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Corpus Uteri Carcinoma | Radiology Key

Corpus Uteri Carcinoma



Corpus Uteri Carcinoma


Todd M. Blodgett, MD






















































(T) Primary Tumor for Uterine
Carcinomas


Adapted from 7th edition AJCC Staging Forms.


TNM


FIGO


Definitions


TX


Primary tumor cannot be assessed


T0


No evidence of primary tumor


Tis1


Carcinoma in situ (preinvasive carcinoma)


T1


I


Tumor confined to corpus uteri



T1a


IA


Tumor limited to endometrium or invades < 1/2 of the myometrium



T1b


IB


Tumor invades ≥ 1/2 of the myometrium


T2


II


Tumor invades stromal connective tissue of the cervix but does not extend beyond
uterus2


T3a


IIIA


Tumor invades serosa &/or adnexa (direct extension or metastasis)


T3b


IIIB


Vaginal involvement (direct extension or metastasis) or parametrial involvement


T4


IVA


Tumor invades bladder mucosa &/or bowel mucosa (bullous edema is not sufficient to
classify a tumor as T4)


1 FIGO no longer includes stage 0 (Tis).

2 Endocervical glandular involvement only should be considered as stage I and not as stage II.

























(N) Regional Lymph Nodes for
Uterine Carcinomas


Adapted from 7th edition AJCC Staging Forms.


TNM


FIGO


Definitions


NX


Regional lymph nodes cannot be assessed


N0


No regional lymph node metastasis


N1


IIIC1


Regional lymph node metastasis to pelvic lymph nodes


N2


IIIC2


Regional lymph node metastasis to paraaortic lymph nodes, with or without positive pelvic lymph nodes


















(M) Distant Metastasis for Uterine
Carcinomas


Adapted from 7th edition AJCC Staging Forms.


TNM


FIGO


Definitions


M0


No distant metastasis


M1


IVB


Distant metastasis (includes metastasis to inguinal lymph nodes intraperitoneal disease,
or lung, liver, or bone; excludes metastasis to paraaortic lymph nodes, vagina, pelvic
serosa, or adnexa)

















































































AJCC Stages/Prognostic Groups for Uterine Carcinomas1


Adapted from 7th edition AJCC Staging Forms.


Stage


T


N


M


0


Tis


N0


M0


I


T1


N0


M0



IA


T1a


N0


M0



IB


T1b


N0


M0


II


T2


N0


M0


III


T3


N0


M0



IIIA


T3a


N0


M0



IIIB


T3b


N0


M0



IIIC1


T1-T3


N1


M0



IIIC2


T1-T3


N2


M0


IVA


T4


Any N


M0


IVB


Any T


Any N


M1


1 Carcinosarcomas should be staged as carcinoma.

































































(T) Primary Tumor for Leiomyosarcoma and Endometrial
Stromal Sarcoma1


Adapted from 7th edition AJCC Staging Forms.


TNM


FIGO


Definitions


TX


Primary tumor cannot be assessed


T0


No evidence of primary tumor


T1


I


Tumor limited to the uterus



T1a


IA


Tumor ≤ 5 cm in greatest dimensions



T1b


IB


Tumor > 5 cm


T2


II


Tumor extends beyond the uterus, within the pelvis



T2a


IIA


Tumor involves adnexa



T2b


IIB


Tumor involves other pelvic tissues


T3


III2


Tumor infiltrates abdominal tissues



T3a


IIIA


1 site



T3b


IIB


> 1 site


T4


IVA


Tumor invades bladder or rectum


1 Simultaneous tumors of the uterine corpus and ovary/pelvis in association with ovarian/pelvic endometriosis should be classified as independent primary tumors.

2 In this stage lesions must infiltrate abdominal tissues and not just protrude into the abdominal cavity.





















(N) Regional Lymph Nodes for
Leiomyosarcoma and Endometrial
Stromal Sarcoma


Adapted from 7th edition AJCC Staging Forms.


TNM


FIGO


Definitions


NX


Regional lymph nodes cannot be assessed


N0


No regional lymph node metastasis


N1


IIIC


Regional lymph node metastasis



















(M) Distant Metastasis for
Leiomyosarcoma and Endometrial
Stromal Sarcoma


Adapted from 7th edition AJCC Staging Forms.


TNM


FIGO


Definitions


M0


No distant metastasis


M1


IVB


Distant metastasis (excluding adnexa, pelvic and abdominal tissues)






































































(T) Primary Tumor for
Adenosarcoma1


Adapted from 7th edition AJCC Staging Forms.


TNM


FIGO


Descriptions


TX


Primary tumor cannot be assessed


T0


No evidence of primary tumor


T1


I


Tumor limited to the uterus



T1a


IA


Tumor limited to the endometrium/endocervix



T1b


IB


Tumor invades to < 1/2 of the myometrium



T1c


IC


Tumor invades ≥ 1/2 of the myometrium


T2


II


Tumor extends beyond the uterus, within the pelvis



T2a


IIA


Tumor involves adnexa



T2b


IIB


Tumor involves other pelvic tissues


T3


III2


Tumor involves abdominal tissues



T3a


IIIA


1 site



T3b


IIIB


> 1 site


T4


IVA


Tumor invades bladder or rectum


1 Simultaneous tumors of the uterine corpus and ovary/pelvis in association with ovarian/pelvic endometriosis should be classified as independent primary tumors.

2 In this stage lesions must infiltrate abdominal tissues and not just protrude into the abdominal cavity.





















(N) Regional Lymph Nodes for
Adenosarcoma


Adapted from 7th edition AJCC Staging Forms.


TNM


FIGO


Descriptions


NX


Regional lymph nodes cannot be assessed


N0


No regional lymph node metastasis


N1


IIIC


Regional lymph node metastasis


















(M) Distant Metastasis for Adenosarcoma


Adapted from 7th edition AJCC Staging Forms.


TNM


FIGO


Definitions


M0


No distant metastasis


M1


IVB


Distant metastasis (excluding adnexa, pelvic and abdominal tissues)


































































AJCC Stages/Prognostic Groups for
Uterine Sarcomas


Adapted from 7th edition AJCC Staging Forms.


Stage


T


N


M


I


T1


N0


M0



IA1


T1a


N0


M0


IB1


T1b


N0


M0


IC2


T1c


N0


M0


II


T2


N0


M0


IIIA


T3a


N0


M0


IIIB


T3b


N0


M0


IIIC


T1, T2, T3


N1


M0


IVA


T4


Any N


M0


IVB


Any T


Any N


M1


1 Stage IA and IB differ from those applied for leiomyosarcoma and endometrial stromal sarcoma.

2 Stage IC does not apply for leiomyosarcoma and endometrial stromal sarcoma.








Coronal graphic shows T1 tumors, those confined to corpus uteri. T1a tumors are limited to the endometrium image or involve less than 1/2 of the myometrium image; T1b tumors invade 1/2 or more of the myometrium image indicated by the tumor traversing the dotted horizontal line, marking the halfway plane of the myometrium.






Coronal graphic shows a typical T2 tumor image, which invades the cervix but does not extend beyond the uterus. Endocervical glandular involvement only should be considered stage I and not stage II.






Coronal graphic shows stage III disease, both T3a, which is tumor involving the serosa &/or adnexa image, and T3b, which is tumor that involves the vagina image by direct extension or metastases or parametrial involvement.






Sagittal graphic shows stage IVA disease with tumor that invades the bladder mucosa image /or bowel mucosa image. However, bullous edema is not sufficient to classify a tumor as T4. Stage IVB is defined as distant metastasis, including metastasis to inguinal lymph nodes, peritoneum, lung, liver, or bone.







Coronal graphic shows an example of N1 disease, defined as regional lymph node metastasis to pelvic lymph nodes image.






Coronal graphic shows an example of N2 disease, defined as regional lymph node metastasis to paraaortic lymph nodes image with or without positive pelvic lymph nodes image.















image


METASTASES, ORGAN FREQUENCY


Lung


32%


Liver


7%


Other sites (adrenals,
breast, brain, bone, skin)


4%




OVERVIEW


General Comments



  • Corpus uteri carcinoma is the most common gynecologic cancer in USA



    • Also most common gynecologic cancer in many other developed countries


  • 95% of uterine malignancies are endometrial carcinomas


  • Malignancies of uterine corpus



    • Cancers above level of the cervical os involving upper 2/3 of uterus


  • Endometrial cancer can be divided into 2 types



    • Type I



      • Endometrioid histology


      • Includes the very common endometrioid adenocarcinoma


      • Makes up to 70-80% of new diagnoses in USA


      • Association with chronic estrogen exposure


      • Premalignant disease, such as endometrial hyperplasia, often precedes cancer


    • Type II



      • Nonendometrioid histology


      • Includes papillary serous and clear cell carcinomas


      • Aggressive clinical course


      • No association with estrogen exposure has been identified


      • Not associated with readily observable premalignant disease


Classification



  • Primary malignant tumors (WHO classification)



    • Endometrial carcinoma



      • Endometrioid adenocarcinoma



        • Several forms


      • Mucinous adenocarcinoma


      • Serous adenocarcinoma


      • Clear cell adenocarcinoma


      • Mixed cell adenocarcinoma


      • Squamous cell carcinoma


      • Transitional cell carcinoma


      • Small cell carcinoma


      • Others


    • Mesenchymal tumors



      • Endometrial stromal and related tumors



        • Endometrial stromal sarcoma, low grade


        • Endometrial stromal nodule


        • Undifferentiated endometrial sarcoma


      • Smooth muscle tumors



        • Leiomyosarcoma (epithelioid and myxoid variants)


        • Smooth muscle tumor of uncertain malignant potential


        • Leiomyoma, not otherwise specified


      • Miscellaneous mesenchymal tumors


    • Mixed epithelial and mesenchymal tumors



      • Carcinosarcoma


      • Adenosarcoma


      • Carcinofibroma


      • Adenofibroma


      • Adenomyoma


    • Gestational trophoblastic disease



      • Trophoblastic neoplasms



        • Choriocarcinoma


        • Placental site trophoblastic tumor


        • Epithelioid trophoblastic tumor


      • Molar pregnancies



        • Hydatiform mole


      • Nonneoplastic



        • Nonmolar trophoblastic lesions


    • Miscellaneous tumors



      • Sex cord-like tumors


      • Neuroectodermal tumors


      • Melanotic paraganglioma


      • Tumors of germ cell type


      • Others


    • Lymphoid and hematopoietic tumors



      • Malignant lymphoma


      • Leukemia


PATHOLOGY


Routes of Spread



  • Direct extension



    • Most common


  • Lymphatic spread



    • Common nodes include



      • Pelvic (N1)


      • Paraaortic (N2)


      • Inguinal nodes (less common)


  • Hematogenous spread



    • Lungs


    • Liver


    • Bone


    • Skin


    • Brain (uncommon)


  • Peritoneal spread



    • Intraperitoneal implants


    • Common in papillary serous carcinoma


General Features



  • Comments



    • Endometrioid adenocarcinoma



      • Represents 75-80% of endometrial cancers


  • Genetics



    • Rare hereditary form



      • Lynch II family cancer syndrome



        • Nonpolyposis colorectal cancer


        • Ovarian cancer


        • Endometrial cancer


    • Type I endometrial cancers



      • Microsatellite instability


      • KRAS mutations


      • PTEN mutations


      • DNA mismatch repair defects


      • Mutations in p53



        • Less frequent


        • Late occurrence in development (differing from type II cancers)


    • Type II endometrial cancers



      • Mutations in p53



        • Common mutation


      • Nondiploid karyotype


      • Her-2/neu (c-erB-2) overexpression


  • Etiology



    • Carcinoma that spontaneously arises from endometrium that is atrophic or inert


  • Epidemiology & cancer incidence




    • Estimated 2009 statistics in USA for endometrial cancer overall



      • 42,160 new cases


      • 7,780 deaths


    • Represents 6% of all cancers in women


    • Risk factors



      • Estrogen hormone replacement therapy



        • Increases risk 2-10x


      • Obesity



        • Increases risk 2-20x


      • Polycystic ovarian syndrome (PCOS)



        • Increases risk 3x


      • Chronic anovulation



        • Increases risk 3x


      • Tamoxifen



        • Increases risk 2-3x


      • Nulliparity



        • Increases risk 2-3x


      • Early menarche



        • Increases risk 2-3x


      • Late menopause



        • Increases risk 2-3x


      • Hypertension



        • Increases risk 2-3x


      • Diabetes



        • Increases risk 2-3x


    • Demographics



      • Age



        • Most common in 6th and 7th decades of life


      • Ethnicity



        • Common in Eastern Europe and USA


        • Uncommon in Asia


  • Associated diseases, abnormalities



    • Endometrial hyperplasia



      • Associated with 20-40%


Microscopic Pathology



  • H&E



    • Histological patterns can be broadly divided into type I and type II endometrial cancers



      • Endometrioid histology


      • Nonendometrioid histology


    • Histopathologic types



      • Endometrioid carcinomas



        • Most common endometrial cancer (75-80% of cases)


        • Most are well differentiated


        • Back-to-back glandular proliferation of endometrium lacking intervening stroma


      • Villoglandular adenocarcinoma



        • Many villous fronds


        • Delicate central fibrovascular cores of villi and simpler branching pattern differentiates it from papillary serous carcinoma


      • Adenocarcinoma with benign squamous elements, squamous metaplasia, or squamous differentiation (adenoacanthoma)


      • Adenosquamous carcinoma (mixed adenocarcinoma and squamous cell carcinoma)


      • Mucinous adenocarcinoma


      • Serous adenocarcinoma (papillary serous)



        • Bizarre nuclei


        • Scant cytoplasm


        • Nuclear stratification


        • Marked nuclear atypia


        • Complex papillary architecture


        • Psammoma bodies (seen in 30% of cases)


        • Aggressive nature


        • Often presents late


      • Clear cell carcinoma



        • Possible patterns include tubulocystic, papillary, or solid


        • Psammoma bodies may be present but not as commonly as in papillary serous tumors


        • Clear cell appearance due to glycogen


        • Myometrial invasion is common (80% of carcinomas)


        • Aggressive nature


        • Often presents late


      • Squamous cell carcinoma


      • Undifferentiated carcinoma


      • Malignant mixed mesodermal tumors


IMAGING FINDINGS


Detection

Sep 18, 2016 | Posted by in OBSTETRICS & GYNAECOLOGY IMAGING | Comments Off on Corpus Uteri Carcinoma
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