title: Clinicopathological analysis of mixed endometrial carcinomas: clinical relevance of different neoplastic components.
abstract: Mixed endometrial carcinomas (MECs) refer to tumors characterized by 2 or more distinct histotypes mostly that comprised endometrioid (EC) and serous/clear cell carcinomas (SC/CC). The specific quantification of these distinct components represents a challenging and critical point for both prognosis and management. Herein, we analyze a large series of MEC and compare them with EC and SC/CC. We evaluated a series of 69 MECs between January 2002 and December 2015. We compared the MEC series with 186 ECs (including 117 endometrioid G3), 31 SCs, and 38 CCs. The prognostic implication of the percentage of each component was analyzed. Among the 69 MECs, those patients older than 45 years represent the significant population, with 52.2% of them with stage III-IV disease. A similar result was found among pure SC. The comparative analysis of some prognostic parameters (multifocality, vascular invasion, and lymph node metastasis) underlined that MECs with a type II component larger than 5% represent a more aggressive entity. However, relapse, disease-free survival, mortality, and overall survival are statistically significant (P<.05) in EC-SC (SC<5%or >5%) and in EC-CC (CC<5%or >5%), whereas they are not significant (P>.05) in SC-CC (SC/CC<%or >5%). MECs, including also cases with less than 5% of SC/CC, show features as aggressive as those of pure SC/CC. In this perspective, MEC should be followed by personalized and tailored managements. The presence of different components suggests different pathogenic and metastatic processes when compared with pure carcinomas.
authors.affiliation: Division of Anatomic Pathology and Histology, Università Cattolica del Sacro Cuore, "Agostino Gemelli" School of Medicine, Rome, 1-00168, Italy.
authors.forename: Esther Diana
authors.initials: ED
authors.lastname: Rossi
authors.affiliation: Division of Anatomic Pathology and Histology, Università Cattolica del Sacro Cuore, "Agostino Gemelli" School of Medicine, Rome, 1-00168, Italy.
authors.forename: Tommaso
authors.initials: T
authors.lastname: Bizzarro
authors.affiliation: Division of Gynecology, Università Cattolica del Sacro Cuore, "Agostino Gemelli" School of Medicine, Rome, 1-00168, Italy.
authors.forename: Giorgia
authors.initials: G
authors.lastname: Monterossi
authors.affiliation: Division of Anatomic Pathology and Histology, Università Cattolica del Sacro Cuore, "Agostino Gemelli" School of Medicine, Rome, 1-00168, Italy.
authors.forename: Frediano
authors.initials: F
authors.lastname: Inzani
authors.affiliation: Division of Gynecology, Università Cattolica del Sacro Cuore, "Agostino Gemelli" School of Medicine, Rome, 1-00168, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Fanfani
authors.affiliation: Division of Gynecology, Università Cattolica del Sacro Cuore, "Agostino Gemelli" School of Medicine, Rome, 1-00168, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Scambia
authors.affiliation: Division of Anatomic Pathology and Histology, Università Cattolica del Sacro Cuore, "Agostino Gemelli" School of Medicine, Rome, 1-00168, Italy. Electronic address: gfzannoni@rm.unicatt.it.
authors.forename: Gian Franco
authors.initials: GF
authors.lastname: Zannoni
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D018269:Carcinoma, Endometrioid / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D018572:Disease-Free Survival; D016889:Endometrial Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D018193:Neoplasms, Complex and Mixed / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D018297:Neoplasms, Cystic, Mucinous, and Serous / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D011237:Predictive Value of Tests; D013997:Time Factors; D016896:Treatment Outcome
keywords: Clear cell carcinomas; Endometrial tumor; Mixed endometrial carcinomas; Molecular testing; Serous carcinomas; Type I carcinomas; Type II carcinomas