Advertisement
Advertisement
Table of Contents
Definition / general | Epidemiology | Etiology | Clinical features | Case reports | Treatment | Gross description | Microscopic (histologic) description | Microscopic (histologic) images | Positive stains | Negative stains | Differential diagnosis | Additional referencesCite this page: Secretory carcinoma. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/uterussecretory.html. Accessed July 16th, 2017.
Definition / general
- Subtype of well differentiated endometrioid adenocarcinoma
Epidemiology
- Rare; mean age 55 years (range 36 - 79 years, Int J Gynecol Pathol 1985;4:328)
Etiology
- In 1970s, disproportionate number of cases associated with young women using oracon, a sequential oral contraceptive agent with high estrogen and small progesterone content, no longer available (Cancer 1977;39:592, Fertil Steril 1976;27:346)
Clinical features
- 2/3 present after menopause with vaginal bleeding
- Nulliparous and multiparous women
- 50% of patients are obese
- Favorable prognosis
Case reports
- 42 year old woman (Basic and Applied Pathology 2011;4:21)
Treatment
- TAH / BSO then possible radiation (for advanced disease) for disease limited to the uterus (NCCN Guidelines Version 1.2014); consideration of preoperative radiation for tumors grossly involving the cervix before doing surgery (this is uncommon)
Gross description
- Indistinguishable from other carcinomas on gross examination
- May not be apparent on gross examination despite an obvious tumor on microscopic examination
- May resemble late secretory phase endometrium
- Visible tumors vary from sessile polyps to nodules or irregular, thickened plaques that may be localized or diffuse
Microscopic (histologic) description
- Confluent, cribriform or villoglandular voluminous glands with glycogen, subnuclear vacuoles (resembles day 17 - 22 endometrium), plus late secretory pattern in uninvolved endometrium
- Above pattern may coexist with conventional endometrioid pattern
- FIGO grade 1 - 2 and nuclear grade 1
- Corpus luteum typically present in ovaries, particularly in premenopausal women not on hormone therapy
Microscopic (histologic) images
Images hosted on PathOut server:
The glands at upper
left demonstrate
clear cytoplasm
due to glycogen
High power reveals
small regular nuclei
and abundant
vacuolated cytoplasm
Images hosted on other servers:
Prominent cytoplasmic vacuoles
and intraluminal secretions
Positive stains
- Periodic acid-schiff (predigested or not), partly positive with Alcian blue, rarely positive with CEA
Negative stains
- Best's carmine, alpha feto-protein
Differential diagnosis
- Clear cell carcinoma
- Endometrioid carcinoma: may have clear cells lining tubules, but lack a focal secretory pattern
- Endometrioid carcinoma with squamous differentiation: may have glycogenated cells that resemble secretory carcinoma
- Lipid rich endometrioid carcinoma
- Metastatic renal cell carcinoma
- Arias-Stella reaction
- Clear cell change of pregnancy
Additional references
Advertisement
