Challenges for the pathologist in the interpretation of laparoscopic hysterectomy and cytologic specimens in endometrial carcinoma

The introduction of new and improved surgical techniques for treatment of endometrial carcinoma has been shown to be associated with histological artifacts making interpretation and diagnosis a challenge for the pathologist with an impact on clinical staging. In this review, challenging artifacts associated with the use of manipulated laparoscopic hysterectomies for endometrial carcinoma are discussed with a review of the literature. Topics discussed include the artifacts of vascular pseudoinvasion; endomyometrial cleft displacement, disruption of endometrial lining, nuclear crush artefact and positive peritoneal cytology. The pathologist should be aware of these artifacts in order to prevent diagnostic errors and unwarranted therapy for some patients.