Adenocarcinoma, adenoacanthoma, and mixed adenosquamous carcinoma of the endometrium

Purpose: To determine the frequency of endometrial adenocarcinoma (AC) with squamous cell differentiation and to compare the histopathologic and clinical characteristics of patients with adenoacanthoma (AA) and adenosquamous carcinoma (AS) to evaluate possible prognostic differences.

Materials and methods: Two hundred forty patients with endometrial carcinoma (72.2% AC, 21.25% AA, 6.25% AS) treated at the Department of Gynecologic Oncology of Marmara University Hospital, between January 1986 and December 1997, were reviewed. The diagnoses of the diseases were made with fractional D&C, and the definitive therapy for all patients was carried out at the same hospital. Extrafascial hysterectomy + BSO with or without pelvic and para-aortic lymph node dissection, and omentectomy according to the FIGO staging and grading system were performed.

Results: AC and AS had median ages around 60 years with a similar percent distribution of postmenopausal patients (around 74%). AA had an earlier median age of 51 years which reflects an incidence of only 50% postmenopausal patients. There was a tendency for AA to be of low-grade malignancy (72%), 51% of AC were of low-grade, while only 20% of AS were low-grade tumors. There was no difference for any of the three pathological entities in survival by FIGO stages. Over 80% of the tumors were Stage I and about 10% were Stage II, with less than 10% in Stages III and IV.

Conclusion: Considering the more modern and uniform approaches in therapy for these tumors, there seems to be no differences in prognosis for adenocarcinoma with or without squamous elements. The neoplasms AC, AA and AS should be regarded, and consequently approached, as any low-grade adenocarcinoma of the endometrium.

Adenocarcinoma; Adenoacanthoma; Adenosquamous carcinoma

[1] Kurman R. J., Zaino R. J., Norris H.J.: "Endometrial carcinoma". In: Kurman R. J., ed. "P athology of the Female Genital Tract", 4th ed. New York, Springer-Verlag, 1994, 461.

[2] Ng A. B. P., Reagan J. W., Storaasli J. P., Wentz W. B.: "Mixed adenosquamous carcinoma of the endometrium". Am. J. Clin. Pathol., 1973, 59, 765.

[3] Albershasky R. C., Connelly P. J., Christopherson W. M.: "Carcinoma of the endometrium. IV. Mixed adenosquamous carcinoma. A clinicopathological study of 68 cases with long-term followup". Am. Clin. Pathol., 1982, 77, 655.

[4] Salazar 0. M., DeP ap E. W., Bonfiglio T. A., Feldstein M. K., Rubin P., Rudolph J. H.: "Adenosquamous carcinoma of the endometrium. An entity with an inherent poor prognosis?". Cancer, 1977, 40, 119.

[5] Abeler V. M., Kjorstad K. E.: "Endometrial adenocarcinoma with squamous cell differentiation". Cancer, 1992, 69, 488.

[6] Zaino R. J., Kurman R. J., Herbold D., Gliedman J., Bundy N., Voet R., Advani H.: "The squamous differentiation in endometrial carcinoma: Data from a Gynecologic Oncology Group Study". Cancer, 1991, 68, 2293.

[7] Ng A. B. P., Reagan J. W.: "Incidence and prognosis of endometrial carcinoma of histologic grade and extent". Obstet. Gynecol., 1970, 35, 437.

[8] Gross A. J., Clark V. A.: "Survival distributions: Reliability applications in the biomedical sciences". New York, Wiley and Sons Inc., 1975, 23.

[9] Skinner I. C., McDonald J. R.: "Mixed adenocarcinoma and squamous cell carcinoma of the uterus". Am. J. Obstet. Gynecol., 1940, 40, 258.

[10] Connelly P. J., Alberhasky R. C., Christopherson W. M.: "Carcinoma of the endometrium. III. Analysis of 865 cases of adenocarcinoma and adenoacanthoma". Obstet. Gynecol., 1982, 59, 569.

[11] Ng A. B. P.: "Mixed carcinoma of the endometrium". Am. J. Obstet. Gynecol., 1968, 102, 506.