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Uterus (excludes Cervix)
Epithelial tumors
Secretory carcinoma
Reviewer: Mohamed Mokhtar Desouki, MD, PhD (see Reviewers page)
Revised: 23 August 2011, last major update August 2011
Copyright: (c) 2002-2011, PathologyOutlines.com, Inc.
Definition
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● Subtype of well-differentiated endometrioid adenocarcinoma
Epidemiology
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● Rare; mean age 55 years (range 36-79 years, Int J Gynecol Pathol 1985;4:328)
Etiology
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● In 1970's, 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
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● 2/3 present after menopause with vaginal bleeding
● Nulliparous and multiparous women
● 50% of patients are obese
● Favorable prognosis
Case reports
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● 42 year old woman (Basic and Applied Pathology 2011;4: 21)
Treatment
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● Similar to that for conventional endometrioid adenocarcinoma - total abdominal hysterectomy with pre- and post-operative radiation
Gross description
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● 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
Micro description
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● 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 co-exist with conventional endometrioid pattern
● FIGO grade 1-2 and nuclear grade 1
● Corpus luteum typically present in ovaries, particularly in pre-menopausal women not on hormone therapy
Micro images
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Prominent cytoplasmic vacuoles and intraluminal secretions
The glands at upper left demonstrate clear cytoplasm due to glycogen
High power reveals small regular nuclei and abundant vacuolated cytoplasm
Secretory endometrium (benign) for comparison
Positive stains
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● Periodic acid-schiff (predigested or not), partly positive with Alcian blue, rarely positive with CEA
Negative stains
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● Best's carmine, alpha-fetoprotein
Differential Diagnosis (2)
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● 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
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End of Uterus > Epithelial tumors > Secretory carcinoma
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