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Histological features associated with occult lymph node metastasis in FIGO clinical stage I , grade I endometrioid carcinoma
Author(s) -
Han Guangming,
Lim Diana,
Leitao Mario M,
AbuRustum Nadeem R,
Soslow Robert A
Publication year - 2014
Publication title -
histopathology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.626
H-Index - 124
eISSN - 1365-2559
pISSN - 0309-0167
DOI - 10.1111/his.12254
Subject(s) - micrometastasis , medicine , lymphovascular invasion , pathology , metastasis , carcinoma , stage (stratigraphy) , lymph node , cancer , biology , paleontology
Aims Lymph node involvement affects prognosis/treatment in endometrial carcinoma patients. We assessed various histological features associated with nodal metastasis in patients with grade I , stage I endometrial endometrioid carcinoma ( EEC ). Methods and results Eighteen stage I EEC s with occult positive lymph nodes and 36 controls were assessed for depth of myoinvasion; microcystic, elongated and fragmented ( MELF ) pattern of myometrial invasion; lymphovascular invasion ( LVI ); and epithelial metaplasia. Nodal metastases were subclassified as isolated tumour cells ( ITC s; ≤0.2 mm), micrometastasis (>0.2 mm and <2 mm), or macrometastasis (≥2 mm). Node‐positive cases had significantly higher rates of LVI ( P < 0.001) and MELF invasion ( P = 0.003) on univariate analysis. Only LVI was associated significantly with nodal metastasis on multivariate analysis ( P = 0.002). Tumours with MELF invasion demonstrated reduced E ‐cadherin expression. Macrometastases were identified in seven cases (39%) with or without micrometastasis/ ITC s. Eight (44%) contained only ITC s. Eleven (61%) had histiocyte‐like nodal metastases. Biopsy material from four of six (67%) and five of 17 (29%) cases with and without nodal metastasis showed detached eosinophilic tumour cell buds. Of the former, three were associated with histiocyte‐like nodal metastases – a feature absent in biopsies without tumour budding. Conclusions Lymph nodes from grade I EEC exhibiting cellular budding or LVI should be examined for occult metastases, especially in the form of histiocyte‐like cells.