[1143] Pathologic Characteristics of Endometrial Carcinoma in Women 40 Years of Age and Younger.

Cora Uram-Tuculescu, Ema Dragoescu. Virginia Commonwealth University Health System, Richmond

Background: Endometrial carcinoma (EC) is the most common invasive gynecologic cancer. Arising mainly in postmenopausal women, it is uncommon before 40 years (y) of age. Previously considered to have favorable histology and excellent outcome, recent studies suggest that EC arising prior to age 40y (EC<40y) may have unfavorable histology and extrauterine disease. The etiology of EC<40y is considered to be primarily unopposed estrogen stimulation in the setting of obesity and anovulatory cycles with a smaller number of cases attributed to microsatellite instability (MSI) as an inherited risk factor. The aim of this series is to analyze the pathologic features of EC<40y in our academic center.
Design: All cases of EC<40y diagnosed at our center between January 2005 and September 2010 were retrieved and information from the pathology reports at the time of surgery was recorded. For patients who elected for uterine conservation/medical treatment, results from endometrial biopsy/curettage were used. Status of MSI, estrogen (ER) and progesterone (PR) by immunohistochemistry was retrieved. Body mass index (BMI) of each patient was recorded.
Results: 15 cases of EC<40 y were identified, representing 13.2% of all 113 EC diagnosed during this interval. Women ranged in age from 20 to 40y (mean=34.8). Table 1 summarizes the findings for 11 patients (73.3%) who had surgery.

Pathologic features of endometrial tumors at total hysterectomy
Histologic typeTotal number of cases
Endometrioid10(90.9%)
Non-endometrioid1(9.1%)
FIGO histologic grade
I3(27.3%)
II and III8(72.7%)
Size of tumor
< 2.0 cm (0.3-0.7 cm)3(27.3%)
> 2.0 cm (3.9-9.8 cm)8(72.7%)
FIGO stage
IA3(27.3%)
IB3(27.3%)
II1(9.1%)
III4(36.3%)
LVI
Absent6(54.5%)
Present5(45.5%)
Pelvic washing cytology
Negative6(54.5%)
Positive5(45.5%)


4 patients elected uterine conservation/medical treatment; 3 had FIGO I endometrioid adenocarcinoma and 1 had serous carcinoma in an endometrial polyp. 86.6% of women were obese (BMI>30), mean BMI=45 (range 25-61). Of the 7 cases tested, 4 were ER positive (57.1%) and 3 PR positive (42.8%). MSI testing in 3 cases showed positive staining in 2 cases and MSH2/MSH6 negative result in 1 case submitted for mutational analysis.
Conclusions: EC<40 y is uncommon (13.2% of all EC) and is not an indolent disease. In our series 45.4% of patients had advanced disease, LVI, positive pelvic cytology and 72.7% had large tumors. 86.6% of EC<40y were endometrioid type. The majority of patients were obese and MSI studies were initiated by the clinician in a minority of cases.
Category: Gynecologic & Obstetrics

Wednesday, March 2, 2011 1:00 PM

Poster Session VI # 150, Wednesday Afternoon

 

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