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Uterus

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.

General
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● 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
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● Also called secondary tumors of the uterine corpus

Epidemiology
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● 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
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● 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
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● Primary tumor is usually known; but rarely metastatic tumor in D&C may be the first clinical presentation

Clinical features
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● Mainly postmenopausal women, mean age 60 years
● Patients present with vaginal bleeding

Prognostic features
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● Usually widespread metastases at diagnosis, with mean survival of 20 months after diagnosis

Case reports
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● Breast metastases to tamoxifen induced polyp (Case of the Week #125)

Gross description
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● Solitary, multiple or diffuse growth

Micro description
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● 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
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Breast lobular carcinoma to tamoxifen induced polyp:
       

H&E


ER


PR


GCDFP-15

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

End of Uterus > Stromal tumors > Metastases to uterus

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