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Título:
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High-grade Endometrial Carcinomas: Morphologic and Immunohistochemical Features, Diagnostic Challenges and Recommendations
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Autor/a:
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Murali, Rajmohan; Davidson, Ben; Fadare, Oluwole; Carlson, Joseph A.; Crum, Christopher; Gilks, C. Blake; Irving, Julie A.; Malpica, Anais; Matias-Guiu, Xavier; McCluggage, W. Glenn; Mittal, Khush; Oliva, Esther; Parkash, Vinita; Rutgers, Joanne; Staats, Paul; Stewart, Colin; Tornos, Carmen; Soslow, Robert A.
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Notas:
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This review of challenging diagnostic issues concerning high-grade endometrial carcinomasisderivedfromtheauthors’ reviewoftheliteraturefollowedbydiscussionsatthe Endometrial Cancer Workshop sponsored by the International Society of Gynecological Pathologists in 2016. Recommendations presented are evidence-based, insofar as this is possible,giventhatthelevelsofevidenceareweakormoderateduetosmallsamplesizesand nonuniform diagnostic criteria used in many studies. High-grade endometrioid carcinomas include FIGO grade 3 endometrioid carcinomas, serous carcinomas, clear cell carcinomas, undifferentiated carcinomas, and carcinosarcomas. FIGO grade 3 endometrioid carcinoma is diagnosed when an endometrioid carcinoma exhibits >50% solid architecture (excluding squamousareas), orwhenan architecturallyFIGOgrade2endometrioid carcinomaexhibits marked cytologic atypia, provided that a glandular variant of serous carcinoma has been excluded. The most useful immunohistochemical studies to make the distinction between these 2 histotypes are p53, p16, DNA mismatch repair proteins, PTEN, and ARID1A. Endometrial clear cell carcinomas must display prototypical architectural and cytologic features for diagnosis. Immunohistochemical stains, including, Napsin A and p504s can be used as ancillary diagnostic tools; p53 expression is aberrant in a minority of clear cell carcinomas. Of note, clear cells are found in all types of high-grade endometrial carcinomas, leading to a tendency to overdiagnose clear cell carcinoma. Undifferentiated carcinoma (which when associated with a component of low-grade endometrioid carcinoma is termed “dedifferentiated carcinoma”) is composed of sheets of monotonous, typically dyscohesive cells, which can have a rhabdoid appearance; they often exhibit limited expression of cytokeratins and epithelial membrane antigen, are usually negative for PAX8 and hormone receptors, lack membranous e-cadherin and commonly demonstrate loss of expression of DNA mismatch repair proteins and SWI-SNF chromatin remodeling proteins. Carcinosarcomas must show unequivocal morphologic evidence of malignant epithelial and mesenchymal differentiation.
This work was funded in part through the NIH/NCI Cancer Center Support Grant P30 CA008748. |
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Materia(s):
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-Carcinosarcoma
-Clear cell carcinoma
-Dedifferentiated carcinoma
-Endometrioid carcinoma |
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Derechos:
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cc-by (c) Rajmohan Murali et al., 2019
http://creativecommons.org/licenses/by/4.0/
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Tipo de documento:
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Artículo
Artículo - Versión publicada |
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Editor:
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Lippincott, Williams & Wilkins
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