Architectural versus nuclear atypia-defined FIGO grade 2 endometrial endometrioid adenocarcinoma (EEC): a clinicopathologic comparison of 154 cases with clinical follow-up.
International Federation of Gynecology and Obstetrics (FIGO) Grade 2 endometrial endometrioid adenocarcinoma carries a 88% 5-yr survival rate. They are defined by >5% but <50% solid epithelial component. A small subset may display <5% solid growth, but marked nuclear atypia and are designated Grade 2. We compared tumor characteristics, staging, and clinical outcome of patients with architectural versus atypia-defined Grade 2 endometrial endometrioid adenocarcinoma. A total of 154 Grade 2 endometrial endometrioid adenocarcinoma cases were reviewed to confirm grade; percent solid growth, and presence of atypia. Only marked atypia (significant nuclear pleomorphism identifiable at 10× or enlarged nuclei, 1.5 to 2× normal, with irregular nuclear contours, dispersed chromatin, and prominent nucleoli) increased the FIGO Grade 1 level. Depth of invasion, tumor stage, lymph node status, and clinical outcomes were then compared. A total of 154 cases were evaluated. Twenty-three were eliminated (6 Grade 3, 17 Grade 1). Of the 131 FIGO II cases, 19 (15%) were based on the presence of severe atypia and 112 (85%) met the architecturally defined criteria. Atypia-defined versus architecturally defined Grade 2 endometrial endometrioid adenocarcinoma's show no significant difference in stage and prognosis. An increase in grade based on presence of nuclear atypia stratifies patients at increased risk as 89% of these patients have myoinvasion at the time of hysterectomy which is in distinct contrast to our previous study (International Journal of Gynecologic Pathology. 2012 July; 31(4): 337-43), where 70% of Grade I cases were noninvasive. No significant correlation between percentage of solid component and risk of recurrence was identified in this study.
Department of Pathology (W.M.W., C.M.Q.), University of Arkansas for Medical Sciences, Little Rock, AR Department of Pathology (D.L., M.R.N.), Division of Women's & Perinatal Pathology, Brigham and Women's Hospital, Boston, MA Gynecologic Oncology (P.J.S.), Rocky Mountain Cancer Centers/The US Oncology Network, Boulder, Colorado.
Whitney M
WM
Winham
Douglas
D
Lin
Pamela J
PJ
Stone
Marisa R
MR
Nucci
Charles M
CM
Quick
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018269:Carcinoma, Endometrioid / Q000473:pathology*; D016889:Endometrial Neoplasms / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D011379:Prognosis