Architectural vs. Nuclear Atypia Defined FIGO Grade 2 Endometrial Endometrioid Adenocarcinoma (EEC): A Clinicopathologic Comparison of 154 Cases
Whitney Winham, Douglas Lin, Pam Stone, Marisa Nucci, Matt Quick. UAMS, Little Rock, AR; Brigham and Women's Hospital, Boston, MA
Background: FIGO grade 2 EEC carries a 88% five year survival rate. They are defined by >5% but <50% solid epithelial component. A small subset may display <5% solid growth, but display marked nuclear atypia and are therefore designated grade 2. We compared tumor characteristics, staging, and clinical outcome of patients with architectural versus atypia defined grade 2 EEC.
Design: 154 cases of grade 2 EEC were reviewed to confirm grade; percent solid growth, and presence/absence of atypia. Only marked atypia (characterized by significant nuclear pleomorphism identifiable at low power magnification or a pattern of enlarged nuclei, 1.5-2 x normal, with irregular nuclear contours, dispersed chromatin and prominently enlarged nucleoli) increased the FIGO grade one level. Depth of invasion, tumor stage, lymph node status and clinical outcomes were then compared.
Results: 154 cases were evaluated. 23 were eliminated based on review (6 to grade 3, 17 to grade 1). Of the remaining 131 FIGO II cases, 19 (15%) were grade 2 based on the presence of severe atypia and 112 (85%) met the architecturally defined criteria (Tables 1 & 2).
|Invasive||<50% Invasive||>50% Invasive||Cervix +||Nodes +||Recurrance|
|Atypia Defined||17 (89%)||10 (53%)||7 (37%)||2 (11%)||2 (11%)||1 (5%)|
|Architecturally Defined||89 (79%)||63 (56%)||26 (23%)||3 (12%)||5 (4%)||8 (7%)|
|Atypia||% Solid||Depth (%)||LVI \ LN||Stage||Recur site \ Time (months)||Adjuvant||Status|
|Severe||0||55||- \ 0||IB||Vaginal Cuff \ 6||No||NED|
|NS||5||0||- \ 0||IB||Unknown \ 10||No||NED|
|NS||30||25||+ \+||1A||Lung \ 16||+||LFU|
|NS||5||40||+ \ 0||1A||Lung, LN\ 27||+||DOD|
|NS||5||90||+ \ 0||1B||Unknown \ 46||+||LFU|
|NS||10||20||- \0||2||Port Site \ 24||+||NED|
|NS||10||50||+ \ 0||3||Lung \ 7||+||LFU|
|NS||40||100||+ \ 0||2||Unknown \ 12||+||AWD|
|NS||5||>90||0 \ 0||4||Lung \ 1||+||LFU|