Association of Low-Grade Endometrioid Carcinoma of the Uterus and Ovary With Undifferentiated Carcinoma: A New Type of Dedifferentiated Carcinoma?
- 1 January 2006
- journal article
- Published by Ovid Technologies (Wolters Kluwer Health) in International Journal of Gynecological Pathology
- Vol. 25 (1), 52-58
- https://doi.org/10.1097/01.pgp.0000183048.22588.18
Abstract
Low-grade endometrioid carcinomas, either of the endometrium or the ovaries, usually have an excellent prognosis. The association of this type of tumor with undifferentiated carcinoma is rare. In this study, we present the clinicopathologic features of 25 such cases. The age of the patients ranged from 30 to 82 years (median, 51 years). At presentation, the patients had either vaginal bleeding or pelvic pain. The endometrioid carcinoma involved the endometrium in 14 cases, the endometrium and 1 or both ovaries in 9 cases, and the ovaries in 2 cases. Undifferentiated carcinoma associated with low-grade endometrioid carcinoma was found at presentation in 19 grade 1 or 2 endometrioid carcinomas: 15 in the endometrium and 5 in the ovary. In one of these cases, undifferentiated carcinoma was found in the endometrium and the ovary. Undifferentiated carcinoma was found after resection of low-grade endometrioid carcinoma in six cases, involving the retroperitoneum, pelvis, vagina, or liver. The undifferentiated carcinoma was composed exclusively of diffuse sheets and solid nests of epithelial cells in l0 cases. Epithelial cells with isolated foci of keratinization were seen in nine cases and rhabdoid cells in a myxoid background in six cases. Twenty-four patients were treated with total abdominal hysterectomy and with bilateral salpingo-oophorectomy. Twenty-two patients received additional therapy as follows: chemotherapy (), radiotherapy (), and tamoxifen (). Follow-up showed that 15 patients died of disease in 1 to 60 months (median, 6 months), and 5 patients are alive with progressive disease with a follow-up between 6 and 8 months; 1 patient is alive with no evidence of disease at 104 months. In four cases, the diagnosis was made recently, with short follow-ups of 3 and 4 months. Foci of undifferentiated carcinoma may be confused with solid endometrioid adenocarcinoma erroneously leading to the diagnosis of a grade 3 or a significantly less aggressive grade 2 endometrioid carcinoma. The recognition of undifferentiated carcinoma in an otherwise low-grade endometrioid adenocarcinoma is extremely important because it indicates aggressive behavior. In asynchronous cases, being aware of this association can explain the absence of a second primary.Keywords
This publication has 35 references indexed in Scilit:
- Prognostic significance and interobserver variability of histologic grading systems for endometrial carcinomaCancer, 2004
- Dedifferentiated Adenoid Cystic Carcinoma: A Clinicopathologic Study of 6 CasesLaboratory Investigation, 2003
- FIGO staging classifications and clinical practice gudelines in the management of gynecologic cancersInternational Journal of Gynecology & Obstetrics, 2000
- Low-Stage Clear-Cell Carcinoma of the EndometriumThe American Journal of Surgical Pathology, 1995
- The Prognostic Value of Nuclear Versus Architectural Grading in Endometrial AdenocarcinomaInternational Journal of Gynecological Pathology, 1994
- Uterine papillary serous carcinoma (UPSC) treated with cisplatin, doxorubicin, and cyclophosphamide (PAC)Gynecologic Oncology, 1992
- Undifferentiated carcinoma of the endometrium. A histopathologic and clinical study of 31 casesCancer, 1991
- Serous papillary carcinoma of the endometrium: A histopathological study of 22 casesGynecologic Oncology, 1990
- Clear cell carcinoma of the endometrium: A histopathological and clinical study of 97 casesGynecologic Oncology, 1990
- Uterine papillary serous carcinomaThe American Journal of Surgical Pathology, 1982