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254 Current Topics in Menopause, 2013, 254-314<br />
CHAPTER 10<br />
New Insights into Pathology of Endometrial Carcinoma at<br />
Menopause<br />
Efthimios Sivridis * and Alexandra Giatromanolaki<br />
Department of Pathology, Democritus University of Thrace Medical School, and<br />
University General Hospital of Alexandroupolis, Greece<br />
Abstract: The risk for endometrial carcinoma is directly related to age, with most cases<br />
occurring after the menopause. At this age group, the synthesis of estrogens continues,<br />
despite the decline of ovarian function. Androgen metabolism, in particular, is<br />
accelerated postmenopausally in all women, with the conversion of androstenedione to<br />
estrone. The reaction increases with increasing body weight. Thus, estrone, while a<br />
weak estrogen, by acting continuously and over a long period of time in its target tissue,<br />
the endometrium, may elicit the same biological response as does a potent estrogen such<br />
as estradiol in premenopausal women. This is evidenced by the fact that the<br />
postmenopausal endometrium, whilst atrophic, not only is potentially capable of giving<br />
genesis to endometrial carcinoma, but it does show a dramatic increase in the incidence<br />
of endometrial cancer during these years. Hence, endometrial carcinomas should no<br />
longer be regarded as “estrogen dependent” (Typed I carcinomas occurring in<br />
premenopausal women) or “estrogen independent” (Typed II carcinomas developing at<br />
menopause), but rather as neoplasms of high and low hormone dependency. Despite a<br />
general belief to the contrary, 55% of endometrial neoplasms occurring during<br />
menopause are G1 endometrioid adenocarcinomas, and almost 20% are G2-G3. A G1<br />
endometrioid adenocarcinoma developing in a postmenopausal woman, however, has<br />
the same favorable prognosis as does an adenocarcinoma of similar type and grade<br />
originating in young pre-menopausal women. On the other hand, Grade 3 endometrioid<br />
adenocarcinomas together with serous papillary and clear cell carcinomas (which by<br />
definition are also Grade 3) are of poor prognosis. Hence, is neither the state of the nonneoplastic<br />
endometrium (atrophic or hyperplastic) nor the menopausal status that<br />
determines the behaviour of an endometrial tumor, but rather is the histological type<br />
(whether endometrioid or non endometrioid) and the degree of tumor differentiation<br />
(whether low or high grade) that matters. On this basis, it is believed that the malignant<br />
potential of endometrial carcinomas can be defined precisely.<br />
Keywords: Adenocarcinoma, endometrium, menopause, pathogenesis, aetiology,<br />
androgens, histological type, endometrioid, non endometrioid, histological grade,<br />
prognosis, autophagy.<br />
*Address correspondence to Efthimios Sivridis: Department of Pathology, Democritus University of<br />
Thrace Medical School, and University General Hospital of Alexandroupolis, Alexandroupolis 68100,<br />
Greece; Tel: 0030-25510 75119; Fax: 0030-25510 30440; Email: esivrid@med.duth.gr.<br />
Volodymyr Dvornyk (Ed)<br />
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