology

138

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“…Adjuvant pelvic irradiation following surgery without lymphadenectomy only reduced the rate of vaginal stump recurrence, but did not improve the survival rate (Aalders et al, 1980;Creutzberg et al, 2000); in patients who underwent this treatment, distant metastases developing from undetected and untreated paraaortic nodes that were located outside of the irradiation field may decrease their survival; paraaortic node metastases were found in 32 -78% of the patients with pelvic node involvement (Chen et al, 1985;Morrow et al, 1991;Yokoyama et al, 1997;Onda et al, 1997;Hirahatake et al, 1997) and in 16 -44% of the patients with deep (4½) myometrial invasion (Morrow et al, 1991;Yokoyama et al, 1997;Hirahatake et al, 1997).…”

Section: Discussionmentioning

confidence: 99%

“…In contrast, paraaortic lymph nodes that were positive in approximately 10% of patients should be dissected only in patients at a high risk of metastases; Morrow et al (1991) noted that 98% of paraaortic node metastases were found in patients with either grossly positive pelvic nodes, grossly positive adnexal metastases, or outer one third myometrial invasion. In the present study, all patients with paraaortic node metastases had deep (4½) myometrial invasion.…”

Section: Clinicalmentioning

confidence: 99%

“…In endometrial carcinoma, lymph node metastasis is one of the most important prognostic factors for disease recurrence and death (DiSaia et al, 1985;Lurain et al, 1991;Morrow et al, 1991); however, the role of lymphadenectomy in the management of endometrial carcinoma still remains controversial. Lymphadenectomy is recommended for predicting patients prognosis and for tailoring postoperative therapy in many studies (Chuang et al, 1995;Kilgore et al, 1995;Blythe et al, 1997;Yokoyama et al, 1997).…”

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confidence: 99%

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Lymphadenectomy and adjuvant therapy in endometrial carcinoma: role of adjuvant chemotherapy

2002

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To evaluate the therapeutic benefit of lymphadenectomy and adjuvant therapy, in particular chemotherapy, we retrospectively analysed survival rates and patterns of recurrence of endometrioid adenocarcinoma in 106 patients who underwent surgery including retroperitoneal lymphadenectomy. Adjuvant chemotherapy was administered to 46 patients (42 received a platinumbased regimen) and pelvic irradiation to 12. The 5-year survival rate of 23 patients with lymph node metastasis was worse than that of patients without lymph node metastasis (60% vs 96%, P50.0001). Recurrence was observed in 14 patients (10 patients with chemotherapy, two with irradiation, and two without adjuvant therapy); the first site of recurrence was in distant sites in 12 patients; recurrence in the pelvic sidewall or exclusively in lymph nodes was not observed. The 5-year survival rate of 18 patients with lymph node metastasis treated with chemotherapy, was 61% including all 14 with macroscopically positive nodes and all nine with paraaortic metastasis. Of seven patients with bulky positives nodes, three patients with bulky paraaortic nodes died of the disease, three of the four patients with bulky pelvic but without bulky paraaortic nodes had no recurrence. In summary, lymphadenectomy may afford a survival benefit via the debulking of macroscopically positive nodes, and the predominance of distant recurrences suggests that chemotherapy is a suitable choice as an adjuvant therapy in endometrial carcinoma after lymphadenectomy.

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“…9 Important prognostic factors of endometrial cancer are stage, grade, and lymph node positivity. [10][11][12] For surgical staging of gynecologic cancers, many countries follow standards set by FIGO. 13 The 7th edition of the American Joint Committee on Cancer (AJCC) Staging Manual, published in January 2010, includes the same staging categories as the FIGO staging guidelines of 2008, except that the AJCC 7th edition does not include IIICNOS or IVNOS.…”

Section: Introductionmentioning

confidence: 99%

Site‐specific factors for cancer of the corpus uteri from SEER registries: Collaborative stage data collection system, version 1 and version 2

Jamison

Altekruse

Chang

et al. 2014

Cancer

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BACKGROUND: Uterine cancer is the fourth leading cancer among US women. Changes in uterine cancer staging were made from the American Joint Committee on Cancer (AJCC) 6th to 7th edition staging manuals, and 8 site-specific factors (SSFs) and 3 histologic schemas were introduced. Carcinomas account for 95% of cases and are the focus of this report. METHODS: Distributions of SSF values were examined for 11,601 cases of malignant cancer of the corpus uteri and uterus, NOS (not otherwise specified) diagnosed in Surveillance, Epidemiology, and End Results (SEER) Program registries during 2010. AJCC 6th and 7th edition staging distributions were compared for 11,176 cases using data in both staging systems. AJCC 6th edition staging distributions during 2004-2010 were examined. AJCC 7th edition SSFs required by SEER were International Federation of Gynecology and Obstetrics stage (SSF1), peritoneal cytology (SSF2), number of positive pelvic lymph nodes (SSF3), number of pelvic lymph nodes examined (SSF4), number of positive para-aortic lymph nodes (SSF5), and number of para-aortic lymph nodes examined (SSF6). RESULTS: For SSFs related to lymph nodes, a third of cases were classified as "not applicable," reflecting that lymph node dissection is not indicated for cases with stage1A and stage 4 diagnoses. AJCC 7th edition criteria assigned more cases to stage I (72.9%) than AJCC 6th edition criteria (68.7%). Annual counts significantly increased during 2004-2010, as did counts for AJCC 6th edition stages INOS, IA, IB, IC, IIIA, IIIB, IIIC, and IVB. The proportion of cases diagnosed with stage I cancer was stable, whereas stages II and IV decreased and stage III increased. CONCLUSIONS: Five SSFs were suitable for analysis: peritoneal cytology results (SSF2), numbers of positive pelvic lymph nodes (SSF3), pelvic lymph nodes examined (SSF4), positive para-aortic lymph nodes (SSF5), and para-aortic lymph nodes examined (SSF6). INTRODUCTIONAmong cancers of the female genital system, corpus uteri and corpus, not otherwise specified (NOS) is the most commonly diagnosed cancer and the second most common cause of cancer death after ovarian cancer. Overall, uterine cancer is the fourth most frequently diagnosed cancer among women in the United States, with 49,560 newly diagnosed cases and 8190 deaths estimated to occur during 2013. 1 Incidence rates historically have been slightly higher among white women than black women and women of other races; however, the mortality rate among black women is almost twice that of other women. 2 Factors affecting racial variation include tumor aggressiveness and racial differences in the prevalence of hysterectomy. 3,4 In recent years, the incidence rate of corpus uteri and corpus, NOS cancer has been increasing among women of all major racial and ethnic groups. Estrogen unopposed by progesterone is a main risk factor for endometrial cancer; and the increasing prevalence of obesity is thought to contribute to the recent increase in incidence. 5 Diabetes and nulliparity are both risk factors that ...

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Relationship between surgical‐pathological risk factors and outcome in clinical stage I and II carcinoma of the endometrium: A Gynecologic Oncology Group study

Cited by 221 publications

References 0 publications

Problems in the Differential Diagnosis of Endometrial Hyperplasia and Carcinoma

Problems in the Differential Diagnosis of Endometrial Hyperplasia and Carcinoma

Lymphadenectomy and adjuvant therapy in endometrial carcinoma: role of adjuvant chemotherapy

Site‐specific factors for cancer of the corpus uteri from SEER registries: Collaborative stage data collection system, version 1 and version 2

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