Vagina
Malignant tumors
Endometrioid adenocarcinoma

Author: Shweta Gera, M.D. (see Authors page)
Editor: Arzu Buyuk, M.D.

Revised: 26 September 2017, last major update April 2014

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

PubMed Search: Endometrioid adenocarcinoma vagina

Cite this page: Gera, S. Endometrioid adenocarcinoma. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/vaginaendometrioid.html. Accessed October 21st, 2017.
Definition / general
  • Second most common subtype of primary vaginal adenocarcinoma with majority of cases associated and likely arising from endometriosis
  • Metastatic endometrioid adenocarcinoma to vagina and local spread from a neoplasm arising in an adjacent organ needs to be excluded (Am J Surg Pathol 2007;31:1490)
Epidemiology
Sites
Pathophysiology
  • Prior hysterectomy and trauma due to surgery might predispose to development of endometriosis at vaginal apex and further development of carcinoma at the same site (Am J Surg Pathol 2007;31:1490)
Etiology
Clinical features
  • Most common symptoms are vaginal bleeding or vaginal discharge (Am J Surg Pathol 2007;31:1490)
  • Also pelvic pain and constipation
  • Can be discovered incidentally as pelvic mass on routine vaginal examination
  • May have history of prior hysterectomy due to endometriosis or other benign disease (Pathol Int 2010;60:636)
Diagnosis
  • Based on histologic examination of biopsy or resection specimen which shows pure or predominant component of typical endometrioid adenocarcinoma and excluding local spread or metastatic carcinoma to vagina
Prognostic factors
  • May recur and can metastasize to distant sites including lungs, bowel
  • Stage I and II do well without distant metastasis and have better 5 year survival (Am J Surg Pathol 2007;31:1490)
Case reports
Treatment
  • Radical resection of tumor; if tumor is small, conservative local resection can be attempted
  • Post surgical radiotherapy, chemotherapy, hormonal therapy or a combination (Am J Surg Pathol 2007;31:1490)
Gross description
  • Polypoid, papillary, rough, granular, fungating, exophytic or flat
  • Can also be partially cystic
  • Size ranges from 1.4 cm to 7.0 cm (Am J Surg Pathol 2007;31:1490)
Microscopic (histologic) description
  • Atypical glandular proliferation composed of tubular glands lined by columnar cells with moderate amount of eosinophilic cytoplasm and occasional intracytoplasmic mucin
  • Nuclei are oval to elongated, large and stratified or pseudostratified
  • Glands can show microcysts and numerous neutrophils within and around cysts, microglandular pattern (Pathol Int 2010;60:636, Am J Surg Pathol 2007;31:1490)
  • Nuclear features are bland in microglandular pattern so careful histological examination for classic endometrioid adenocarcinoma and architectural complexity is required (Pathol Int 2010;60:636)
  • Squamous metaplasia can also be seen with cytoplasmic clearing due to glycogen accumulation
  • Rare cases have nonvillous papillary budding pattern (Am J Surg Pathol 2007;31:1490)
  • Grades: vary from well differentiated to moderately to poorly differentiated (Am J Surg Pathol 2007;31:1490, Am Fam Physician 2000;62:734)
Microscopic (histologic) images

Images hosted on other servers:

Endometroid adenocarcinoma

Well differentiated grade 1

Variably shaped glands

Papillary pattern

Complex outlines and a cribriform pattern

Cytology description
  • Atypical glandular cells with hyperchromatic nuclei and high N:C ratio with prominent nucleolus
  • Microglandular pattern has clusters of epithelial cells in papillary arrangement and microglandular structures; neutrophils are seen within and around cystic glands
  • Cells have lacy and pale cytoplasm, round to oval small nuclei with fine chromatin and small but distinct nucleoli (Pathol Int 2010;60:636)
Cytology images

Images hosted on other servers:

Various images

Positive stains
Differential diagnosis
Additional references