Home   Chapter Home   Jobs   Conferences   Fellowships   Books



Stromal tumors

Metastases to uterus

Reviewer: Mohamed Desouki, M.D. (see Reviewers page)
Revised: 23 October 2011, last major update October 2011
Copyright: (c) 2002-2011, PathologyOutlines.com, Inc.


● 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


● Also called secondary tumors of the uterine corpus


● 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)


● 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


● 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 features

● 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

Micro 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

Micro images

Breast lobular carcinoma to tamoxifen induced polyp:





Positive stains

● Panel of immunohistochemical markers is helpful to determine primary: CK7, CK20, IDX, GCDFP15

End of Uterus > Stromal tumors > Metastases to uterus

This information is intended for physicians and related personnel, who understand that medical information is often imperfect, and must be interpreted in the context of a patient's clinical data using reasonable medical judgment. This website should not be used as a substitute for the advice of a licensed physician.

All information on this website is protected by copyright of PathologyOutlines.com, Inc. Information from third parties may also be protected by copyright. Please contact us at [email protected] with any questions (click here for other contact information).