Serous carcinoma

Uterus
Carcinoma
Serous carcinoma

Author: Mohamed Mokhtar Desouki, M.D., Ph.D. (see Authors page)

Revised: 25 January 2017, last major update August 2011

Copyright: (c) 2002-2017, PathologyOutlines.com, Inc.

PubMed search: serous [title] carcinoma uterus

Table of Contents

Cite this page: Serous carcinoma. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/uterusserous.html. Accessed July 16th, 2017.

Definition / general

Type 2 (nonendometrioid) carcinoma, often arises in black, multiparous and nonobese women
Associated with endometrioid adenocarcinoma, clear cell carcinoma and ovarian serous carcinoma

Terminology

Also called papillary serous carcinoma, uterine papillary serous carcinoma (UPSC), endometrial type 2 tumor

Epidemiology

Compared to endometrioid carcinoma, UPSC is less common (10%), older age, and more common in black vs. white women
Associated with p53 mutations (considered an early event), usually clinically understaged

Etiology

Not associated with estrogen secretion as endometrioid tumors are; may follow radiation therapy for cervical carcinoma
Associated with atrophic endometria

Clinical features

Presents with vaginal bleeding
Resembles ovarian serous carcinoma and spreads throughout abdomen in a similar manner; may metastasize to bladder, simulating a bladder primary
May be a superficial endometrial tumor with extensive peritoneal disease, suggesting tubal or angiolymphatic invasion
Minimally invasive disease: no myometrial invasion; usually cured if NO extrauterine involvement by careful staging; may have minimal disease involving ovarian surface epithelium, serous adenofibroma or omentum; similar behavior as endometrial intraepithelial carcinoma if 1 cm or less of tumor

Prognostic factors

Often recurs and death common from tumor spread, despite aggressive surgery, chemotherapy or radiotherapy
40% with stage I disease die of disease, 60% will get retroperitoneal involvement

Treatment

Extended surgical staging and tumor debulking
Adjuvant therapy with taxane and platinum based combination chemotherapy, with or without radiation therapy
Do not respond to progesterone therapy

Gross description

Uterus is small for a high grade tumor
Associated with endometrial polyps and is often polypoid
25% have primary endocervical involvement
Drop metastases to vagina are common
Transtubal spread is common, may create ovarian implants and omental tumor nodules

Microscopic (histologic) description

Resembles ovarian serous carcinoma; usually well formed papillae (thick and thin) or tubules with "lobster claw" appearance containing highly pleomorphic tumor cells containing prominent nucleoli, small detached buds and tufts
May have glandular pattern and resemble villoglandular carcinoma on low power
Prominent myometrial invasion, frequent mitotic activity and necrosis
Usually marked desmoplastic response resembling carcinosarcoma; angiolymphatic invasion common; 40% have psammoma bodies
Associated with endometrial atrophy, not hyperplasia
Abrupt transition from normal to serous carcinoma is common
Considered high grade and is not graded using FIGO
Note: if one gland is serous, consider tumor to be aggressive (others say must be 25% of tumor)
Minimally invasive serous carcinoma: no myometrial invasion

Microscopic (histologic) images

Images hosted on PathOut server:

Broad fibrovascular cores lined by stratified cells

Small complex papillae; poorly differentiated cells

Complex papilloglandular pattern

Complex papilloglandular pattern
with exfoliation of small
groups of cells into lumina

Classic small
but round hyperchromatic nuclei

Invasion of myometrial lymphatics

Extensive invasion of myometrial lymphatics

Cytology description

2/3 have malignant pap smears since buds and tufts break off
Features of high grade malignancy with readily identified malignant features, but site of origin may be unknown
Positive peritoneal cytology upgrades the stage

Positive stains

p53 (useful for differentiating from endometrioid carcinoma), CK7, CA125; also p16, Ki67 (high index) and vimentin

Negative stains

ER (may be low level), PR, CEA, CK20

Molecular / cytogenetics description

Most cases are aneuploid
Mutations of TP53 represent the most well characterized alteration in > 90% of cases, but 50% have loss of p53 (TP53) function
Also HER2 / neu overexpression (18% - 61%), EGFR overexpression (36% - 56%, Br J Cancer 2009;100:89), PIK3CA mutations (15%, Gynecol Oncol 2009;113:370)
Claudin-3 and claudin-4 are highly expressed; PTEN mutations are rare
63% of cases showed loss of heterozygosity of chromosome 1p

Differential diagnosis

Clear cell carcinoma: may have overlapping features, distinction not important since management is same
Minimally invasive disease may resemble eosinophilic metaplasia or complex hyperplasia with atypia