••• Chapter 51^ Gynecologic Pathology^509
❍ What is the prognosis of clear cell carcinoma of the endometrium compared with typical endometrioid
carcinoma?
Clear cell carcinoma tends to occur in older women and carries a poor prognosis.
❍ What is the embryologic origin of the tumor cells in clear cell carcinoma?
They are of Müllerian origin. Histologically, they are characterized by clear cells, frequently showing a “hobnail”
pattern and focal papillary configuration.
❍ Which is more important in the prognosis of endometrial carcinoma, the progesterone receptor status or
estrogen receptor status?
The progesterone receptor status.
❍ Is there a history of estrogen replacement in most patients with clear cell carcinoma of the endometrium?
No. Most patients are older and do not have that history.
❍ What tumor of the endometrium is characterized by a population of cells that are histologically similar to
the stromal cells of a normal proliferative endometrium but exhibit an infiltrative pattern and extensive
intravascular involvement by tumor?
Low-grade endometrial stromal sarcoma.
❍ What is the prognosis in low-grade endometrial stromal sarcoma?
It is excellent, although it can recur quite late (decades later). The most important factor is stage at presentation.
❍ What is an alternative term for mixed Müllerian tumors?
Carcinosarcoma that depicts the true nature of the neoplasm—a mixture of carcinoma and sarcoma.
❍ What is the classic clinical presentation for patients with mixed Müllerian tumor?
They most commonly present with bleeding and on examination have a protuberant polypoid mass protruding
through the cervical os.
❍ What do the designations homologous and heterologous elements mean in mixed Müllerian tumors?
Homologous refers to the state of an undifferentiated sarcoma, while heterologous refers to the presence of
differentiated sarcomatous elements that are not derived from the normal uterus such as chondrosarcoma,
osteosarcoma, or skeletal muscle differentiation (rhabdomyosarcoma).
❍ What is the prognosis of patients with mixed Müllerian tumor?
It is very poor, and these tend to occur in older patients. It does not appear that the presence of homologous or
heterologous elements markedly affects survival.
❍ What are some of the complications of acute salpingitis?
- Infertility.
- Small bowel obstruction (secondary to adhesions).
- Pyosalpinx.
- Tubo-ovarian abscess.