[1081] Papillary Endometrioid Carcinoma Is More Aggressive Than Endometrioid Adenocarcinoma FIGO Grade 2

ED Euscher, A Malpica. MD Anderson Cancer Center, Houston, TX

Background: Papillary Endometrioid Carcinoma (PEC) is a variant endometrioid carcinoma characterized by short papillae lined by eosinophilic cells with at least grade 2 nuclear atypia and loss of nuclear polarity. Myoinvasion is often infiltrative wtih angulated, eosinophilic glands with attenuated epithelium and associated inflammation (neutrophils). Some have proposed that PEC may behave more aggressively than FIGO grade 2 endometrioid carcinoma (EC). This study compares the clinicopathologic features of PEC to a group of FIGO grade 2 EC to determine whether differences beyond morphologic appearance exist.
Design: 86 cases of PEC were retrieved (1993-2004) with slides reviewed by 2 pathologists for the following features: %PEC, depth of myometrial invasion (MI) and presence/absence of lymphovascular invasion (LVSI). Tumors with serous, clear cell or FIGO grade 3 endometrioid carcinoma were excluded. 92 consecutive ECs, FIGO grade 2, from the same period were evaluated for MI and LVSI and served as the control group. Cases with synchronous primary carcinoma or metachronous primary carcinoma within 5 years of treatment for EC were excluded. Patient (pt) age, FIGO stage, recurrence history and follow up (F/U) were obtained for both groups.
Results: Clinicopathologic features of pts with PEC and EC are summarized in Table 1 and % of PEC in relation to recurrence history is summarized in Table 2.

Comparsion of Clinicopathologic Data for Patients with PEC and EC
Age (years)Stage I/IIStage III/IVLVSIRecurrenceF/U
PEC (n=86)36-87 (mean, 60.8)56 (68%)30 (32%)51 (59%)21 (24%)12 DOD (14%)
EC (n=92)25-83 (mean, 62.5)82 (89%)10 (11%)28 (30%)10 (11%)5 DOD (5%)
PEC, papillary endometrioid carcinoma; EC, endometrioid carcinoma; DOD, dead of disease

Percent PEC and Recurrent Disease
% PECStage I/II, no recurrenceStage I/II, recurredStage III/IV, no recurrenceStage III/IV, recurred
≤25 (n=14)7322
26-50 (n=26)12347
51-75 (n=17)9251
>75 (n=29)18281

In pts with recurrent PEC, 9/21 pts had supradiaphragmatic recurrences while in pts with EC, 4/10 pts recurred had supradiaphragmatic sites.
Conclusions: PEC tends to present more frequently with advanced stage and has a higher percentage of pts with recurrent disease compared to EC. This suggests that tumors with PEC morphology may behave more aggressively than typical FIGO grade 2 EC. Because of the tendency towards advanced stage at presentation, recognition of PEC at the time of frozen section is essential in order to alert the clinican to the need for staging.
Category: Gynecologic & Obstetrics

Wednesday, March 24, 2010 9:30 AM

Poster Session V # 124, Wednesday Morning


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