Diagnosis

What is the difference between endometrioid adenocarcinoma with clear cell changes and mixed endometrioid and serrous.

Thank you so much.

[Annekathryn Goodman, M.D.]

Hi There

you are asking about differences in the way a cancer looks under the microscope.That is called histology. here is a nice review of histology of endometrial cancer from UpToDate

http://www.uptodate.com/patients/content/topic.do?topicKey=~b0aGJ4eiCuXiBlf



 Endometrial cancers are classified into two major divisions (types I and II), which are based upon light microscopic appearance, clinical behavior, and epidemiology.



 • Type I endometrial cancers, which have endometrioid histology, comprise 70 to 80 percent of newly diagnosed cases of endometrial cancer in the United States. They are associated with chronic exposure to estrogen unopposed by a progestin, and are often preceded by premalignant disease (endometrial hyperplasia).

 • Type II endometrial cancers have nonendometrioid histology (usually papillary serous or clear cell histology) and an aggressive clinical course. Hormonal risk factors have not been identified, and there is no readily observed premalignant phase.



Serous carcinoma — Serous carcinomas are believed to develop from "endometrial intraepithelial carcinoma" (EIC), a lesion related to malignant transformation of the endometrial surface epithelium (such as a benign endometrial polyp), against a background of endometrial atrophy [13].

EIC has been found in association with extrauterine serous carcinoma, with both sites having identical clones of p53 mutations [22]. This finding has led some to suggest that EIC represents an early form of UPSC rather than its true precursor [23]. A relatively new entity, "endometrial glandular dysplasia," which histologically bridges benign endometrium and EIC, may be the putative precursor lesion to UPSC




Clear cell carcinoma — No proven precursor lesions or epidemiologic risk factors for clear cell carcinoma have been identified. A putative precursor lesion has been proposed, but further confirmatory studies are needed [26].

These tumors have a distinctive pattern by gene expression profile [7]. They generally do not express estrogen and progesterone receptors, and, in contrast to serous tumors, they are negative for p53 mutations.