Got Path? Issues in Gynecological Pathology-Minimal Serous Carcinoma of the Uterus

Figure 1-Low power magnification showed the majority of the endometrial currettings consisted of proliferative endometrium

Figure 2-In between the benign endometrial tissue fragments were detached papillary fragments of pleomorphic epithelial cells, some of which contained microcalcifications.

Figure 3-Areas of papillary excrescences arose in continuity with the benign surface mucosa.

Figure 4-High power magnification of the carcinoma exhibited high-grade nuclear changes.

Figure 5-p53 nuclear staining was prominent within the carcinoma and negative within the adjacent benign surface mucosa.

Figure 1-Low power magnification showed the majority of the endometrial currettings consisted of proliferative endometrium Figure 2-In between the benign endometrial tissue fragments were detached papillary fragments of pleomorphic epithelial cells, some of which contained microcalcifications. Figure 3-Areas of papillary excrescences arose in continuity with the benign surface mucosa. Figure 4-High power magnification of the carcinoma exhibited high-grade nuclear changes. Figure 5-p53 nuclear staining was prominent within the carcinoma and negative within the adjacent benign surface mucosa.	Minimal Serous Carcinoma of the Uterus
	The entity of minimal serous carcinoma of the uterus is now established in the pathology literature. Most investigators believe it represents a precursor lesion to papillary serous carcinomas of the uterus. The finding of p53 nuclear positivity provides another link between the two entities. Although intuitively, the diagnosis should be straight forward given the high grade nuclear changes and papillary architecture, a recent case illustrates the subtle histologic changes which can easily be mistaken for syncytial metaplasia in shedding endometrium. Most of the biopsy consisted of proliferative endometrium but nestled between the clumps of benign endometrium were detached papillary fragments of atypical epithelial cells. Further investigation revealed one focus (Figure 3) of a surface papillary excrescence exhibiting continuity with the adjacent benign surface mucosa. Higher power magnification confirmed the high grade nuclear features in at least some of the cells. Immunohistochemical analysis for p53 was performed upon the biopsy with striking results. The serous carcinoma demonstrated strong nuclear staining, contrasted with the benign endometrial glands and surface mucosa (Figure 5). This case is good example of the subtle histopathologic findings of minimal serous carcinoma. The references cited above are good reviews of the topic. Although the overall prognosis is excellent when the carcinoma is limited to the uterus, as many as 45% of the cases may be associated with extra-uterine disease. In these latter patients (18 of 40 pts), 8 of 18 died of their disease. Thus, a complete surgical staging is necessary to predict the prognosis. References: Hui P, Kelly M, O'malley DM, Tavassoli F, Schwartz PE. Minimal uterine serous carcinoma: a clinicopathological study of 40 cases. Mod Pathol. 2005 Jan;18(1):75-82 Wheeler DT, Bell KA, Kurman RJ, Sherman ME. Minimal uterine serous carcinoma: diagnosis and clinicopathologic correlation. Am J Surg Pathol. 2000 Jun;24(6):797-806.