Problematic areas in the reporting of endometrial carcinomas in hysterectomy specimens

Accurate pathological reporting of endometrial carcinomas in hysterectomy specimens is critical in determining the tumour stage, which together with other clinical and pathological parameters, provides prognostic value and determines the need for adjuvant therapy. In this review, a variety of parameters which are important in accurate pathological staging of endometrial carcinomas are discussed, especially concentrating on areas which potentially result in diagnostic difficulty for pathologists. Topics discussed include assessment of the presence of and depth of myometrial invasion, tumour involvement of adenomyosis, unusual patterns of myometrial invasion, lymphovascular space invasion and peritoneal washings. Cervical and adnexal involvement are discussed, the former potentially presenting a variety of problems for the pathologist and the latter often creating a dilemma regarding the distinction between synchronous independent uterine and ovarian tumours and metastatic neoplasms. The implications for pathology reporting with the new FIGO staging system for endometrial cancer are discussed.