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9 - Clear cell adenocarcinoma and other uterine corpus carcinomas, including unusual variants

Published online by Cambridge University Press:  05 July 2013

Robert A. Soslow  and
Teri A. Longacre
Robert A. Soslow
Affiliation:
Memorial Sloan-Kettering Cancer Center, New York
Teri A. Longacre
Affiliation:
Stanford University School of Medicine, California
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Summary

INTRODUCTION

Although endometrioid and serous adenocarcinomas comprise the majority of uterine corpus carcinomas, the less common clear cell, mucinous, and very rare squamous variants may pose considerable diagnostic problems. In addition, there are a variety of unusual carcinomas that occur in the uterus, some of which demonstrate distinctive clinical behavior as well as distinctive morphology. In contrast to the more common endometrioid and serous tumors, there are fewer data concerning these tumors.

CLEAR CELL CARCINOMA

Clear cell carcinoma currently accounts for less than 5% of all endometrial carcinomas in the United States.

Clinical characteristics

Clear cell carcinoma is considered to be a type II estrogen-independent nonendometrioid carcinoma. Patients tend to be older than those with endometrioid carcinoma, but slightly younger than those with serous carcinoma, with a mean age of 62 to 67 years. As with serous carcinoma, African-American women are more frequently affected. Despite its high grade, disease is confined to the uterus at presentation in 70% of patients. Radiation and tamoxifen have been implicated in a subset of clear cell carcinomas.

Clear cell carcinoma has a worse prognosis than endometrioid carcinoma. The five-year overall survival rate is 62.5% for patients with clear cell adenocarcinoma compared with 83.2% for those with endometrioid carcinoma. Stage is the most important prognostic factor; in the M. D. Anderson Center study, patients with low-stage (FIGO I and II) clear cell carcinoma had an estimated survival rate similar to that of patients with FIGO grade 3 endometrioid adenocarcinoma, and better than that of patients with serous carcinoma of similar stages.

Type
Chapter
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Uterine Pathology , pp. 174 - 195
Publisher: Cambridge University Press
Print publication year: 2012

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References

Abeler, VM, Kjorstad, KE. Clear cell carcinoma of the endometrium: a histopathological and clinical study of 97 cases. Gynecol Oncol 1991;40:207–17.CrossRefGoogle ScholarPubMed
Abeler, VM, Vergote, IB, Kjorstad, KE, et al. Clear cell carcinoma of the endometrium. Prognosis and metastatic pattern. Cancer 1996;78:1740–7.3.0.CO;2-Y>CrossRefGoogle ScholarPubMed
Kurman, R, Scully, R.Clear cell carcinoma of the endometrium: an analysis of 21 cases. Cancer 1976;37:872–82.3.0.CO;2-L>CrossRefGoogle ScholarPubMed
Lax, SF.Molecular genetic changes in epithelial, stromal and mixed neoplasms of the endometrium. Pathology 2007;39:46–54.CrossRefGoogle ScholarPubMed
Gadducci, A, Cosio, S, Spirito, N, et al. Clear cell carcinoma of the endometrium: a biological and clinical enigma. Anticancer Res 2010;30:1327–34.Google ScholarPubMed
Malpica, A, Tornos, C, Burke, TW, et al. Low-stage clear-cell carcinoma of the endometrium. Am J Surg Pathol 1995;19:769–74.CrossRefGoogle ScholarPubMed
Lee, L, Garrett, L, Lee, H, et al. Association of clear cell carcinoma of the endometrium with a high rate of venous thromboembolism. J Reprod Med 2009;54:133–8.Google ScholarPubMed
Fadare, O, Liang, SX, Ulukus, EC, et al. Precursors of endometrial clear cell carcinoma. Am J Surg Pathol 2006;30:1519–30.CrossRefGoogle ScholarPubMed
Lax, SF, Pizer, ES, Ronnett, BM, et al. Clear cell carcinoma of the endometrium is characterized by a distinctive profile of p53, Ki-67, estrogen, and progesterone receptor expression. Hum Pathol 1998;29:551–8.CrossRefGoogle ScholarPubMed
Yamamoto, S, Tsuda, H, Aida, S, et al. Immunohistochemical detection of hepatocyte nuclear factor 1beta in ovarian and endometrial clear-cell adenocarcinomas and nonneoplastic endometrium. Hum Pathol 2007;38:1074–80.CrossRefGoogle ScholarPubMed
Hendrickson, M, Ross, J, Eifel, P, et al. Uterine papillary serous carcinoma: a highly malignant form of endometrial adenocarcinoma. Am J Surg Pathol 1982;6:93–108.CrossRefGoogle ScholarPubMed
Silva, EG, Young, RH.Endometrioid neoplasms with clear cells: a report of 21 cases in which the alteration is not of typical secretory type. Am J Surg Pathol 2007;31:1203–8.CrossRefGoogle Scholar
Nucci, MR, Prasad, CJ, Crum, CP, et al. Mucinous endometrial epithelial proliferations: a morphologic spectrum of changes with diverse clinical significance. Mod Pathol 1999;12:1137–42.Google ScholarPubMed
Ross, J, Eifel, P, Cox, R, et al. Primary mucinous adenocarcinoma of the endometrium. A clinicopathologic and histochemical study. Am J Surg Pathol 1983;7:715–29.CrossRefGoogle ScholarPubMed
Vang, R, Tavassoli, FA.Proliferative mucinous lesions of the endometrium: analysis of existing criteria for diagnosing carcinoma in biopsies and curettings. Int J Surg Pathol 2003;11:261–70.CrossRefGoogle ScholarPubMed
Zaloudek, C, Hayashi, GM, Ryan, IP, et al. Microglandular adenocarcinoma of the endometrium: a form of mucinous adenocarcinoma that may be confused with microglandular hyperplasia of the cervix. Int J Gynecol Pathol 1997;16:52–9.CrossRefGoogle ScholarPubMed
Fujiwara, M, Longacre, TA.Low grade mucinous adenocarcinoma of the uterine corpus: a rare and deceptively bland form of endometrial carcinoma. Am J Surg Pathol 2011;35:537–44.CrossRefGoogle ScholarPubMed
Longacre, TA, Chung, MH, Jensen, DN, et al. Proposed criteria for the diagnosis of well-differentiated endometrial carcinoma. A diagnostic test for myoinvasion. Am J Surg Pathol 1995;19:371–406.CrossRefGoogle Scholar
Cacciatore, B, Lehtovirta, P, Wahlstrom, T, et al. Preoperative sonographic evaluation of endometrial cancer. Am J Obstet Gynecol 1989;160:133–7.CrossRefGoogle ScholarPubMed
Hricak, H, Lacey, C, Schriock, E, et al. Gynecologic masses: value of magnetic resonance imaging. Am J Obstet Gynecol 1985;153:31–7.CrossRefGoogle ScholarPubMed
Posniak, H, Olson, M, Dudiak, C, et al. MR imaging of uterine carcinoma: correlation with clinical and pathologic findings. Radiographics 1990;10:15–27.CrossRefGoogle ScholarPubMed
Williams, AS, Kost, ER, Hermann, J, et al. Hysteroscopy in the evaluation and treatment of mucinous adenocarcinoma. Obstet Gynecol 2002;99:509–11.Google ScholarPubMed
Zaino, RJ.The fruits of our labors: distinguishing endometrial from endocervical adenocarcinoma. Int J Gynecol Pathol 2002;21:1–3.CrossRefGoogle ScholarPubMed
Kumar, A, Schneider, V.Metastases to the uterus from extrapelvic primary tumors. Int J Gynecol Pathol 1983;2:134–40.CrossRefGoogle ScholarPubMed
Kumar, N, Hart, W.Metastases to the uterine corpus from extragenital cancers. A clinicopathologic study of 63 cases. Cancer 1982;50:2163–9.3.0.CO;2-F>CrossRefGoogle ScholarPubMed
Qiu, W, Mittal, K.Comparison of morphologic and immunohistochemical features of cervical microglandular hyperplasia with low-grade mucinous adenocarcinoma of the endometrium. Int J Gynecol Pathol 2003;22:261–5.CrossRefGoogle ScholarPubMed
Goodman, A, Zukerberg, LR, Rice, LW, et al. Squamous cell carcinoma of the endometrium: a report of eight cases and a review of the literature. Gynecol Oncol 1996;61:54–60.CrossRefGoogle Scholar
Abeler, VM, Kjorstad, KE, Berle, E.Carcinoma of the endometrium in Norway: a histopathological and prognostic survey of a total population. Int J Gynecol Cancer 1992;2:9–22.CrossRefGoogle ScholarPubMed
Bagga, PK, Jaswal, TS, Datta, U, et al. Primary endometrial squamous cell carcinoma with extensive squamous metaplasia and dysplasia. Indian J Pathol Microbiol 2008;51:267–8.CrossRefGoogle ScholarPubMed
Seltzer, VL, Klein, M, Beckman, EM.The occurrence of squamous metaplasia as a precursor of squamous cell carcinoma of the endometrium. Obstet Gynecol 1977;49:34–7.Google ScholarPubMed
Kataoka, A, Nishida, T, Sugiyama, T, et al. Squamous cell carcinoma of the endometrium with human papillomavirus type 31 and without tumor suppressor gene p53 mutation. Gynecol Oncol 1997;65:180–4.CrossRefGoogle ScholarPubMed
Illanes, D, Broman, J, Meyer, B, et al. Verrucous carcinoma of the endometrium: case history, pathologic findings, brief review of literature and discussion. Gynecol Oncol 2006;102:375–7.CrossRefGoogle ScholarPubMed
Kay, S.Squamous-cell carcinoma of the endometrium. Am J Clin Pathol 1974;61:264–9.CrossRefGoogle ScholarPubMed
Horn, LC, Richter, CE, Einenkel, J, et al. p16, p14, p53, cyclin D1, and steroid hormone receptor expression and human papillomaviruses analysis in primary squamous cell carcinoma of the endometrium. Ann Diagn Pathol 2006;10:193–6.CrossRefGoogle ScholarPubMed
Houghton, O, Connolly, , McCluggage, WG.Morules in endometrioid proliferations of the uterus and ovary consistently express the intestinal transcription factor CDX2. Histopathology 2008;53:156–65.CrossRefGoogle ScholarPubMed
Chen, KT.Extraovarian transitional cell carcinoma of female genital tract. Am J Clin Pathol 1990;94:670–1.CrossRefGoogle ScholarPubMed
Lininger, RA, Ashfaq, R, Albores-Saavedra, J, et al. Transitional cell carcinoma of the endometrium and endometrial carcinoma with transitional cell differentiation. Cancer 1997;79:1933–43.3.0.CO;2-W>CrossRefGoogle ScholarPubMed
Spiegel, GW, Austin, RM, Gelven, PL.Transitional cell carcinoma of the endometrium. Gynecol Oncol 1996;60:325–30.CrossRefGoogle ScholarPubMed
Mills, A, Pai, R, Liou, S, et al. Clinicopathologic features of sporadic endometrial carcinomas with MLH1 promoter hypermethylation: a study of 54 cases. Mod Pathol 2011;24:260A.Google Scholar
Altrabulsi, B, Malpica, A, Deavers, MT, et al. Undifferentiated carcinoma of the endometrium. Am J Surg Pathol 2005;29:1316–21.CrossRefGoogle ScholarPubMed
Tafe, LJ, Garg, K, Chew, I, et al. Endometrial and ovarian carcinomas with undifferentiated components: clinically aggressive and frequently underrecognized neoplasms. Mod Pathol 2010;23:781–9.CrossRefGoogle ScholarPubMed
Garg, K, Leitao, MM, Kauff, ND, et al. Selection of endometrial carcinomas for DNA mismatch repair protein immunohistochemistry using patient age and tumor morphology enhances detection of mismatch repair abnormalities. Am J Surg Pathol 2009;33:925–33.CrossRefGoogle ScholarPubMed
Vargas, MP, Merino, MJ.Lymphoepitheliomalike carcinoma: an unusual variant of endometrial cancer. A report of two cases. Int J Gynecol Pathol 1998;17:272–6.CrossRefGoogle ScholarPubMed
Jones, MA, Young, RH, Scully, RE.Endometrial adenocarcinoma with a component of giant cell carcinoma. Int J Gynecol Pathol 1991;10:260–70.CrossRefGoogle ScholarPubMed
Mulligan, AM, Plotkin, A, Rouzbahman, M, et al. Endometrial giant cell carcinoma: a case series and review of the spectrum of endometrial neoplasms containing giant cells. Am J Surg Pathol 2010;34:1132–8.CrossRefGoogle ScholarPubMed
Takahashi, Y, Inoue, T.Hepatoid carcinoma of the uterus that collided with carcinosarcoma. Pathol Int 2003;53:323–6.CrossRefGoogle ScholarPubMed
Takeuchi, K, Kitazawa, S, Hamanishi, S, et al. A case of alpha-fetoprotein-producing adenocarcinoma of the endometrium with a hepatoid component as a potential source for alpha-fetoprotein in a postmenopausal woman. Int J Gynecol Cancer 2006;16:1442–5.CrossRefGoogle Scholar
Toyoda, H, Hirai, T, Ishii, E.Alpha-fetoprotein producing uterine corpus carcinoma: a hepatoid adenocarcinoma of the endometrium. Pathol Int 2000;50:847–52.CrossRefGoogle ScholarPubMed
Nogales, F, Gomez-Morales, M, Raymundo, C, et al. Benign heterologous tissue components associated with endometrial carcinoma. Int J Gynecol Pathol 1982;1:286–91.CrossRefGoogle ScholarPubMed
Kotru, M, Chandra, H, Singh, N, et al. Localized amyloidosis in endometrioid carcinoma of the uterus: a rare association. Arch Gynecol Obstet 2007;276:383–4.CrossRefGoogle ScholarPubMed
Ferrandina, G, Zannoni, GF, Petrillo, M, et al. Glassy cell carcinoma of the endometrium: a case report and review of the literature. Pathol Res Pract 2007;203:217–20.CrossRefGoogle ScholarPubMed
Clement, PB, Young, RH, Scully, RE.Extraovarian pelvic yolk sac tumors. Cancer 1988;62:620–6.3.0.CO;2-P>CrossRefGoogle ScholarPubMed
Copeland, LJ, Sneige, N, Ordonez, NG, et al. Endodermal sinus tumor of the vagina and cervix. Cancer 1985;55:2558–65.3.0.CO;2-J>CrossRefGoogle ScholarPubMed
Joseph, MG, Fellows, FG, Hearn, SA.Primary endodermal sinus tumor of the endometrium. A clinicopathologic, immunocytochemical, and ultrastructural study. Cancer 1990;65:297–302.3.0.CO;2-E>CrossRefGoogle ScholarPubMed
Pileri, S, Martinelli, G, Serra, L, et al. Endodermal sinus tumor arising in the endometrium. Obstet Gynecol 1980;56:391–6.Google ScholarPubMed
Spatz, A, Bouron, D, Pautier, P, et al. Primary yolk sac tumor of the endometrium: a case report and review of the literature. Gynecol Oncol 1998;70:285–8.CrossRefGoogle ScholarPubMed
Oguri, H, Sumitomo, R, Maeda, N, et al. Primary yolk sac tumor concomitant with carcinosarcoma originating from the endometrium: case report. Gynecol Oncol 2006;103:368–71.CrossRefGoogle ScholarPubMed
Patsner, B.Primary endodermal sinus tumor of the endometrium presenting as “recurrent” endometrial adenocarcinoma. Gynecol Oncol 2001;80:93–5.CrossRefGoogle ScholarPubMed
Ansah-Boateng, Y, Wells, M, Poole, D.Coexistent immature teratoma of the uterus and endometrial adenocarcinoma complicated by gliomatosis peritonei. Gynecol Oncol 1985;21:106–10.CrossRefGoogle ScholarPubMed
Bradley, CS, Benjamin, I, Wheeler, JE, et al. Endometrial adenocarcinoma with trophoblastic differentiation. Gynecol Oncol 1998;69:74–7.CrossRefGoogle ScholarPubMed
Horn, LC, Hanel, C, Bartholdt, E, et al. Serous carcinoma of the endometrium with choriocarcinomatous differentiation: a case report and review of the literature indicate the existence of 2 prognostically relevant tumor types. Int J Gynecol Pathol 2006;25:247–51.CrossRefGoogle ScholarPubMed
Kalir, T, Seijo, L, Deligdisch, L, et al. Endometrial adenocarcinoma with choriocarcinomatous differentiation in an elderly virginal woman. Int J Gynecol Pathol 1995;14:266–9.CrossRefGoogle Scholar
Pesce, C, Merino, M, Chambers, J, et al. Endometrial carcinoma with trophoblastic differentiation. Cancer 1991;68:1799–1802.3.0.CO;2-3>CrossRefGoogle ScholarPubMed
Savage, J, Subby, W, Okagaki, T.Adenocarcinoma of the endometrium with trophoblastic differentiation and metastases as choriocarcinoma: a case report. Gynecol Oncol 1987;26:257–62.CrossRefGoogle ScholarPubMed
Abeler, VM, Kjorstad, KE, Nesland, JM.Undifferentiated carcinoma of the endometrium. A histopathologic and clinical study of 31 cases. Cancer 1991;68:98–105.3.0.CO;2-R>CrossRefGoogle ScholarPubMed
Marquette, A, Moerman, P, Vergote, I, et al. Second case of uterine mesonephric adenocarcinoma. Int J Gynecol Cancer 2006;16:1450–4.CrossRefGoogle ScholarPubMed
Ordi, J, Nogales, FF, Palacin, A, et al. Mesonephric adenocarcinoma of the uterine corpus: CD10 expression as evidence of mesonephric differentiation. Am J Surg Pathol 2001;25:1540–5.CrossRefGoogle ScholarPubMed
Erhan, Y, Dikmen, Y, Yucebilgin, MS, et al. Large cell neuroendocrine carcinoma of the uterine corpus metastatic to brain and lung: case report and review of the literature. Eur J Gynaecol Oncol 2004;25:109–12.Google ScholarPubMed
Huntsman, DG, Clement, PB, Gilks, CB, et al. Small-cell carcinoma of the endometrium. A clinicopathological study of sixteen cases. Am J Surg Pathol 1994;18:364–75.CrossRefGoogle ScholarPubMed
Katahira, A, Akahira, J, Niikura, H, et al. Small cell carcinoma of the endometrium: report of three cases and literature review. Int J Gynecol Cancer 2004;14:1018–23.CrossRefGoogle ScholarPubMed
Manivel, C, Wick, MR, Sibley, RK.Neuroendocrine differentiation in mullerian neoplasms. An immunohistochemical study of a “pure” endometrial small-cell carcinoma and a mixed mullerian tumor containing small-cell carcinoma. Am J Clin Pathol 1986;86:438–43.CrossRefGoogle Scholar
Varras, M, Akrivis, C, Demou, A, et al. Primary small-cell carcinoma of the endometrium: clinicopathological study of a case and review of the literature. Eur J Gynaecol Oncol 2002;23:577–81.Google ScholarPubMed

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