Impact of Pathologic Features on Clinical Practice for Endometrial Cancer Patients

In this modern era of medicine, with new knowledge and technologies emerging every day, a multidisciplinary team approach is important.Especially in oncology, input from surgical oncologists, radiologists, and pathologists is crucial to optimizing patient care.In endometrial cancer (EMC), there are several pathologic features which serve as indicators for staging diagnosis and appropriate treatment.Both anatomical pathologists and gynecologic oncologists should recognize the clinical significance of these features in order to optimize patient care.Clinicians should detail patient history, clinical findings, and primary diagnosis in a request form for pathologic study.Pathologists, on the other hand, should detail all important findings in their pathologic reports.Despite good overall practice by both parties, some problems are still encountered in clinical practice.In this review, some pathologic features and their prognostic influence on the clinical management of EMC patients are described. Atypical endometrial hyperplasia/endometrioid intraepithelial neoplasia vs endometrial cancerAtypical hyperplasia (AH) and endometrioid intraepithelial neoplasia (EIN) belong to a spectrum of diseases that range from premalignant AH at one end to EMC at the other end.In 2014, the World Health Organization 1 included AH and EIN together due to their common clonality and similar cancer risk. 2 Furthermore, a pathologic diagnosis is sometimes difficult because of similar histopathologic features.This new entity results in a high diagnostic reproducibility among pathologists.3 Some pathologic features which suggest adenocarcinoma rather than AH/EIN are the following: backto-back glandular lining without or with minimal intervening stroma, a cribriform structure resulting from adjacent glandular bridging, papillary formation, luminal necrosis with neutrophils infiltration, or desmoplastic, or inflammatory stromal reaction.