Routine histologic features in complex atypical hyperplasia can predict the presence of endometrial carcinoma: a clinicopathologic study of 222 cases

Publication date: Available online 17 March 2018
Source:Human Pathology
Author(s): Cunxian Zhang, Edmond Y Wang, Fang Liu, C James Sung, M Ruhul Quddus, Joyce Ou, Michele Lomme, W Dwayne Lawrence
There is a wide range of finding endometrial adenocarcinoma (ADCA) in the uterus following a diagnosis of complex atypical hyperplasia (CAH), likely due to a poor diagnostic reproducibility and an inherent heterogeneity in CAH. We evaluated whether histologic subtyping of CAH would help predict ADCA. Our study consisted of 222 cases of CAH diagnosed by endometrial biopsy or curettage. ADCA was seen in 38.3% of these cases at hysterectomy. We divided CAH into two subtypes: type A was defined as back-to-back glands in a focus smaller than 2.1 mm, and type B as crowded glands with cytologic atypia but there was still intervening stroma regardless of lesional size. Type A was associated with a significantly higher frequency of ADCA (75.9%) than type B (26.2%). Lesions containing neutrophilic/cellular debris showed a higher association of ADCA (60.0%) compared to those without neutrophilic/cellular debris (35.5%). CAH present outside endometrial polyp was associated with a higher frequency of ADCA (42.5%) than that confined to endometrial polyp (19.5%). Within type B cases, lesions greater than 3 mm had a higher association of ADCA (34.3%) than smaller ones (13.6%). Patients older than 50 years were more likely to have ADCA in the uterus compared to younger women with a preoperative diagnosis of CAH (43.2% versus 28.3%). CAH made on office biopsy showed a higher association of ADCA (46.6%) compared to a diagnosis made on curettage (31.1%). Recognition of these clinicopathologic features in CAH may prove useful in predicting the likelihood of ADCA in the uterus.



http://ift.tt/2IzZMv6