Difficulties in Assessing the Depth of Myometrial Invasion in Endometrial Carcinoma

Asya Ali, Destin Black, Robert A Soslow
International journal of gynecological pathology : official journal of the International Society of Gynecological Pathologists · 2007 · vol. 26(2) , pp. 115–123 · doi:10.1097/01.pgp.0000233165.56385.0b · PMID:17413976 · W1983997374
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Reassessing 100 endometrial carcinomas revealed discrepancies in myometrial invasion depth measurement in 29% of cases, particularly those with exophytic tumors, irregular junctions, adenomyosis, and smooth muscle metaplasia.

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Abstract

The depth of myometrial invasion (DMI) is one of the most important prognostic indicators and determinants of therapy in endometrial cancer. There are well-documented problems in recognizing DMI. We examined 100 previously diagnosed endometrioid endometrial carcinomas in hysterectomy specimens, reassessed DMI, and explored morphological features that complicated appraisal of myometrial invasion. The DMI was different from the original measurement in 29% of cases. Twelve percent of all cases (40% of cases with measurement discrepancies) involved differences in the assignment of invasion categories (noninvasive, 50% myometrial invasion). Nearly all endometrial cancers originally diagnosed as invasive were considered noninvasive on review. We examined whether the distribution of stromal metaplasia, noninvasive patterns (exophytic tumors, irregular endomyometrial junctions, and adenomyosis), and myometrial invasion patterns were different in cases with and without measurement discrepancies. Irregular endomyometrial junctions, exophytic tumors, and adenomyosis tended to coexist and were more common in the cases with DMI discrepancies. Although there seemed to be a relationship between smooth muscle metaplasia and exophytic tumors, it did not appear that smooth muscle metaplasia was significantly more common in cases with measurement difficulties. However, cases with extensive smooth muscle metaplasia posed problems with assessment of myometrial invasion. Patterns of myometrial invasion other than the conventional destructive pattern were sufficiently uncommon as to not impact on DMI measurement in large numbers of cases. Measuring the DMI is usually uncomplicated, but additional scrutiny should be paid to cases involving exophytic tumors, irregular endomyometrial junctions, adenomyosis, and extensive stromal smooth muscle metaplasia.

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Condition tags

adenomyosis

MeSH descriptors

Endometrial Neoplasms Endometrial Stromal Tumors Myometrium Adult Aged Aged, 80 and over Carcinoma, Endometrioid Carcinoma, Endometrioid Cohort Studies Endometrial Neoplasms Endometrial Neoplasms Endometrial Stromal Tumors Endometrial Stromal Tumors Female Humans Middle Aged Myometrium Neoplasm Invasiveness Prognosis Reproducibility of Results

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