Morphologic Criteria for Distinguishing Endometrial Adenocarcinoma from Complex Atypical Endometrial Hyperplasia
K Mittal, S Sasturkar, A Salem. New York University School of Medicine, New York
Background: Morphologic criteria for distinguishing endometrial adenocarcinoma from complex atypical endometrial hyperplasia have been described previously, but have not been examined extensively for their individual predictive ability for finding endometrial adenocarcinoma in subsequent hysterectomy. We examined endometrial biopsies diagnosed in the spectrum of complex atypical endometrial hyperplasia to well differentiated endometrial adenocarcinoma for various morphologic features that may be predictive for presence of endometrial adenocarcinoma in subsequent hysterectomy.
Design: Cases diagnosed as FIGO grade I endometrial adenocarcinoma or complex atypical endometrial hyperplasia in endometrial biopsies seen at NYU Medical Center from 2003 to 2006 were analyzed for the presence of various morphologic features without the knowledge of hysterectomy findings. Only those cases with subsequent hysterectomy were included in the study. The data was analyzed to identify features with high specificity for finding of endometrial adenocarcinoma in subsequent hysterectomy.
Results: There were a total of 95 cases in the study, with 50 cases previously diagnosed as endometrial adenocarcinoma and 45 cases previously diagnosed as complex atypical endometrial hyperplasia. The following features were found to have high specificity for the finding of endometrial adenocarcinoma in subsequent hysterectomy (feature, specificity, sensitivity): A. Greater than 95% of area occupied by glands, with or without cribriforming, in single or multiple fragments with combined diameter of 2 mm or more, 83%, 81.6% B. Cribriforming in a fragment of tissue at least 2 mm in length, 83.3%, 16.6%. C. At least 2 mm combined diameter of all foci of cribriforming, 84%, 35%. Fibroblastic stroma, masses of squamous cells, or extensive papillary pattern were not found to be specific or sensitive predictive markers for endometrial adenocarcinoma.
Conclusions: The criteria generated in this study can be used to provide a more reliable diagnosis of endometrial adenocarcinoma than is possible with the currently used criteria. Dilated glands, secretory endometrium, gestational endometrium, and atypical polypoid adenomyoma should be excluded when making the evaluations of glandular crowding for endometrial hyperplasia and carcinoma.
Category: Gynecologic & Obstetrics
Wednesday, March 24, 2010 9:30 AM
Poster Session V # 122, Wednesday Morning