Vulva, vagina & female urethra
Other carcinomas
Endometrioid carcinoma


Topic Completed: 1 April 2014

Minor changes: 4 February 2021

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PubMed Search: Endometrioid adenocarcinoma vagina

Shweta Gera, M.D.
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Cite this page: Gera S. Endometrioid carcinoma. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/vaginaendometrioid.html. Accessed April 16th, 2021.
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

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Endometroid adenocarcinoma

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)
Positive stains
Differential diagnosis
Additional references
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