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Gynaepath- Endo ca - Coggle Diagram
Gynaepath- Endo ca
Molecular
Genetic suscceptibility
Lynch/MMR
Cowden/PTEN
Genes
PTEN>ARID1>PIK3CA>PIK3R1>KRAS>TP53
PRK1
KRAS
mucinous
mesonephric like
TCGA classification
Copy number
Low
High
POLE
Polymerase ε (POLE) ultramutated
MMR
Endometrial adenocarcinoma, challenging differentials - Dr. Quick (UAMS)
:fountain_pen:
DDs :red_flag:
Atypical polypoid adenomyoma
focal invasive EC with AEH/EIN
glandular integrity lost
cribriform
solid
mosac like glands
Grade 2 EC bump versus serous
p16
p53
High grade mullerian carcinoma (focal)
More sections
IHC
PanK, PTEN, MMR, p16, p53, ER, PR
p16 strong favors serous!
PTEN and ARID1 loss goes against serous
ARID1A
Napsin, racemase
CK8/18
how to work up high grade solid tumor?
Metastasis to endometrium
G3 EC versus Dedifferentiated ca/Undiff ca
IHC
MMR
CK8/18
SMARC
BRG1
INI1
p53
Take home emssage
dont call invasion on bx; think apa
if diffuse nuclear atypia; order p53
focal invasive EC
funny tumor- think metastasis
High grade tumor- think undiff
resources
Endometrial adenocarcinoma, challenging differentials - Dr. Quick (UAMS)
Non PAthology related
Risk factors
unopposes estrogen
anovulation
external estrogen
Obesity
Rx
regional node dissection if
high grade,
tumor size > 2 cm
deep myometrial invasion
Chemotherapy &/or hormonal therapy, if advanced stage
Prognosis
Good
POLE mutations
Bad
TP53
B catenin
Pattern of myometrial invasion
Infiltrative glands
MELF
