Department of Pathology and Molecular Genetics, Hospital Universitari Arnau de Vilanova, University of Lleida, Lleida, IRBLleida, Spain.
Semin Diagn Pathol. 2010 Nov;27(4):226-40. doi: 10.1053/j.semdp.2010.09.001.
Endometrioid carcinoma of the endometrium is the most common type of endometrial carcinoma. The microscopic appearance of the tumor resembles that of the proliferative endometrium, with a variable degree of glandular complexity and cellular pleomorphism. Several subtypes have been described, including the presence of squamous differentiation, villoglandular pattern, secretory features and ciliated cells. Recently recognized subtypes are the tumors that arise in the setting of hereditary nonpolyposis colon cancer syndrome, tumors with small nonvillous papillae, presence of microglandular pattern, sertoliform features, and dedifferentiated carcinomas. The main differential diagnosis includes endocervical adenocarcinoma, atypical polypoid adenomyoma, malignant mixed Müllerian tumors, and metastatic tumors to the endometrium. The main prognostic factors are stage, histologic grade, myometrial, cervical and vascular invasion. There are several pathologic features that should be recognized to avoid underestimation of these prognostic factors, such as presence of MELF pattern of myometrial invasion, and invasion of the cervical stroma with a deceptive pattern of spread. Six different molecular features are frequent in this type of tumor, including microsatellite instability, and mutations in PTEN, k-RAS, PIK3CA, FGFR2 and CTNNB1.
子宫内膜样腺癌是最常见的子宫内膜癌类型。肿瘤的显微镜下表现类似于增生期子宫内膜，具有不同程度的腺体复杂性和细胞多形性。已经描述了几种亚型，包括存在鳞状分化、绒毛状模式、分泌特征和纤毛细胞。最近被认识到的亚型是遗传性非息肉病性结直肠癌综合征背景下发生的肿瘤、具有小非绒毛状乳头的肿瘤、存在微腺体模式、 sertoliform 特征和去分化癌。主要的鉴别诊断包括宫颈腺癌、非典型息肉样腺肌瘤、恶性混合性 Müllerian 肿瘤和转移到子宫内膜的肿瘤。主要的预后因素包括分期、组织学分级、肌层、宫颈和血管浸润。有几种病理特征需要识别，以避免低估这些预后因素，如存在肌层浸润的 MELF 模式和具有欺骗性扩散模式的宫颈间质浸润。在这种类型的肿瘤中经常出现六种不同的分子特征，包括微卫星不稳定性以及 PTEN、k-RAS、PIK3CA、FGFR2 和 CTNNB1 的突变。
