Endometrial carcinomas - Challenges and updates on selected topics.

Area of Science:

• Gynecologic Pathology
• Oncology
• Molecular Pathology

Background:

• Endometrial carcinoma is a heterogeneous disease with diverse subtypes.
• Understanding these subtypes is crucial for accurate diagnosis, prognosis, and treatment.
• This review updates knowledge on selected, less common endometrial carcinoma variants.

Purpose of the Study:

• To provide an updated overview of selected endometrial carcinoma subtypes.
• To highlight diagnostic challenges and clinical implications of these variants.
• To emphasize the importance of integrated diagnostic approaches.

Main Methods:

• Review of current literature on endometrial carcinoma subtypes.
• Focus on histologic, immunophenotypic, and molecular features.
• Integration of diagnostic modalities including morphology, immunohistochemistry, and molecular testing.

Main Results:

• Endometrial serous carcinoma, though rare, is aggressive and requires comprehensive staging.
• Variants like CHEC, PiMHEC, MLA, PESCC, and EmGA present unique morphologic and molecular features.
• Accurate classification relies on integrating morphology with p53, MMR, POLE, and HER2 testing.
• HER2 testing is vital for targeted therapy selection in advanced/recurrent disease.

Conclusions:

• Accurate classification of endometrial carcinoma subtypes is essential for patient management.
• Integrated diagnostic approaches combining morphology and molecular testing are critical.
• Targeted therapies, guided by biomarkers like HER2, are improving outcomes for advanced disease.