| • The arrow points to a keratin pearl indicative of squamous differentiation.
• The nuclei of all the cells look similar.
• The nuclei are enlarged with chromatin clumping and identifiable nucleoli. |
| • The arrow points to a keratin pearl indicative of squamous differentiation.
• The nuclei of all the cells look similar.
• The nuclei are enlarged with chromatin clumping and identifiable nucleoli. |
| Adenocarcinoma with Squamous Differentiation |
| Etiology |
•associated with unopposed estrogen use •may be exogenous (non-cycled estrogens) but generally •endogenous due to peripheral aromatization of adrenal
androgens by adipose in obese women •also associated with granulosa cell tumors and other estro-
gen producing ovarian tumors as well as polycystic ovary
syndrome •small group of women with high grade neoplasms lack
evidence of hyperestrinism |
| Pathogenesis |
•estrogen drives continued proliferation
with eventual
acquisition of somatic mutations •in the absence of progesterone maturation of the endometrium
and spiral arteries never occurs, nor does regular menses |
| Epidemiology |
•obese post-menopausal women •may also have diabetes and hypertension (classic triad) •small group of women with high grade neoplasms lacks
these correlates •increasing incidence with aging population •not picked up on pap smear •increasing incidence of squamous differentiation |
| Clinical |
•post-menopausal bleeding is usual symptom;
other
symptoms rare and may indicate advanced disease •most patients are Stage I (confined to endometrium) at
diagnosis and respond completely to hysterectomy •neoplasm spreads to cervix, deep in myometrium, ovary,
regional lymph nodes and then distant sites •when death occurs from disease it is usually due to local disease in the pelvis •squamous component does not affect prognosis •For more information about prognosis and treatment, consult the NCI web site. |
| General Gross Description |
•fungating,
friable, tan mass with irregular infiltration
of underlying myometrium |
| General Micro Description |
•glands exhibit crowding so that they are
"back-to-back" •stratified nuclei with mitotic activity •cells lose orientation to the lumen •nucleoli become prominent, nuclei are vesicular •lumenal necrosis •if >90% glandular grade 1, 10-90% glandular grade 2,
<10% glandular grade 3 •presence of squamous cells in >5% considered squamous differentiation •benign appearing squamous cells in neoplasms that are grade 1 •overtly malignant cells in neoplasms that are grade 3 |
| Reference |
• Cotran RS, Kumar V, Robbins SL: Robbins Pathologic Basis of Disease. 5th ed. Philadelphia, W.B. Saunders, 1994, pp. 1060-6
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