Histological features associated with occult lymph node metastasis in FIGO clinical stage I, grade I endometrioid carcinoma.
OBJECTIVE
Lymph node involvement affects prognosis/treatment in endometrial carcinoma patients. We assessed various histological features associated with nodal metastasis in patients with grade I, stage I endometrial endometrioid carcinoma (EEC).


RESULTS
Eighteen stage I EECs with occult positive lymph nodes and 36 controls were assessed for depth of myoinvasion; microcystic, elongated and fragmented (MELF) pattern of myometrial invasion; lymphovascular invasion (LVI); and epithelial metaplasia. Nodal metastases were subclassified as isolated tumour cells (ITCs; ≤0.2 mm), micrometastasis (>0.2 mm and <2 mm), or macrometastasis (≥2 mm). Node-positive cases had significantly higher rates of LVI (P < 0.001) and MELF invasion (P = 0.003) on univariate analysis. Only LVI was associated significantly with nodal metastasis on multivariate analysis (P = 0.002). Tumours with MELF invasion demonstrated reduced E-cadherin expression. Macrometastases were identified in seven cases (39%) with or without micrometastasis/ITCs. Eight (44%) contained only ITCs. Eleven (61%) had histiocyte-like nodal metastases. Biopsy material from four of six (67%) and five of 17 (29%) cases with and without nodal metastasis showed detached eosinophilic tumour cell buds. Of the former, three were associated with histiocyte-like nodal metastases - a feature absent in biopsies without tumour budding.


CONCLUSIONS
Lymph nodes from grade I EEC exhibiting cellular budding or LVI should be examined for occult metastases, especially in the form of histiocyte-like cells.
Department of Pathology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.
Guangming
G
Han
Diana
D
Lim
Mario M
MM
Leitao
Nadeem R
NR
Abu-Rustum
Robert A
RA
Soslow
D000328:Adult; D000368:Aged; D015820:Cadherins / Q000378:metabolism; D018269:Carcinoma, Endometrioid / Q000378:metabolism / Q000473:pathology* / Q000556:secondary*; D016022:Case-Control Studies; D016889:Endometrial Neoplasms / Q000378:metabolism / Q000473:pathology*; D005260:Female; D006644:Histiocytes / Q000473:pathology; D006801:Humans; D008207:Lymphatic Metastasis / Q000473:pathology*; D008875:Middle Aged; D015999:Multivariate Analysis; D009215:Myometrium / Q000473:pathology; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness / Q000473:pathology; D061206:Neoplasm Micrometastasis / Q000473:pathology; D009367:Neoplasm Staging
D015820:Cadherins
endometrial carcinoma; lymph node; metastasis; microcystic elongated and fragmented; micrometastasis