D efinition — An early, noninvasive form of serous adenocarcinoma of the endometrium. Clinical Features Epidemiology Serous endometrial intraepithelial carcinoma (EIC) is a rare neoplasm. The vast majority of patients are postmenopausal. EIC is most commonly seen in a background of endometrial atrophy and associated with endometrial polyps. You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership…

D efinition — Epithelial proliferations with evidence of p53 mutations that do not fulfill the criteria for intramucosal carcinoma. Clinical Features Epidemiology These lesions are rare and occur around menopause. Occasionally seen in endometrial polyps. Link between p53 positive epithelium with minimal atypia and cancer risk (of subsequent serous cancer) unknown. You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited…

D efinition — Nonepithelial cells present during both benign and neoplastic conditions. Clinical Features Epidemiology/Significance Histiocytes are common in postmenopausal endometrial samples, often associated with surface injury or erosion. They do not confer an increased risk of malignancy. Foamy stromal macrophages are commonly associated with, although not specific for, well-differentiated endometrial adenocarcinomas. You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy…

D efinition — Implants of keratinous material within the peritoneal cavity causing an associated granulomatous response. Clinical Features Epidemiology Overall, peritoneal keratin granulomas are an uncommon finding; however, they most commonly occur in patients with gynecologic tumors. The most common associated tumor is endometrioid adenocarcinoma with squamous differentiation, but squamous cell carcinoma, atypical polypoid adenomyomas, and ruptured dermoid cysts have been known to cause this finding…

D efinition — A diagnostic conundrum influencing management and outcome. Presentation Abnormal uterine bleeding or postmenopausal bleeding is the most common presenting sign. Increased age at the time of postmenopausal bleeding is associated with increased incidence of carcinoma. The risk of endometrial cancer may be as high as 40% 10 years out from menopause. You’re Reading a Preview Become a Clinical Tree membership for Full access…

D efinition — Adenocarcinoma arising in the lower uterine segment (LUS). Clinical Features Epidemiology Uncommon variant of endometrial adenocarcinoma, accounting for from 3% to 6%. Associated with Lynch syndrome in up to 29% versus approximately 2% of conventional endometrial adenocarcinoma. A higher frequency of MSH2 loss has been reported by some. More commonly associated with higher-grade, deep myometrial invasion and less likely to have an associated…

D efinition — Adenocarcinoma of the endometrium that maintains some histologic features of normal endometrium. Clinical Features Epidemiology Endometrioid endometrial carcinoma (EMCA) is the most common form of gynecologic malignancy. The overall lifetime incidence is between 2% and 3%. The majority of patients are between 55 and 65 years of age at the time of diagnosis; however, cases can occur at almost any age. Women with…

D efinition — A microacinar arrangement of endometrioid epithelium seen in endometrial biopsies/curettings that signifies the presence of endometrial neoplasia. Clinical Features Epidemiology Most commonly occurs in postmenopausal women in their sixth and seventh decades. You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member. Log in here

D efinition — Alteration of the epithelial cells consisting of tubular differentiation, including oxyphilic cytoplasm. Clinical Features Epidemiology Tubal metaplasia is common, although clonal expansions of tubal metaplasia are less so. Eosinophilic metaplasia is an uncommon entity. Both tubal and eosinophilic metaplasia have been described in conjunction with endometrial intraepithelial neoplasia (EIN) and endometrial adenocarcinoma. You’re Reading a Preview Become a Clinical Tree membership for Full…

D efinition — An endometrial malignancy composed almost entirely of squamous carcinoma. Clinical Features Epidemiology Rare, comprises less than 1% of uterine endometrial carcinomas. Most commonly occurs in postmenopausal women in their seventh and eighth decades. Usually not associated with human papillomavirus (HPV), although rare reports have linked HPV to some cases. You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy…

D efinition — Extensive, superficial endometrial squamous (nonmorular) metaplasia. Clinical Features Epidemiology Ichthyosis uteri is rare. It is seen in patients with longstanding irritation of the endometrium (intrauterine device [IUD] or chronic endometritis). In postmenopausal patients care should be exercised in order to exclude concurrent adenocarcinoma. You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you…

D efinition — Partial or complete replacement of an endometrial gland tract by a generally nonkeratinizing squamous metaplasia. Clinical Features Pathogenesis Squamous morules are seen at all ages, mostly in the fifth decade. Can be isolated, associated with minor gland proliferations, seen with endometrial intraepithelial neoplasia (EIN) and cancers. You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become…

D efinition — Change of the epithelium of the endometrium to a mucinous phenotype. Clinical Features Epidemiology Most commonly occurs in the perimenopausal to postmenopausal years. Papillary and microglandular forms are associated with a significantly increased risk of a coexisting endometrioid adenocarcinoma. You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member. Log…

D efinition — Surface changes in the endometrium associated with breakdown and injury. Clinical Features Epidemiology Most commonly occurs in the fifth decade associated with endometrial breakdown or injury (submucosal leiomyoma or polyp). You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member. Log in here

D efinition — Degenerative changes of the surface epithelium associated with breakdown and ischemia. Clinical Features Epidemiology Most commonly occurs in the fifth decade. Associated with anovulatory bleeding or other unscheduled breakdown, including polyps and submucosal leiomyomas. You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member. Log in here

D efinition — Involvement of the endometrium by endocervical glandular neoplasia, either by direct extension or by contamination during sampling. Clinical Features Epidemiology True endometrial involvement (direct extension) by endocervical adenocarcinoma is rare. Not uncommonly, endometrial biopsies in patients with endocervical neoplasia may contain fragments of endocervical adenocarcinoma. You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership…

D efinition — A polypoid neoplasm composed of atypical glands and smooth muscle stroma. Clinical Features Epidemiology Atypical polypoid adenomyomas (APAs) are rare neoplasms. Typically seen in the fifth decade. You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member. Log in here

D efinition — A premalignant clonal expansion of altered endometrial glands. Clinical Features Epidemiology Endometrial intraepithelial neoplasia (EIN) is relatively common and carries an increased risk of development of type 1 endometrial adenocarcinoma. Women with excess estrogen (whether exogenous or endogenous) are at increased risk. Because of the production of excess estrogens, obese women are at an increased risk. Patients with hereditary nonpolyposis colorectal cancer (HNPCC)…

D efinition — Morphologic changes secondary to medical therapy that destroys the endometrial lining. Clinical Features Epidemiology Seen in patients who undergo endometrial ablation for dysfunctional uterine bleeding. You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member. Log in here