Vulva & vagina
Other carcinomas
Endometrioid carcinoma-vagina
Authors: Shweta Gera, M.D., Arzu Buyuk, M.D.
Last author update: 1 April 2014
Last staff update: 2 April 2024
Copyright: 2002-2024, PathologyOutlines.com, Inc.
PubMed Search: Endometrioid adenocarcinoma vagina
Table of Contents
Definition / general | Epidemiology | Sites | Pathophysiology | Etiology | Clinical features | Diagnosis | Prognostic factors | Case reports | Treatment | Gross description | Microscopic (histologic) description | Microscopic (histologic) images | Cytology description | Positive stains | Negative stains | Differential diagnosis | Additional referencesCite this page: Gera S. Endometrioid carcinoma-vagina. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/vaginaendometrioid.html. Accessed April 16th, 2024.
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
- Age range 45 to 81 years (mean age 60 years) (Am J Surg Pathol 2007;31:1490)
Sites
- Most common site is vaginal apex
- Can also occur in posterior wall, lateral wall and anterior wall (Am J Surg Pathol 2007;31:1490)
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
- Vaginal endometriosis (Am J Surg Pathol 2007;31:1490, Pathol Int 2010;60:636, Gynecol Oncol 1989;34:232, Am Fam Physician 2000;62:734, Obstet Gynecol 1984;64:592, Gynecol Oncol 1982;14:271)
- Patient can have history of prior hysterectomy for endometriosis
- Unrelated to exposure to DES that is usually seen in association with clear cell carcinoma (Am J Surg Pathol 2007;31:1490 but see Cancer 1970;25:745)
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
- 34 year old woman with primary invasive vaginal cancer in setting of Mayer-Rokitansky-Küster-Hauser syndrome (Gynecol Oncol 2002;85:384)
- 42 year old woman (Proc R Soc Med 1967;60:999)
- 57 year old woman with endometrioid adenocarcinoma of the vagina with a microglandular pattern arising from endometriosis after hysterectomy (Pathol Int 2010;60:636)
- 68 year old woman with adenocarcinoma arising in endometriosis (Am Fam Physician 2000;62:734)
- Arising in vaginal endometriosis (Gynecol Oncol 1989;34:232)
- Primary vaginal endometrioid carcinoma following unopposed estrogen administration (J Obstet Gynaecol 2003;23:316)
- Malignant transformation of vaginal endometriosis (Obstet Gynecol 1984;64:592)
- Adenocarcinoma of vagina arising in endometriosis (Gynecol Oncol 1982;14:271)
- Vaginal adenocarcinoma developing in residual pelvic endometriosis (Gynecol Oncol 1989;33:96)
- Adenocarcinoma of vaginal vault following prolonged unopposed estrogen hormone replacement therapy (J Obstet Gynaecol 2005;25:220)
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
Images hosted on other servers:
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
Negative stains
Differential diagnosis
- Metastasis from adjacent organs including: uterus, cervix, ovary, vulva, urinary tract and from distant sites such as lower GI tract
- Other subtypes of primary vaginal adenocarcinoma: serous adenocarcinoma, adenosarcoma, polypoid endometriosis (Am J Surg Pathol 2007;31:1490)
Additional references
