Histological spectrum and diagnostic challenges in endometrial carcinoma of the uterus

Background: Endometrial carcinoma is the most common type of malignancy of the uterine corpus accounting for 95% of all primary malignancies. Epidemiological studies have proved the role of unopposed estrogen as an important factor in pathogenesis of endometrial carcinoma. Pathologists play an important role not only in the histological confirmation of the diagnosis, but in subtyping, grading and staging of the tumor. Current study is undertaken to study the histological spectrum in endometrial carcinomas. Methods: Present study includes histologically confirmed cases of endometrial carcinoma of uterine corpus over a period of 24 months (July2020 to June 2022) in a tertiary health care center in central India. After gross examination, and standard sectioning, all these tumors were subtyped on histology and grading, staging was done as per WHO and FIGO recommendations. In cases with diagnostic dispute and overlapping features, IHC markers were applied. Results: Amongst total 30 confirmed cases of endometrial carcinoma, endometrioid type was most common (25) followed by villoglandular and serous type of adenocarcinoma. Architectural and nuclear grading was done in all cases. Staging could be done in hysterectomy specimens only. Difficulties encountered while grading and staging are discussed. Conclusions: Endometrial carcinoma was the most common type of malignancy. Other types were villoglandular and serous adenocarcinoma. Various additional histological features were also observed. Grade I tumors were commonly seen. Depth of myometrial invasion was measured in hysterectomy specimens. Various diagnostic challenges encountered are discussed

Spectrum of vulvar lesions: patient’s anxiety, clinician’s concern and pathologist’s diagnostic challenge

Background: A wide variety of inflammatory, premalignant and malignant lesions can occur on the vulva. Some of the lesions are limited to the vulva, while some also involve other parts of the body. Although vulvar diseases can cause a significant issue in the patients, they are less commonly discussed than those of cervix, uterus and ovary. Most of the asymptomatic lesions remain un-noticed, and are seen during routine gynecological checkups. Common complaints in symptomatic lesions are lumps, discomfort, itching and pain. Since the symptoms are nonspecific; determining the location of the lesion can assist with the diagnosis. Being a genital part with skin covering on outer aspect and mucosal lining inside, it is associated with various dermatological, nutritional, and hormonal as well as sexually transmitted diseases. The present study thus was conducted to categorize vulvar lesions based on their histological diagnosis and also to study the morphological spectrum of precursor lesions for malignancy.Methods: Present study includes all types of vulvar lesions sent for pathological study in the Department of pathology, at GMC Nagpur over the period of one year.Results: Total 34 lesions were studied including a wide diagnostic range from inflammatory, dermatological to benign, premalignant and malignant. Inflammatory lesions including various infections and LSA (Lichen sclerosus atrophicus) were the most commonly seen lesions along with collection of neoplastic lesions.Conclusions: Proper diagnostic categorization of the lesions is essential for initiating therapy and reducing patient’s anxiety. Morphology of these lesions along with their diagnostic significance is discussed