LGCmain
Indian Journal of Pathology and Microbiology
Home About us Instructions Submission Subscribe Advertise Contact e-Alerts Ahead Of Print Login 
Users Online: 261
Print this page  Email this page Bookmark this page Small font sizeDefault font sizeIncrease font size


 
  Table of Contents    
LETTER TO EDITOR  
Year : 2020  |  Volume : 63  |  Issue : 3  |  Page : 500-502
Endometrial glandular dysplasia: A finding not to be missed


1 Department of Pathology, Consultant Pathologist, Ivy Hospital, Panchkula, Haryana, India
2 Department of Pathology, Consultant Pathologist and Head of Department, Ivy Hospital, Mohali, Punjab, India

Click here for correspondence address and email

Date of Submission22-Jul-2019
Date of Decision12-Oct-2019
Date of Acceptance23-Oct-2019
Date of Web Publication7-Aug-2020
 

How to cite this article:
Chauhan K, Hatwal V. Endometrial glandular dysplasia: A finding not to be missed. Indian J Pathol Microbiol 2020;63:500-2

How to cite this URL:
Chauhan K, Hatwal V. Endometrial glandular dysplasia: A finding not to be missed. Indian J Pathol Microbiol [serial online] 2020 [cited 2020 Oct 25];63:500-2. Available from: https://www.ijpmonline.org/text.asp?2020/63/3/500/291676




Dear Editor,

The fact that uterine serous carcinoma (USC) also has a precursor form is not known to many. This is why serous endometrial intraepithelial carcinoma (SEIC) is not commonly incorporated in histopathology reports despite the fact that SEIC has an aggressive behavior similar to USC and is also associated with extrauterine serous carcinoma (EUSC) even in the absence of a coexisting USC.[1] We present a case of 71-year-old postmenopausal female complaining of bleeding per vaginum. Ultrasonographic examination revealed an endometrial polyp. All hematological investigations including coagulation profile and biochemical investigations (LFT, RFT, lipid profile) were unremarkable. The patient underwent total hysterectomy with bilateral salpingo-oopherectomy. Grossly, the polyp measured 5.5 cm in length and had a cystic firm cut surface. Microscopic examination showed a group of endometrial glands on the surface of polyp exhibiting papillary clusters with hobnailing, pseudostratified epithelium showing loss of polarity [Figure 1]. Cells were pleomorphic, had a high nucleocytoplasmic ratio, hyperchromatic nuclei with prominent nucleoli. Cytoplasm was clear to eosinophilic [Figure 2]. Mitotic figures were abundant. Background showed cystically dilated atrophic glands. Additional sections revealed an invasive focus of tumor cells in a desmoplastic stroma [Figure 3]. Myometrium was free of tumor. The non polypoidal endometrium was atrophic. Bilateral adnexa and cervix did not show any tumor foci. On subjection to staging procedure, pelvic lymph nodes and omentum were removed. All eleven lymph nodes and omentum were negative for metastasis. Hence, a diagnosis of endometrial glandular dysplasia evolving to serous carcinoma confined to the endometrial polyp was rendered TNM (pT1aN0). The incidence of malignant and premalignant lesions in endometrial polyps ranges from 0.8% to 4.8% which includes both type 1 (endometrioid adenocarcinoma) and type 2 (serous and clear cell adenocarcinoma).[2] [Table 1] enumerates the clinical and histological differences between type 1 and type 2 cancers. Zheng et al. reported that SEIC manifests first as p53 immunoreactive morphologically normal endometrial cells evolving into EmGd (which is identifiable on morphology), then to SEIC [Figure 3]a and finally into fully developed invasive USC.[3] Hence, there is often EmGd sorrounding SEIC or it can also be said that EmGd and SEIC are synonymous with low-grade dysplasia and carcinoma-in situ, respectively. SEIC is now considered an early form of USC and clear cell carcinoma and is even equated to invasive USC stage 1A because of its potential to metastasize and recur.[4] Surgically identified metastases have been detected in 30–63% of SEIC cases.[5] Hence, surgical staging is a necessity in all SEIC cases. SEIC can be commonly confused with metaplastic changes like papillary syncytial metaplasia and tubal metaplasia in endometrial glands, atypical endometrial hyperplasia.[1] An abrupt transition from normal atrophic glands to group of glands showing marked nuclear atypia and mitotic figures is hallmark of SEIC. To conclude, it can be said that findings consistent with SEIC can be focal and easily missed. Thus, all endometrial specimens (biopsies, polyps, and resections) in postmenopausal females should be carefully examined for changes of EmGd or SEIC because it can potentially offer an opportunity to search for an associated USC or EUSC and to prevent its development by timely intervention.
Figure 1: Low-power view showing foci of SEIC on the surface of polyp (green arrow) and dysplastic endometrial glands (EmGd) (red arrow) (a, 100× H and E). Low-power view showing glandular (b) and papillary arrangement of SEIC (c) (100× H and E)

Click here to view
Figure 2: Respective low-power and high power-view of SEIC (green arrow) showing eosinophilic cytoplasm (a and b) and clear cytoplasm (c and d) (100×, 400× H and E). EmGd in red arrow and atrophic glands in black arrow

Click here to view
Figure 3: (a) High-power view showing the nuclear and cytological details of tumor cells and the typical gradation from benign (black arrow) to EmGD (red arrow) to SEIC (green arrow) (400×, H and E). (b) Low-power view showing focus of invasive serous carcinoma (yellow arrow) (100× H and E)

Click here to view
Table 1: Difference between type 1 and type 2 Uterine cancers

Click here to view


Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Acknowledgements

The authors would like to thank the technical staff of histopathology department, the head of department and the chairman of hospital for their immense support and contribution in the making of this case report.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Ram M, Bharadwaj M, Yadav R. Endometrial intraepithelial carcinoma: A case report and brief review. Indian J Pathol Microbiol 2008;51:512-4.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
Tabrizi AD, Vahedi A, Esmaily HA. Malignant endometrial polyps: Report of two cases and review of literature with emphasize on recent advances. J Res Med Sci 2011;16:574-9.  Back to cited text no. 2
    
3.
Zheng W, Xiang L, Fadare O, Kong B. A proposed model for endometrial serous carcinogenesis. Am J Surg Pathol 2011;35:e1-14.  Back to cited text no. 3
    
4.
Yi X, Zheng W. Endometrial glandular dysplasia and endometrial intraepithelial neoplasia. Curr Opin Obstet Gynecol 2008;20:20-5.  Back to cited text no. 4
    
5.
Dunton CJ, Balsara G, McFarland M, Hernandez E. Uterine papillary serous carcinoma: A review. Obstet Gynecol Surv 1991;46:97-102.  Back to cited text no. 5
    

Top
Correspondence Address:
Kriti Chauhan
Ivy Hospital, Panchkula, MDC Sector 4, Panchkula - 134 114, Haryana
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/IJPM.IJPM_573_19

Rights and Permissions


    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1]



 

Top
 
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Email Alert *
    Add to My List *
* Registration required (free)  


    References
    Article Figures
    Article Tables

 Article Access Statistics
    Viewed238    
    Printed0    
    Emailed0    
    PDF Downloaded31    
    Comments [Add]    

Recommend this journal