Endometrial Adenocarcinoma: Prevention and Early Diagnosis : Including Contributions by Iglesias Goy, E. (Madrid); Rios Vallejo, M. (Madrid)

The incidence of endometrial adenocarcinoma, the most common malignant tumor of the female genital tract in developed countries, has increased over recent years. A variety of collection techniques are available to obtain cytologic or histopathologic samples for its diagnosis but their interpretation can be difficult without proper collection and preparation. However, this monograph, written by internationally recognized experts, is a most valuable educational resource for the pathologist and cytopathologist in the techniques of endometrial sampling and diagnosis. The chapters are comprehensive and logically organized, covering the epidemiology and pathogenesis of endometrial adenocarcinoma, endometrial sampling techniques and the spectrum of cytomorphologic appearance from benign through hyperplasia to adenocarcinoma of the endometrium. A separate chapter covers non-epithelial uterine malignancies. Throughout the monograph, inclusion of both cytologic and H&E histologic images allows cytohistologic correlation of lesions. In summary, this endometrial handbook seeks to clarify a difficult area of cytodiagnosis and will become an important reference text for cytopathologists, pathologists and cytotechnologists. Cover 1 Contents 8 Preface 11 Foreword 12 List of Abbreviations 13 Chapter 1: Current Status of the Prevention and Early Diagnosis of Endometrial Adenocarcinoma 14 1.1. Epidemiology 14 Increasing Incidence of Endometrial Adenocarcinoma 14 Viral Agents Human Papillomavirus 15 1 .2. Pathogenesis 15 1.3. Hormonal Therapy.The Effects on the Endometrium 15 Endometrial Pathology and Breast Cancer 16 Coadjuvant Therapy with Tamoxifen 16 Endometrial Polyp and Hyperplasia 16 Risk of Adenocarcinoma 16 Risk of Carcinosarcoma 17 Papillary Serous Carcinoma of the Uterus and Breast Carcinoma 17 Management of Patients 17 Value of the Pap Smear 18 1 .4. High-Risk Population 18 1 .5. Prevention of Uterine Cancer 19 1 .6. Population Screening Programs. Diagnostic Methods (table 1.1) 19 Chapter 2: The Value of Endometrial Cytology 20 2.1. Types of Endometrial Cells 20 2.2. The Bethesda System 20 2.3. Benign Endometrial Cells in Cervicovaginal Smears 22 2.4. Histiocytes and Psammoma Bodies 23 2.5. Effectiveness of Endometrial Cytology in Detecting Endometrial Malignancy 24 Chapter 3: Techniques of Endometrial Cytology 26 3.1. Techniques for the Detection and Early Diagnosis of Endometrial Cancer 26 3.2. Techniques of Endometrial Cytology 26 3.2.1. The Medhosa Cannula 26 3.2.2. Mi-Mark Helix Technique 27 Results of the Technique 27 3.2.3. Endobrush 28 3.2.4. Endopap 28 Results of Technique 29 3.3. Spanish Endometrial Experience 29 3.4. Tao Brush 30 3.5. Other Endometrial Techniques 31 Endocyte 31 3.6. New Resources for Endometrial Cytologic Diagnosis 31 Chapter 4: Techniques of Endometrial Histopathology 34 4.1. Office Procedures (tables 4.3, 4.4) 34 4.1.1. Vacuum-Based Sampling Techniques 34 Results of the Technique 34 4.1.1.1. Internal Piston 35 Pipelle 35 Results of the Technique 35 Other Internal Piston Devices 35 4.1.1.2. Vacuum Syringe 35 Novak Curette 35 Results of the Technique 36 Other Devices with Vacuum Syringe 36 Uterine Explora Curette 36 4.1.1.3. Vacuum Pump (Electric Suction Devices) 36 Vabra Aspirator 36 Results of the Technique 36 Other Electric Suction Devices 36 4.1.2. Brushing Technique 37 Results of the Technique 37 4.2. Dilatation and Curettage 37 Results of the Technique 37 4.3. Hysteroscopy and Curettage 38 Results of the Technique 38 Chapter 5: New Techniques for the Diagnosis of Endometrial Pathology 39 Introduction 39 Diagnostic Methods for Endometrial Pathology 39 5.1. Ultrasound 39 Endometrial Thickness (ETh) 40 Endometrial Sonostructure 40 5.2. Hysterosonography 41 5.3. Color Doppler and Pulsed Doppler 41 5.4. 3D Ultrasound (fig. 5.5, 5.6) 42 5.5. Hysteroscopy in the Office 42 Chapter 6: Cytology of the Normal Endometrium – Cycling and Postmenopausal 45 6.1. Histology of the Endometrium 45 6.2. The Endometrial Smear 46 Endometrial Epithelial Cells 46 Stromal Cells of the Endometrium 47 6.3. Patterns of Normal Endometrial Smears 48 6.3.1. Endometrial Smear during the Menstrual Cycle 48 Proliferative Phase 48 Secretory Phase 49 Menstrual Phase 49 6.3.2. Endometrial Cytology in the Menopause 50 6.4. Differential Diagnosis of Normal Endometrial Cells 51 Chapter 7: Benign Endometrial Lesions 53 7.1. Inflammation 53 7.1.1. Non-Specific Acute and Chronic Endometritis 53 7.1.2. Specific Endometritis 53 7.2. Dysfunctional Uterine Bleeding 54 7.3. Effects of Radiation 55 7.4. Benign Endometrial Tumors 55 Chapter 8: Cytopathology of Endometrial Hyperplasias 57 8.1. Introduction 57 8.2. Histopathology 57 8.2.1. Criteria for Histological Typing 57 8.2.2. WHO Classification of Endometrial Hyperplasia 57 8.2.3. Multicentric European Study on Endometrial Hyperplasia 58 8.2.4. Contemporary Approach to Endometrial Hyperplasia 59 8.2.5. Endometrial Intraepithelial Neoplasia 60 8.3. Cytopathology of Endometrial Hyperplasias 60 8.3.1. The Spanish Society of Cytology Endometrial Nomenclature 60 8.3.2. Current Status of Cytopathology of Endometrial Hyperplasias 61 8.3.3. Practical Considerations in the Cytopathology of Endometrial Hyperplasia 62 8.4. Cytopathology of Endometrial Hyperplasias. The Jiménez-Ayala Classification 62 Endometrial Hyperplasia (table 8.5) 62 Endometrioid Neoplasia (table 8.6) 62 Final Remarks and Conclusions 64 Chapter 9: Cytopathology of Endometrial Adenocarcinoma 65 9.1. Problems and Accuracy for the Cytological Diagnosis of Endometrial Adenocarcinoma 65 Problems 65 Accuracy 65 9.2. Classification of Endometrial Epithelial Tumors 65 9.3. Histopathology of Endometrioid Adenocarcinoma 66 Immunohistochemistry of Endometrioid Adenocarcinoma 67 9.4. Cytopathological Grading of EnA 67 9.5. Cytological Diagnosis of Endometrioid Adenocarcinoma 68 Cervicovaginal Smear 68 Endometrial Brushing 69 Liquid-Based Preparation 71 9.6. Special Types of Malignant Endometrial Epithelial Tumors 71 9.6.1. Variants of EnA 71 Variant with Squamous Differentiation 71 Villoglandular Variant 72 9.6.2. Mucinous Adenocarcinoma 72 9.6.3. Serous Endometrial Adenocarcinoma 73 9.6.4. Clear Cell Endometrial Adenocarcinoma 74 9.6.5. Mixed Adenocarcinoma 74 9.6.6. Primary Squamous Cell Carcinoma of the Endometrium 74 9.6.7. Small Cell Carcinoma 76 9.6.8. Undifferentiated Carcinoma 76 9.7. Differential Diagnosis of Endometrial Adenocarcinoma 77 9.7.1. Benign Processes 77 9.7.1.1. Endometrial Polyp 77 9.7.1.2. Chronic Endometritis 77 9.7.1.3. Arias-Stella Reaction 78 9.7.1.4. Reactive Endocervical Cells 78 9.7.1.5. IUD Effects 78 9.7.1.6. Microglandular Hyperplasia of the Cervix 78 9.7.1.7. Effects of Hormonal Therapy 79 9.7.2. Malignant Tumors (table 9.7) 79 9.7.2.1. Epithelial Tumors 79 9.7.2.2. Mesenchymal Tumors and Carcinosarcoma 81 9.7.2.3. Choriocarcinomas 81 Chapter 10: Cytopathology of the Non-Epithelial Malignant Tumors of the Uterine Corpus 82 10.1. Histological Classification of Tumors of the Uterine Corpus 82 10.2. Problems in Cytological Diagnosis 82 10.3. Cytological Features of Non-Epithelial 1 0.3. Cytological Features of Non-Epithelial 82 Shedding 82 Nuclei 83 Cytoplasm 83 10.4. Mesenchymal Malignant Tumors 84 Endometrial Stromal Sarcomas 84 Differential Diagnosis (table 10.2) 85 Malignant Tumors 85 Benign Lesions 87 Leiomyosarcoma 87 Malignant Tumors 88 Benign Lesions 89 10.5. Concept of Mixed Epithelial and Mesenchymal Tumors 89 Carcinosarcoma 89 Diagnostic Methods 90 Histopathology 90 Cytopathology 91 Cytopathology of Recurrences and Metastases 92 Differential Diagnosis 93 References 95 Index 101 A 101 B 101 C 101 D 101 E 101 F 102 G 102 H 102 I 102 J 102 K 102 L 102 M 103 N 103 O 103 P 103 R 103 S 103 T 103 U 103 V 104 W 104 Z 104 Cover......Page 1 Contents......Page 8 Preface......Page 11 Foreword......Page 12 List of Abbreviations......Page 13 Increasing Incidence of Endometrial Adenocarcinoma......Page 14 1.3. Hormonal Therapy.The Effects on the Endometrium......Page 15 Risk of Adenocarcinoma......Page 16 Management of Patients......Page 17 1 .4. High-Risk Population......Page 18 1 .6. Population Screening Programs. Diagnostic Methods (table 1.1)......Page 19 2.2. The Bethesda System......Page 20 2.3. Benign Endometrial Cells in Cervicovaginal Smears......Page 22 2.4. Histiocytes and Psammoma Bodies......Page 23 2.5. Effectiveness of Endometrial Cytology in Detecting Endometrial Malignancy......Page 24 3.2.1. The Medhosa Cannula......Page 26 Results of the Technique......Page 27 3.2.4. Endopap......Page 28 3.3. Spanish Endometrial Experience......Page 29 3.4. Tao Brush......Page 30 3.6. New Resources for Endometrial Cytologic Diagnosis......Page 31 Results of the Technique......Page 34 Novak Curette......Page 35 Other Electric Suction Devices......Page 36 Results of the Technique......Page 37 Results of the Technique......Page 38 5.1. Ultrasound......Page 39 Endometrial Sonostructure......Page 40 5.3. Color Doppler and Pulsed Doppler......Page 41 5.5. Hysteroscopy in the Office......Page 42 6.1. Histology of the Endometrium......Page 45 Endometrial Epithelial Cells......Page 46 Stromal Cells of the Endometrium......Page 47 Proliferative Phase......Page 48 Menstrual Phase......Page 49 6.3.2. Endometrial Cytology in the Menopause......Page 50 6.4. Differential Diagnosis of Normal Endometrial Cells......Page 51 7.1.2. Specific Endometritis......Page 53 7.2. Dysfunctional Uterine Bleeding......Page 54 7.4. Benign Endometrial Tumors......Page 55 8.2.2. WHO Classification of Endometrial Hyperplasia......Page 57 8.2.3. Multicentric European Study on Endometrial Hyperplasia......Page 58 8.2.4. Contemporary Approach to Endometrial Hyperplasia......Page 59 8.3.1. The Spanish Society of Cytology Endometrial Nomenclature......Page 60 8.3.2. Current Status of Cytopathology of Endometrial Hyperplasias......Page 61 Endometrioid Neoplasia (table 8.6)......Page 62 Final Remarks and Conclusions......Page 64 9.2. Classification of Endometrial Epithelial Tumors......Page 65 9.3. Histopathology of Endometrioid Adenocarcinoma......Page 66 9.4. Cytopathological Grading of EnA......Page 67 Cervicovaginal Smear......Page 68 Endometrial Brushing......Page 69 Variant with Squamous Differentiation......Page 71 9.6.2. Mucinous Adenocarcinoma......Page 72 9.6.3. Serous Endometrial Adenocarcinoma......Page 73 9.6.6. Primary Squamous Cell Carcinoma of the Endometrium......Page 74 9.6.8. Undifferentiated Carcinoma......Page 76 9.7.1.2. Chronic Endometritis......Page 77 9.7.1.6. Microglandular Hyperplasia of the Cervix......Page 78 9.7.2.1. Epithelial Tumors......Page 79 9.7.2.3. Choriocarcinomas......Page 81 Shedding......Page 82 Cytoplasm......Page 83 Endometrial Stromal Sarcomas......Page 84 Malignant Tumors......Page 85 Leiomyosarcoma......Page 87 Malignant Tumors......Page 88 Carcinosarcoma......Page 89 Histopathology......Page 90 Cytopathology......Page 91 Cytopathology of Recurrences and Metastases......Page 92 Differential Diagnosis......Page 93 References......Page 95 E......Page 101 L......Page 102 U......Page 103 Z......Page 104 The incidence of endometrial adenocarcinoma, the most common malignant tumor of the female genital tract in developed countries, has increased over recent years. A variety of collection techniques are available to obtain cytologic or histopathologic samples for its diagnosis but their interpretation can be difficult without proper collection and preparation. However, this monograph, written by internationally recognized experts, is a most valuable educational resource for the pathologist and cytopathologist in the techniques of endometrial sampling and diagnosis. The chapters are comprehensive and logically organized, covering the epidemiology and pathogenesis of endometrial adenocarcinoma, endometrial sampling techniques and the spectrum of cytomorphologic appearance from benign through hyperplasia to adenocarcinoma of the endometrium. A separate chapter covers non-epithelial uterine malignancies. Throughout the monograph, inclusion of both cytologic and H & E histologic images allows cytohistologic correlation of lesions. In summary, this endometrial handbook seeks to clarify a difficult area of cytodiagnosis and will become an important reference text for cytopathologists, pathologists and cytotechnologists