448 Obstetrics and Gynecology Board Review •••
❍ A neoplasm that histologically has >50% solid areas and invades approximately three-fourth of the
myometrial thickness is what grade and stage? There is no other evidence of gross or microscopic disease.
Grade 3, stage 1B. Grade 3 has >50% solid areas. Stage 1 disease is limited to the uterine corpus, and Stage 1B has
invasion of >50% of the myometrial thickness.
❍ A neoplasm that histologically has >50% solid areas and invades for approximately 3/4 of the myometrial
thickness is what grade and stage if the para-aortic nodes are positive for disease?
Grade 3, stage III C2. Grade 3 has >50% solid areas. Disease extension beyond the uterus is stage III. Involvement
of the para-aortic lymph nodes is stage III C2. Based on the new 2009 revised FIGO staging, the stage IIIC
diseases are separated to IIIC1 if pelvic lymph nodes are positive, and stage IIIC2 if para-aortic lymph nodes are
positive.
❍ How does the presence of cervical glandular involvement modify the stage of endometrial cancer?
It does not. The cervical glandular involvement was the part of the 1988 FIGO staging but it is not used in the
new 2009 FIGO staging. The new 2009 revised staging excludes glandular involvement and counts only stromal
cervical invasion as stage II cancer.
❍ A woman has a diagnosis of well-differentiated adenocarcinoma (histologic grade 1) from a curettage
specimen. If surgical staging is performed within 1 month how often will (a) the histologic grade be higher
and (b) will there be deep myometrial invasion?
(1) Approximately one-third of neoplasms will be grade 2 or 3 (13% to 50%).
(2) Approximately 25% of uteri will have deep myometrial invasion.
❍ How does the presence of squamous change influence the prognosis of endometrial adenocarcinoma?
Squamous change is typically nonmalignant and occurs in as many as 25% of endometrial adenocarcinomas. The
overall prognosis is unchanged for those tumors known as adenoacanthomas. The histologic grade is assigned based
on the glandular element within the neoplasm.
❍ How does significant nuclear (cytologic) atypia affect the grading of an architectural grade 1 endometrial
adenocarcinoma?
Significant nuclear atypia, otherwise inappropriate for the architectural grade, increases the tumor grade by 1. This
commonly occurs in papillary serous and clear cell endometrial carcinomas.
❍ What is the incidence of pelvic and para-aortic node involvement when the neoplasm appears grossly
confined to the endometrium?
Approximately 6% to 7% of patients will have pelvic node metastases and 2% to 3% will have para-aortic node
metastases.
❍ What is the local and distant recurrence for typical endometrial adenocarcinoma?
20% to 30% recur in the pelvis, 55% to 65% recur at distant sites, and 5% to 10% recur in both sites.
❍ What are the estrogen receptor (ER) status and the progesterone receptor (PR) status in papillary serous
endometrial adenocarcinoma and clear cell endometrial adenocarcinoma?
Papillary serous and clear cell endometrial carcinomas are usually negative for both ER and PR.