Papillary serous and clear cell carcinoma limited to endometrial curettings in FIGO Stage 1a and 1b endometrial adenocarcinoma: Treatment implications

Objective. The aim of this study was to review the significance of papillary serous and clear cell carcinoma in Stage la. and Ib adenocarcinoma of the endometrium where this histological subtype is confined to the endometrial curettings and is absent in the hysterectomy specimen. Methods and Materials. Three hundred twenty patients with Stage la or Ib adenocarcinoma of the endometrium without lymphovascular space invasion or evidence of FIGO Grade 3 histology demonstrated in the hysterectomy specimen were referred to the British Columbia Cancer Agency, Vancouver Clinic, between January 1992 and July 1995. These charts were retrospectively reviewed. Results. On pathology review, eight patients were found to have evidence of papillary serous or clear cell carcinoma confined to the uterine curettings. Five patients also had Grade 1 or 2 endometrioid adenocarcinoma without lymphovascular space involvement seen in the hysterectomy specimen. All patients were managed expectantly. None of these 8 have recurred with a median follow-up of 3 years. Conclusion. A clinical dilemma arises when there is evidence of papillary serous or clear cell carcinoma limited to the endometrial curettings where there is no associated adverse pathological features seen in the hysterectomy specimen. In our series of patients treated expectantly, it appears that a small bulk of aggressive disease seen only in the curettage specimen does not adversely impact disease-free survival. (C) 1998 Academic Press.