2016 Annual Meeting

SC52-Difficult Endometrial Biopsies: Malignancy, Mimics, Molecular and Mishaps

Room CC 611-612, March 18 2016, 8:00am to 11:30am


SC52-Difficult Endometrial Biopsies: Malignancy, Mimics, Molecules and Mishaps

Session Credits: 3 CME and 3 SAMs

Faculty: Bojana Djordjevic MD, University of Ottawa, Ottawa, Ontario, Canada, and Anais Malpica MD and Russell Broaddus MD PhD, The University of Texas M.D. Anderson Cancer Center, Houston, Texas

Endometrial biopsy is a key diagnostic test used to rule out or confirm malignancy in patients with a history of abnormal uterine bleeding, and, as such, heavily directs patient management. The primary goal of this course is to provide a practical and algorithmic guide to endometrial biopsy interpretation in the setting of clinical suspicion of malignancy. Issues of specimen adequacy and sampling, endometrial cells on a Pap smear in women over 40 years of age, endometrial tumor mimics and unusual endometrial proliferations will be discussed. While careful analysis of morphology remains the mainstay of diagnosis, the course will also address the use of immunohistochemistry and emerging molecular markers as ancillary diagnostic tools in the appropriate settings. This will include an overview of mismatch repair immunohistochemistry and PCR-based diagnostic tests in the context of tumor tissue testing for Lynch syndrome, as well as the role of endometrial biopsy in following patients with a previously known Lynch syndrome diagnosis. Recent insights from The Cancer Genome Atlas into endometrial tumor biology and their diagnostic implications will be discussed. Finally, as medical management of pre-neoplastic and certain neoplastic endometrial conditions continues to evolve, the course will introduce an approach to interpretation of follow-up endometrial biopsies in patients undergoing hormonal treatments.

The target audience for this course is general surgical pathologists and pathology trainees. The course is based on case studies illustrating typical clinical scenarios. Case histories and virtual slides as well as the course syllabus will be posted on the USCAP website for review prior to the meeting. At the time of the course, PowerPoint presentations of the course faculty summarizing key case diagnostic features, relevant differential diagnoses and literature references, will made available to the registrants.

Upon completion of this educational activity, the participants should:

  • Have an organized approach to endometrial biopsy interpretation in the setting of clinical suspicion of malignancy and the impact of the pathological diagnosis on patient management
  • Effectively use ancillary techniques in diagnostic work-up of endometrial biopsies
  • Be familiar with recent advances in the understanding of endometrial tumor biology and their potential future clinical utilization
  • Recognize histological features of hormonally treated endometrial proliferations and gauge the level of tissue response to hormonal therapy


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