Endometrial Carcinoma
Endometrial carcinoma is the most common gynecologic malignancy in developed countries. It is categorized into two distinct clinicopathologic types.
1. Clinicopathologic Types
| Type | Pathogenesis | Histology |
|---|---|---|
| Type I (Endometrioid) | Estrogen-dependent; arises from atypical hyperplasia. | Endometrioid glands. |
| Type II (Serous) | Estrogen-independent; associated with p53 mutation, atrophy. | Papillary, aggressive. |
2. Exam Must-Knows
- Presentation: Postmenopausal bleeding is the hallmark. Always perform endometrial sampling/biopsy.
- Lynch Syndrome: Associated with HNPCC; patients have a high lifetime risk of endometrial cancer (also ovarian and colorectal).
- Prognosis: Type I generally has a favorable prognosis; Type II is poorly differentiated and highly aggressive.
Pathology Board Hint: Remember the two-pathway model: Type I is the classic “obese, diabetic, hypertensive” patient driven by estrogen. Type II is the thin, older, atrophic patient with p53 mutations and a much worse prognosis. If a young patient develops this, always check for Lynch syndrome.