Uterus
Stromal tumors
Metastases to uterus

Author: Mohamed Desouki, M.D. (see Authors page)

Revised: 2 February 2017, last major update October 2011

Copyright: (c) 2002-2017, PathologyOutlines.com, Inc.

PubMed search: stromal tumor metastases to uterus

Cite this page: Metastases to uterus. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/uterusmet.html. Accessed June 24th, 2017.
Definition / general
  • Tumors that originate primarily from extrauterine tissue with secondary metastasis to the uterus
  • Primaries usually are divided into genital (cervix, ovary and fallopian tubes) or extragenital (usually breast, GI, kidney, lung and melanoma)
  • Primaries from genital region and nearby organs (bladder, rectum) can invade by direct extension or metastasize by lymphatic or hematogenous spread
  • Extragenital tumors usually spread through hematogenous or lymphatic routes; evidence of disease may first appear in endometrial curettings, particularly lobular carcinoma of breast
  • Metastatic breast carcinoma to tamoxifen-associated polyps has been reported, usually involving lobular carcinoma (Ann Diagn Pathol 2005;9:166, Mod Pathol 2003;16:395, Gynecol Oncol 2005;97:946, Obstet Gynecol 2003;102:1149, Acta Obstet Gynecol Scand 1993;72:585), so careful histologic evaluation of endometrium is important
Terminology
  • Also called secondary tumors of the uterine corpus
Epidemiology
  • Metastatic endometrial cancers are rare compared to metastatic tumors to myometrium
  • Mazur et al. reported 7 metastatic tumors to endometrium out of 149 cases of extragenital tumors metastatic to female genital tract (Cancer 1984;53:1978)
Sites
  • Most metastases are to myometrium; also to leiomyomas and endometrium (Cancer 1982;50:2163)
  • 1/3 involve the endometrium and are detected at D&C biopsies
Etiology
  • Primary tumor is usually known; but rarely metastatic tumor in D&C may be the first clinical presentation
Clinical features
  • Mainly postmenopausal women, mean age 60 years
  • Patients present with vaginal bleeding
Prognostic factors
  • Usually widespread metastases at diagnosis, with mean survival of 20 months after diagnosis
Case reports
Gross description
  • Solitary, multiple or diffuse growth
Microscopic (histologic) description
  • Metastatic tumor features: unusual growth patterns (solid architecture with infiltrative growth as single cells, cords or glands) compared to conventional endometrial carcinomas; replacement of endometrial stroma by tumor cells and sparing of benign endometrial glands; frequent lymphovascular space invasion; no premalignant features (e.g. no hyperplasia); no tumor necrosis
  • Breast lobular carcinoma usually retains its single file growth pattern
  • Cervical metastatic tumor usually grows superficially and blends with benign endometrial glands
  • Colonic metastasis usually form large tumor masses simulating primary endometrial carcinoma of mucinous or endometrioid type
  • GI tumors usually have signet ring morphology
Microscopic (histologic) images

Images hosted on PathOut server:

Breast lobular carcinoma to tamoxifen induced polyp:

H&E

ER

PR

GCDFP-15

Positive stains
  • Panel of immunohistochemical markers is helpful to determine primary: CK7, CK20, IDX, GCDFP-15