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Table of Contents
Definition / general | Terminology | Epidemiology | Sites | Etiology | Clinical features | Prognostic factors | Case reports | Gross description | Microscopic (histologic) description | Microscopic (histologic) images | Positive stainsCite this page: Metastases to uterus. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/uterusmet.html. Accessed July 16th, 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
- Breast metastases to tamoxifen induced polyp (Case of the Week #125)
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
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