Ovary

— thecoma, granulosa cell tumour, endometrioid carcinoma, endometriosis.

Accompanying ovarian carcinoma is seen in 5-10% of endometrial carcinomas. Distinction between synchronous primary lesions and ovarian secondaries rests on the latter being bilateral, multinodular, often serosal and with ovarian stromal lymphovascular invasion. There is a higher frequency of concurrent primaries in endometrioid carcinoma of ovary (25%).

Tamoxifen-related polyps, hyperplasia, adenocarcinoma, adenosar-coma, carcinosarcoma (MMMT): tamoxifen is an anti-oestrogen but has paradoxical oestrogenic effects on the endometrium leading to an increased frequency of a range of endometrial neoplasms, some of which are prognostically adverse. Polyps can be large, multiple, necrotic, have areas of glandular, papillary or clear cell metaplasia and may even harbour carcinoma.

Carcinosarcoma/sarcomatoid carcinoma is often polypoid at the fundus of an elderly patient with lymphovascular invasion and 30% present with stage III/IV disease. The carcinomatous component is usually high-grade glandular (endometrioid, clear cell, serous or undif-ferentiated) and the sarcomatous element homologous (cf. endometrial stroma, leiomyosarcoma, fibrosarcoma) or heterologous (striated muscle, cartilage, bone, fat). Immunohistochemistry for epithelial and mesenchymal markers, e.g. desmin, may be necessary to confirm the diagnosis. Five-year survival is 20-40% in this aggressive neoplasm.

The majority (80%) of adenosarcomas arise in the postmenopausal endometrium. They are polypoid with proliferative type glands and usually homologous stromal type sarcoma distributed in a condensed periglandular cambium layer. Recurrence (30%) relates to mitoses, stromal overgrowth and myoinvasion in this low- to intermediate-grade malignancy.

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