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ENDOMETRIAL CARCINOMAS, OTHER TUMORS OF THE UTERINE CORPUS - Coggle Diagram
ENDOMETRIAL CARCINOMAS
TYPE I: ENDOMETRIOID
- ~70-80%
- Endometrial cell proliferation from estrogen
- Well-to-moderately differentiated
- Lymphovascular space invasion rare in low-grade cancers
FIGO CLASSIFICATION:
- Grading based on the proportions of glandular and solid tumor components (microacini with barely visible lumens = solid)
1) Solid tumor component </= 5%
2) 6-50%
3) >50%
- Marked cytological atypia with upgrade one level
- Applies for endometrioid and mucinous carcinoma
TYPE II: NON-ENDOMETRIOID
- ~10% serous
- ~5% clear cell
- ~ 5% carcinosarcoma
- Not associated with estrogen or endometrial hyperplasia
- Clinically aggressive
- Associated with a higher stage at initial presentation
- Higher risk of recurrence
- Worse prognosis at any stage than grade 1 or 2 endometrioid cancers
- Lymphovascular space invasion commonly seen in high-grade cancers
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IMMUNOHISTOCHEMISTRY & DNA ANALYSIS
- Immunohistochemistry:
1) p53
2) MMR
- DNA Analysis:
1) For POLE (polymerase E)
- POLE-mutated and MSI endometrial cancers are associated with high numbers of tumor-infiltrating lymphocytes and high neoantigen loads, which suggests that they respond well to immunotherapy, particularly PD-1/PD-L1 checkpoint inhibitors
- The majority of tumors are classified as MSS because they show no MSI and no POLE or TP53 mutation
HISTOPATHOLOGY CRITERIA FOR HIGH-RISK DISEASE
1) Grade 3 tumor (poorly-differentiated)
2) Lymphovascular invasion
3) Non-endometrioid histology
4) Cervical stromal involvement
5) Molecular grouping
6) L1CAM overexpression
7) ER/PR negative
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