Diagnostic dilemmas and potential pitfalls in the evaluation of endometrial adenocarcinoma

Endometrial adenocarcinoma is the most common malignancy of the gynaecologic tract, and therefore one of the most commonly encountered surgical pathology specimens. Accurate diagnosis, grading and staging are necessary to direct therapy for this common disease. Evaluation of these cases is usually straightforward. Some cases, however, may be complicated by a variety of issues such as difficulty assessing depth of invasion; difficulty assessing cervical involvement; possibility of synchronous ovarian primaries; evaluation of lymphovascular space invasion; difficulties with FIGO grade (especially in the company of altered differentiation); and subtle patterns of myoinvasion. The purpose of this review is to emphasize these problematic areas and offer straightforward guidelines to apply when these situations are encountered. Proper recognition of these diagnostic challenges will hopefully improve grading and staging accuracy, and subsequently therapy, for the multitudes of women affected by this disease.