Histologic correlates and virulence implications of endometrial carcinoma associated with adenomatous hyperplasia

The association of endometrial carcinoma (EC) with endocrinopathies manifested by obesity, nulliparity, and/or increased estrogen levels of exogenous or endogenous estrogens is now well‐known. EC is also seen in patients without these findings. Are these different cancers? Seventy‐four cases of EC were reviewed and classified into two groups: group I, with associated adenomatous hyperplasia (AH), 31 cases; and group II, without associated AH, 43 cases. Group I included more well‐differentiated and less invasive carcinomas; histologically, the pattern was glandular in all cases. In Group II, the EC were less well‐differentiated, more invasive, and included, besides adenocarcinomas, clear‐cell, papillary, and anaplastic carcinomas with giant tumor cells. Squamoid features were found in both groups. The possible existence of two types of EC, a hormonal‐dependent EC associated with AH (which is believed to result from hyperestrogenism, and to have a better clinical prognosis), and an “independent” EC, not associated with AH, is discussed.