Uterus
Carcinoma
Serous carcinoma

Author: Mohamed Mokhtar Desouki, M.D., Ph.D. (see Authors page)

Revised: 25 January 2017, last major update August 2011

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

PubMed search: serous [title] carcinoma uterus

Cite this page: Serous carcinoma. PathologyOutlines.com website. http://pathologyoutlines.com/topic/uterusserous.html. Accessed August 21st, 2017.
Definition / general
  • Type 2 (nonendometrioid) carcinoma, often arises in black, multiparous and nonobese women
  • Associated with endometrioid adenocarcinoma, clear cell carcinoma and ovarian serous carcinoma
Terminology
  • Also called papillary serous carcinoma, uterine papillary serous carcinoma (UPSC), endometrial type 2 tumor
Epidemiology
  • Compared to endometrioid carcinoma, UPSC is less common (10%), older age, and more common in black vs. white women
  • Associated with p53 mutations (considered an early event), usually clinically understaged
Etiology
  • Not associated with estrogen secretion as endometrioid tumors are; may follow radiation therapy for cervical carcinoma
  • Associated with atrophic endometria
Clinical features
  • Presents with vaginal bleeding
  • Resembles ovarian serous carcinoma and spreads throughout abdomen in a similar manner; may metastasize to bladder, simulating a bladder primary
  • May be a superficial endometrial tumor with extensive peritoneal disease, suggesting tubal or angiolymphatic invasion
  • Minimally invasive disease: no myometrial invasion; usually cured if NO extrauterine involvement by careful staging; may have minimal disease involving ovarian surface epithelium, serous adenofibroma or omentum; similar behavior as endometrial intraepithelial carcinoma if 1 cm or less of tumor
Prognostic factors
  • Often recurs and death common from tumor spread, despite aggressive surgery, chemotherapy or radiotherapy
  • 40% with stage I disease die of disease, 60% will get retroperitoneal involvement
Treatment
  • Extended surgical staging and tumor debulking
  • Adjuvant therapy with taxane and platinum based combination chemotherapy, with or without radiation therapy
  • Do not respond to progesterone therapy
Gross description
  • Uterus is small for a high grade tumor
  • Associated with endometrial polyps and is often polypoid
  • 25% have primary endocervical involvement
  • Drop metastases to vagina are common
  • Transtubal spread is common, may create ovarian implants and omental tumor nodules
Microscopic (histologic) description
  • Resembles ovarian serous carcinoma; usually well formed papillae (thick and thin) or tubules with "lobster claw" appearance containing highly pleomorphic tumor cells containing prominent nucleoli, small detached buds and tufts
  • May have glandular pattern and resemble villoglandular carcinoma on low power
  • Prominent myometrial invasion, frequent mitotic activity and necrosis
  • Usually marked desmoplastic response resembling carcinosarcoma; angiolymphatic invasion common; 40% have psammoma bodies
  • Associated with endometrial atrophy, not hyperplasia
  • Abrupt transition from normal to serous carcinoma is common
  • Considered high grade and is not graded using FIGO
  • Note: if one gland is serous, consider tumor to be aggressive (others say must be 25% of tumor)
  • Minimally invasive serous carcinoma: no myometrial invasion
Microscopic (histologic) images

Images hosted on PathOut server:

Broad fibrovascular cores lined by stratified cells

Small complex papillae; poorly differentiated cells

Complex papilloglandular pattern

Complex papilloglandular pattern
with exfoliation of small
groups of cells into lumina


Classic small
but round hyperchromatic nuclei

Invasion of myometrial lymphatics

Extensive invasion of myometrial lymphatics

Cytology description
  • 2/3 have malignant pap smears since buds and tufts break off
  • Features of high grade malignancy with readily identified malignant features, but site of origin may be unknown
  • Positive peritoneal cytology upgrades the stage
Positive stains
Negative stains
Molecular / cytogenetics description
  • Most cases are aneuploid
  • Mutations of TP53 represent the most well characterized alteration in > 90% of cases, but 50% have loss of p53 (TP53) function
  • Also HER2 / neu overexpression (18% - 61%), EGFR overexpression (36% - 56%, Br J Cancer 2009;100:89), PIK3CA mutations (15%, Gynecol Oncol 2009;113:370)
  • Claudin-3 and claudin-4 are highly expressed; PTEN mutations are rare
  • 63% of cases showed loss of heterozygosity of chromosome 1p
Differential diagnosis