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• Complex hyperplasia Atypical simple hyperplasia Atypical complex hyperplasia defines an endometrium with dilated glands that may contain some outpouching and abundant endometrial stroma Glands cystically dilated and focal crowding

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Less than 4mm had a 100% negative predictive value . i h l c y s • • • C l o m p e this condition. HSSG Thickened Endometrium A measurement of >5mm in the postmenopausal woman and > 15mm in the premenopausal woman warrant further investigation with sonohysterography. Some patients benefit from an oral nonsteroidal antiinflammatory drug taken approximately 30 minutes before biopsy. scalloping and tuffin • Cytomegaly.CBC.Coagulation Profile .Prolactin . These hyperplasias have a low premalignant potential. but paracervical block can be an effective anesthetic aid.Normal Endometrial Thickness Ultrasonography: Postmenopause: <5mm Reproductive Age: *Proliferative Phase: 5-8mm *Periovulatory Phase: 6-10mm *Secretory Phase: 7-14mm • D&C • Hysteroscopy • Diagnostic Procedures and Tests when Appropriate: . • Crowding of glands with disparity in their size and irregularity in their shape.Greater use was eliminating the diagnosis of neoplasia for those with endometrial thickness less than 5mm (negative predictive value of 99%) . • Transvaginal ultrasonongraphy: .Routine screening with transvaginal ultrasound was not of value. loss polarity. It is considered to be weakly premalignant.Serum progesterone . transvaginal color Doppler and/or endometrial tissue sampling Schematic Diagram of Endometrial Management for Reproductive Patients t c y p e r p a s i C l H l i ( i h A a i o m p x e p r p s w t o u t y t p e y a a a ) 2 .HSG. and authors concluded that sampling should be done if the patient experiences bleeding .Thyroid function test . glands are crowded with very little endo-metrial stroma and a very complex gland pattern and outpouching formations this is a variant of adenomatous hyperplasia with moderate to severe degrees of architectural atypia but with no cytologic atypia. prominence of nucleoli • Altered N/C ratio • Mitosis is common Symptoms of Endometrial Hyperplasia • Abnormal Vaginal Bleeding – is the most frequent symptom of endometrial hyperplasia • Younger patients – hyperplasia may develop during anovulatory cycles and maybe even detected after a prolonged periods of oligomenorrhea or amenorrhea • Can occur anytime in reproductive age group • • Most common in perimenopausal period Diagnosis of Endometrial Hyperplasia • Premenopausal women with irregular vaginal bleeding and post menopausal women with any vaginal bleeding should be evaluated with endometrial sampling and D&C • Office sampling: thin plastic pipelle.HCG assay . Many patients tolerate office endometrial sampling without an analgesic agent. introduced through the cervical os into the endometrial cavity and can provide very accurate information. Ferritin . • Budding with fingerlike outpouching in the adjacent endometrial stroma Nuclear Atypia • Loss of polarity • Increased N:C Ratio • Irregular size and shape • Prominent nucleoli • Thick nuclear membrane Atypia • Crowding of glands • Epithelial stratification.• • • Lined by psuedostratified tall columnar epithelium Glands separated by abundant cellular stroma term has been used to describe dilation of the endometrial glands.an adjunct for the diagnosis of endometrial hyperplasia and cancer. which often occurs in a hyperplastic endometrium in a menopausal or postmenopausal woman (cystic atrophy). and simple hyperplasia with atypia is rarely seen. A i l H l x y t p a p e r p y c a s a i refers to hyperplasias that contain glands with cytologic atypia and are considered premalignant • an increase in the nuclear/cytoplasmic ratio with irregularity in the size and shape of the nuclei • Cytologic atypia occurs primarily with complex hyperplasia. Serum iron. hyperchromatism. . partic-ularly in nulliparous women. • Complex atypical hyperplasia has the greatest malignant potential.

Through the uterine wall Lumen of the fallopian tube Medical Management of Endometrial Hyperplasia • Combined oral contraceptive pills • Medroxyprogesterone Acetate • Megestrol Acetate • LNG Containing IUD Surgical Management of Endometrial Hyperplasia • D&C • Endometrial ablation .age <35: 11% a d : n a c 3 r .treatment for atypical hyperplasia .women who refuse hysterectomy .when hysterectomy is contraindicated . The broad ligament lymphatics that drain directly to the pelvic nodes D i P i l S e r c t e r t n o e a p e r n 1. Lymphatic branches from the fallopian tubes 3. A small lymphatic branch along the round ligament that runs to the inguinal femoral nodes 2.- age 35-55: 12% age >56: 28% Endometrial Cancer • most common in 50-65 y/o th • 15 most common overall • #1 in gynecologic cancer.no desire for pregnancy • Hysterectomy . Route of Spread: 4 j h l f l h i d i f h h i m a o r c n n e s o y m p a t a r a e g r o m t u e t r u s t t e s r e v a s s e t s f o a e i d e x t a r u e t r e s p e r a o f t u m o r 1. Ovarian pedicles (infundibulopelvic ligaments). 2. which are large lymphatics that drain into the paraaortic nodes 4.indicated for bleeding unresponsive to therapy . #2 cancer in women • Incidence starts rising steeply at age 50.women who do not want to take medications .

The steroid leels in endometrial carcinoma is lowest than in normal endometrium 2. much less the 65% or better usually recorded for endometrial carcinoma Uterine Papillary Serous Carcinoma • Uncommon (5-10%) • Highly virulent • Histologically resemble papillary serous carcinoma of the ovary (epithelial anaplasia and papillary growth) • High risk of extrauterine disease • (+) progestational stimulation and corpus luteum is frequently detected in the ovary • Good prognosis Mucinous Carcinoma • Extremely rare • Confused with mucinous carcinoma of the ovary. normal weight 6. Survival rate is better for women with receptor rich tumors T b l 3 2 3 C C S i ( A d d 1 9 8 8 o r p u s a n c e r a t g g o p e - - S C - h i a t e g s a a r c e t r s t IA G123 IB G123 IC G123 Tumor limited to endometrium < ½ Invasion to less than half of the myometrium > ½ Invasion to more than half of the myometrium > ½ IIA G123 Endocervical glandular involvement only IIB G123 Cervical stromal invasion c i n e t a ) 4 . cervix and vagina • Tend to develop in postmenopausal women • Prognosis much worse than typical endometrial adenocarcinoma • Survival rates of 39% . cervix or bowel [*] E d i l P i A d o m e t r r m a y r e n o c a c r i o m a n a n s With good prognosis Degree of Differentiation G1 Well differentiated G2 Moderately differentiated G3 Poorly differentiated Less than 6% solid components 6%-50% solid components More than 50% solid components Hyperestrogenic States • Unopposed estrogen stimulation • Unopposed menopausal estrogen (4-6x) replacement therapy • Menopausal after 52 year (2-4x) • Obesity (2-5x) • Nulliparity (2-3x) • Diabetes (2-8x) • Feminizing ovarian tumors • Polycystic ovarian syndrome • Tamoxifen therapy for breast cancer Diminished Risk: 1.55% have been reported. progestine therapy 3. combination oral contraception 4. menopause before 49 years 5. multiparity Steroid Hormone Receptors 1.• Histologic Types Typical endometrioid adenocarcinoma Adenocarcinoma with squamous elements Clear cell carcinoma Serous carcinoma Secretory carcinoma Mucinous carcinoma Squamous carcinoma Adenocarcinoma with Squamous Differentiation • Used with description of the degree of differentiation of both the glandular and squamous components • Adenoacanthoma: previously used to describe a well differentiated tumor • Adenosquamous Carcinoma: described a poorly differentiated carcinoma with squamous elements Clear Cell Carcinoma • Resemble clear cell adenocarcinoma of the ovary. ovulation 2. Highest levels of estrogen and progesterone receptors in tumors have been found in the well differentiated (grade 1) tumors and the lowest (grade 3) tumors 3.

or uterine adnexa. III.Clear cell carcinoma . Histolohic Type • Best Prognosis: .Without ECC • Pap Smear – detects endometrial cancer in only 50% • D&C • Hysteroscopy Prognostic Factors I.Poorly differentiated carcinoma V.With ECC: to rule out invasion to endocervix and the patient is GOOD risk for surgery . Pathologic determinants • tumor grade • histologic type • uterine size • depth of myometrial invasion • microscopic involvement of vascular spaces in the uterus by tumor • spread of tumor outside the uterus to the retroperitoneal lymph nodes. Myometrial Invasion • Deepest myometrial penetration: higher grade. Peritoneal Cytology • Results are conflicting Stratify Low Risk.Typical Adenocarcinoma .IIIA G123 Tumor invades serosa and/or adnexae and/or positive peritoneal cytology IIIB G123 Vaginal metastases IIIC G123 Metastases to pelvic and/or paraaortic lymph nodes IVA G123 IVB S I a t e g S I a t e g I : : Tumor invasion of bladder and/or bowel mucosa Distant metastases including intraabdominal and/or inguinal lymph node uterine corpus corpus at cervix outside uterus but confined in the pelvis. higher stage VI. Histologic Grade • major determinant of prognosis IV. Intermediate Risk and High Risk Stage IA Stage IB Stage IC StageIIA G1 G1 G1 G1 G2 G2 G2 G2 G3 G3 G3 G3 <50% G3 >50% S C h i a t e g s a a r c e t r s t S I I a t a t e g e g I : c i 5 . perito-neal cavity.Papillary serous carcinoma .Secretory carcinoma • Poor Prognosis . Clinical determinants: • patient age at diagnosis: older > young • race: white > black • clinical tumor stage II. involving pelvic or par aortic lymph V : node S I outside pelvis or into the mucosa of the bladder or rectum Schematic for surgical staging for endometrial carcinoma according to 1988 International Federation of Gynecology and Oncology definitions Signs and Symptoms of Endometrial Carcinoma • Post menopausal bleeding • Abnormal premenopausal bleeding • Perimenopausal bleeding Diagnosis • Endometrial Biopsy: .

clear cell or papillary serous or carcinosarcoma 6. G2 No Adjuvant G3 Vaginal Brachytherapy IB G1. PFC. PFC. however remains unknown *Strong predictor of distance and lymphatic recurrence *Warrants adjuvant therapy *Associated with a 2 fold risk of death *Adjuvant therapy chemotherapy (doxorubicin-based) radiotherapy Management: Stage I: Confined to the Corpus Surgery: EHBSO. high grade tumors showing full thickness myometrial invasion 5. Lymph Node Evaluation Adjuvant: Radiation (not for low risk patients) IA G1.Yellow – Low Risk Green – Intermediate Risk Red – High Risk Lymph Node Evaluation • Definition of adequate lymphdenectomy needs further investigation • 21-25 lymph nodes (pelvic & paraaortic): significantly increases the probability of detecting at least 1 positive lymph node in endometrioid uterine cancer Indication for Aortic Node Sampling 1. PFC.G2. G2 No Adjuvant G3 Pelvic EBRT IC G1. LNE Pelvic EBRT. grossly positive pelvic nodes 4. lower uterine segment involvement 7. G2. LNE No Adjuvant IIB EHBSO. G3 by PFC and EHBSO with selective lymphadenectomy (common iliac and para-aortic) Guidelines for Stage III Tumor Extended to the Endocervix Patients who underwent RHBSO Lines of resection are negative Brachytherapy is not necessary RH is the recommended With > 50% myometrial invasion Grade 3 tumors Cevical involvement (+) LVSI Give adjuvant therapy Lower uterine segment involvement Positive LVSI (regardless of stage and grade) 6 . PFC. G2. grossly positive adnexa 3. suspicious para-aortic or common iliac nodes 2. G3 Pelvic EBRT or pelvic Stage II: Tumor extension to the cervix (occult/microscopic) Occult Stage II: is defined as (+) ECC with histologic continuity but with no gross evidence of cervical involvement IIA RHBSO. No Adjuvant LNE For poor surgical risk (pre operative →brachytherapy→surgery Stage II Pre – operative pelvic RT and vaginal brachytherapy followed G1.G3 RHBSO. there is no apparent benefit for additional brachytherapy Stage III: Tumor extension to the cervix For good surgical risk (radical) Surgico Pathologic Staging Surgery Adjuvant IIA/IIB G1. cervical involvement Guidelines lymph node dissection may be ommited *Low risk corpus cancer (level2B) *Surface dimension < 2cm Routine omentectomy is not *As part of surgical staging recommended *For seemingly early stage endometrioid type adenocarcinoma ADJUVANT treatment for adenocarcinoma with squamous differentiation Results of PORTEC 2 (Phase III RCT) Srudy *Depend on the histological grade of the Glandular component *Vaginal brachytherapy vs pelvic EBRT alone *Vaginal brachytherapy provides a better result than pelvic EBRT in terms of QOL (initial) *Predictive of NODAL SPREAD for endometrioid histologic type tumors (odds ratio: 5) *Prognostic significance.

Lymph node (location and number) 10. 1 Generation: tamoxifen nd 2 Generation: raloxifen rd 3 Generation: arzoxifen 3. May give irradiation 4. Vaginal rim/cuff • Megestrol Acetate • MPA • DMPA Side effects: • Weight gain • Edema • Thromboplebitis • Headache • Occasional hypertension Response Rate: 30-50% *poorly differentiated tumors or hormone-receptor negative tumors have significantly lower response rates *should be considered in patients with recurrent endometrial cancer 2 S l i E R M d c t e v o x o r u s p c n a t .distant metastasis Surgery (primary) EHBSO. Depth of myometrial invasion 5. - e a t T . No dose reduction is required even if there is previous RT 2 A P R i D b i i C i l e g m e n : 9. Laparoscopy 2.unselected population 9% . Histologic Type 2. G2 30% Follow-Up after Completion of Treatment Every 3-4 mo for the first 2 years. PFC.Stage III: Tumor extension outside the uterus within the pelvis Surgery (primary): EHBSO. - C i l i P - l i l R i n a i h n i R s p t a c a t e x g m e n w n . Vaginal Hysterectomy Hormonal Treatment 1 P i l r o e g s a t t n o a A e g n t s 1 T A P R i C i l i D b i i P l i l i h F i l g m e n : s p a t o x o r u a c a t e x w t g a r s t i m s u p p o r t e n c - n . PFC. LVSI 4. May give chemotherapy Other Treatment Options 1. Depend on site. Type of cervical involvement 6. extent of disease and receptor status 3. Should be individualized 2. LNE. Every 4 weeks for 6 cycles 4 Stage IV: Tumor invades bladder and/or bowel mucosa. Aromatase Inhibitors (anastrazole) • An oral steroidal aromatase inhibitor • Response Rate: .endometrioid G1. Tumor Debulking Adjuvant Chemotherapy followed by EFRT and vaginal brachytherapy Poor Histologic Types: Uterine Papillary Serous/Clear Cell Carcinoma Surgery (primary treatment) EHBSO. Histologic Grade 3. IO. Debulking Adjuvant: Chemotherapy followed by RT staging adjuvant IIIB Chemotherapy Pelvic EBRT IIIC EFRT C h h O o y i o n m e a r p p e s t t Vaginal Brachytherapy Every 3 weeks for a maximum of 7 cycles or until disease progression or unacceptable toxicity occurs. Parametria 8. : s t r o e g n c e p t o r o u l t o r e e e . RPB (extended surgical staging) Stage Adjuvant IA Observation IB-IV Chemotherapy→Abdominopelvic RT Final Histopathologic Report of Endometrial Cancer Specimens 1. BLND. Peritoneal fluid Persistent or Recurrent Disease Treatment Options 1. PALS. Adnexal involvement 7. +/. - : Every 3 weeks for a maximum of Doxorubicin 500mg/m2 or until disease progression or unacceptable toxicity occurs 3 C b l i P l i l R a r o p t a c a t e x e g i m e n . every 6 months for the next 3 years and yearly thereafter *Pap Smear – at least yearly *MRI or CT Scan – annual for the first 3 years st a s 7 .

• Undifferentiated sarcomas have a greater degree of anaplasia and lack the branching vasculature characteristic of ESSs. • If high-grade elements are present. abnormal mitotic figures. • determination of malignancy is made in part by ascertaining the number of mitoses in 10 hpf as well as the presence of cytologic atypia. • presence of bizarre cells may not necessarily establish the diagnosis because they can occasionally be seen in benign leiomyomas and in patients receiving progestational agents. m a 8 . these tumors would be classified as undifferentiated high-grade sarcomas. bilateral salpingooophorectomy. and staging • recurrence in most of these patients is outside the pelvis • Cisplatin. and cyclophosphamide (Cytoxan) (VAC protocol E d i l S l o m e t r t r o m a S c r o m a n a a Histological Feature: • behavior correlates primarily with mitotic rate • these tumors were once divided into low grade and high grade. Treatment • Primary treatment includes total hysterectomy. when there are four or fewer mitoses per 10 hpf. occasionally accompanied by pain or vaginal bleeding • Leiomyosarcomas are suspected if the uterus undergoes rapid enlargement. • prognosis worsens for tumors with more than 10 mitoses per 10 hpf. partic-ularly in patients in the perimenopausal or postmenopausal age group. Adriamycin. and nuclear pleomorphism • finding of more than five mitoses per 10 hpf with cytologic atypia leads to a diagnosis of leiomyosarcoma. ifosfamide • actinomycin D. paclitaxel (Taxol).L *Ultrasonography +/. • ESSs have a peak incidence in the fifth decade of life. • it is important to note that an increase in mitotic count in leiomyomas occurs in pregnancy as well as during oral contraceptive use Clinical Features: • patient has an enlarged pelvic mass. the tumors usually have a more benign clinical course Prognosis: • Vascular invasion and extrauterine spread of tumor are associated with worse prognoses. more recently all ESSs are considered low grade.Color Doppler – option *Annual CXR – does not contribute to early detection of recurrence *Isolated vaginal vault recurrence – curable in up to 87% of cases in patients not previously exposed to radiation *CA 125 -recommended in cases with advanced surgical stage (stage 3-4) -or high risk histologic subtypes every 6 months on the first year -annually thereafter up to 5 years Sarcomas i m y e o o a s c r o Histologic Features: • comparable with a 12-week pregnancy or larger • risk of sarcoma increased with age.

Prognosis: • The extent of the tumor and the depth of myometrial invasion are important prognostic factors. occurs predominantly in women older than 60 years. and 17αhydroxyprogesterone caproate (Delalutin). • Systemic chemotherapy with cytotoxic agents has not been reported generally to be effective. Clinical Features: • Recurrences are common in the pelvis. slowly progressing tumors. especially in the pelvis. leukemia. • Those with deep myometrial invasion are more likely to have spread to pelvic or paraaortic nodes. there was a moderate rate of response to platinum-based chemotherapy and chemosensitizing radiation. usually beyond the age of 62 years. • These tumors spread into the myometrium and then to the pelvis. a pattern similar to the spread of endometrial carcinoma. Histological Feature: • Microscopically. C i ( • • • • Müllerian adenosarcoma is a rare low-grade malignancy composed of both a sarcomatous stroma (homologous) and a proliferation of benign glandular elements that are intimately associated. it should be remembered that these tumors contain estrogen and progestin steroid hormone receptors and are sensitive to hormone therapy • Complete resolution has been reported with megestrol acetate (Megace). and the tumor may appear to be a polypoid excrescence from the cervix. tamoxifen. although good responses to doxorubicin (Adriamycin) have been reported. Total abdominal hysterectomy with bilateral salpingo-oophorectomy is the streatment of choice patients with advanced-stage disease or recurrent disease. the diagnosis is made in tissue removed with D&C. medroxyprogesterone (Provera). ESS most resembles proliferative endometrial stroma. U d i f f i d n e e r n t e t a S c r o m a a s Clinical Features: • carcinosarcoma tend to be older and primarily postmenopausal. and frequently to the lungs and pleura. more than 10 mitoses per 10 hpf are present. and abdomen • If there is disseminated disease. multiple-agent chemotherapy is used. • Radiation has also been used to treat recurrences of these tumors. • Total abdominal hysterectomy and bilateral salpingo-oophorectomy are completed with stage I tumors • More extensive procedures are occasionally attempted for stage II tumors as well as for those with early extrauterine spread. • M d i f i o e involvement of the uterus may be the initial presentation of disseminated lymphoma usually treated by radiation after hysterectomy d C l i f i i f U i s s a t o n o e t r e a S c r o m a a c n a s ) Carcinosarcoma (malignant mixed mullerian tumor) 9 . lung. high-grade endometrial cancer. but extensive experience with radiation therapy is not available. M ü l l i A r n e d n o a s c r o m a e a Prognosis: • These high-grade tumors behave aggressively and have a poor prognosis. Method of Diagnosis: • Occasionally. diagnosis may be made also by vaginal ultrasound examination. • A common symptom is postmenopausal bleeding. Treatment: • primary treatment is surgical removal of the uterus.• Histologically. and frequently 20 or more mitoses per 10 hpf are present. often accompanied by a large uterus. carcinosarcoma). h o m a y L m p • M l i M i d M ü l l i T a c r o a s c r o m a a n g a n t e x r n u m o r n e Histological Features: • consist of carcinomatous and sarcomatous elements native to the uterus that may resemble the endometrial stroma of smooth muscle (homologous) or of sarcomatous tissues foreign to the uterus (heterologous). Prognosis: • Prognosis depends on the extent of disease and ability to remove all of the tumor at the time of surgery • ESSs are indolent. Clinical Features: • Recurrent disease may be diagnosed as many as 30 years after diagnosis • ESS tends to recur locally in the pelvis or peritoneal cavity and frequently spreads to the lungs Treatment: • In treating metastatic disease. with resolution of all residual tumors. Method of Diagnosis: • These tumors must be evaluated carefully as they are often confused with other large cell undifferentiated tumors (lymphoma. letrozole (Femara). to the abdomen including the peritoneum. as in endometrial carcinomas.

whereas complex hyperplasia will develop into cancer in 29% of patients. Overall survival rates for patients with adenocarcinoma of the endometrium by stage are as follows: stage I. Other important predisposing factors include obesity. Women with Lynch syndrome (hereditary nonpolyposis colorectal cancer syndrome) have a 40% to 60% lifetime risk of endometrial cancer. A key determinant of the risk of nodal spread of endometrial carcinoma is depth of myometrial invasion. stage III. which is similar to their lifetime risk of colon cancer. 44%. bilateral pelvic and paraaorotic lymphadenectomy. stage IV. Recent studies have found that there is a 40% concurrent rate of endometrial cancer in patients with a preoperative diagnosis of complex atypical hyperplasia. The primary symptom of endometrial carcinoma is postmenopausal bleeding. stage II.Homologous (Carcinosarcoma): Carcinosarcoma + Homologous Sarcoma Heterologous Carcinsarcoma + Heterologous Sarcoma Mullerian Adenosarcoma Lymphoma K E Y P O I N T S stage. pelvic cytology. which is often related to tumor grade.7% 5-year survival rate combining clinical and operative staging systems). nulliparity. Chronic unopposed estrogen stimulation of the endometrium leads to endometrial hyperplasia and in some cases adenocarcinoma. The exceptions include young perimenopausal women with stage I and grade 1 endometrial carcinoma associated with endometrial hyperplasia. Cytologic atypia in endometrial hyperplasia is the most important factor in determining malignant potential. the lifetime risk of endometrial cancer is 3%. Women with abnormal bleeding should undergo an endometrial sampling to rule out endometrial pathology. Older patients with atypical hyperplasia are at increased risk of malignant progression compared with younger patients. Histologic variants of endometrial carcinoma with a poor prognosis include uterine papillary serous carcinoma and clear-cell carcinoma. Postoperative adjuvant radiation has not been shown to improve overall survival. Tamoxifen use increases the risk of endometrial neoplasia two. Primary treatment of endometrial cancer includes hysterectomy. In the United States. 66%. tumor • • • • • • • • • • • 10 . and diabetes.to threefold. 16% (overall 72. Most women who develop endometrial cancer are between 50 and 65 years of age. bilateral salpingo-oophorectomy. Uterine papillary serous carcinoma is an aggressive histologic subtype associated with metastatic disease even in the absence of myometrial invasion. and degree of myometrial invasion. and abdomen. The risk of a woman developing endometrial carcinoma is increased three times if her body mass index is greater than 30. Computed tomography scans may miss as many as 50% of patients with nodal disease. 86%. • • • • • • • • • • • • Endometrial carcinoma is the most common malignancy of the female genital tract. and women with increased risk of mortality secondary to medical comorbidities. Well-differentiated (grade 1) endometrial carcinomas usually express steroid hormone receptors. late menopause. histologic type. Patients with uterine papillary serous or clear-cell carcinoma of the endometrium should have a full staging laparotomy similar to that for ovarian carcinoma. Prognosis in endometrial carcinoma is related to tumor grade. Simple hyperplasia will develop into endometrial cancer in 1% of patients. The most frequent sites of distant metastasis of adenocarcinoma of the endometrium are the lung. retroperitoneal nodes. Ninety percent of recurrences of adenocarcinoma of the endometrium occur within 5 years. and resection of all disease. whereas poorly differentiated (grade 3) tumors usually do not express receptors.

which did not reflect clinical behavior. Multiagent chemotherapeutic regimens are usually prescribed for metastatic sarcomas. adnexal involvement Tumor extends to extra-uterine pelvic tissue Tumor invades abdominal tissues. • IA IB IIA IIB IIIA IIIB IIIC IVA Tumor limited to uterus < 5 cm Tumor limited to uterus > 5 cm Tumor extends to the pelvis. Uterine sarcomas comprise less than 5% of uterine malignancies. complete responses are rare and usually temporary. This is described as a best guess staging system. so data will need to be collected and evaluated for further revision.U t i S ( L i E d t i l S t l S d A d e r e a r c o m a s e o m y o s a r c o m a n o m e r a r o m a a r c o m a a n n o s a r c o m n Patients with high stage or recurrent disease should be treated in a multimodality approach including chemotherapy. tubes. one site More than one site Metastasis to pelvic and/or para-aortic lymph nodes Tumor invades bladder and/or rectum Distant metastasis S t I D i f f f O t h U t i n o s a r c o m a a e g e r s r o m r e r e S a r c o m a e n s C i • • • • f t h E d t a r c o m a o n o m e r i m n e u IVB IA IB II IIIA IIIB Tumor confined to the uterus. and ovaries. radiation. . Uterine sarcomas are treated primarily by operation including removal of the uterus. a new corpus sarcoma staging system was developed based on the criteria [2] used in other soft tissue sarcomas. no or < ½ myometrial invasion A e d Tumor confined to the uterus. Therefore. . but not beyond uterus IB Tumor invades serosa or adnexa IB Vaginal and/or parametrial involvement Invasion to > ½ myometrium Invasion to < ½ myometrium Tumor limited to endometrium/endocervix IIIC1 Pelvic node involvement IIIC2 Para-aortic involvement IVA IVB Tumor invasion bladder and/or bowel mucosa Distant metastases including abdominal metastases and/or inguinal lymph nodes Uterine sarcomas were staged previously as endometrial cancers. e a ) 11 . and/or hormone therapy. > ½ myometrial invasion IA Cervical stromal invasion. Endometrial stromal sarcomas are low-grade sarcomas with an indolent course.