••• Chapter 44^ Endometrial Hyperplasia and Carcinoma^447
❍ What histologic findings would be expected if atypical endometrial cells are identified on a routine Pap smear?
- Adenocarcinoma 20%.
- Hyperplasia 11%.
- Polyps 11%.
Thus over 40% of women with atypical endometrial cells identified on a Pap smear will have abnormal histology
on an endometrial biopsy.
❍ In what clinical circumstances is a pelvic and abdominal computed tomography (CT) scan helpful in
evaluating patients with endometrial cancer on biopsy?
(1) Abnormal liver function tests.
(2) Clinical hepatomegaly.
(3) Palpable upper abdominal mass.
(4) Palpable extrauterine pelvic disease.
(5) Clinical ascites.
❍ How does endometrial carcinoma spread?
(1) Direct extension to adjacent structures.
(2) Transtubal passage of exfoliated cells.
(3) Lymphatic dissemination.
(4) Hematogenous dissemination.
❍ Why do younger women have a better prognosis when they have endometrial carcinoma in compared with
older women?
Young women tend to have lower grade tumors with less myometrial invasion.
❍ How is endometrial cancer staged?
Surgically and includes TAH/BSO, selective pelvic, and para-aortic node sampling.
❍ What is the role of the peritoneal washing and cytology in the staging of endometrial carcinoma?
Nothing. The revised International Federation of Gynecologists and Obstetricians (FIGO) staging for endometrial
adenocarcinoma (2009) removed the peritoneal washing and cytology as component of the staging.
❍ What percentage of women with endometrial cancer are diagnosed while in stage I?
72%.
❍ Are postmenopausal women taking tamoxifen at higher risk of developing endometrial cancer than are
age-matched controls?
Yes. The increased relative risk of developing endometrial cancer for postmenopausal women taking tamoxifen is
two to three times higher than that of age-matched controls.
❍ A neoplasm that histologically has <5% solid areas and invades approximately one-third of the myometrial
thickness is what grade and stage? There is no other evidence of gross or microscopic disease.
Grade 1, stage 1A. Grade 1 has <5% solid areas. Stage 1 disease is limited to the uterine corpus, and stage 1A can
have invasion of up to 50% of the myometrium.