Uterine corpus tumors and tumor-like lesions: A clinicopathological evaluation of 430 patients

Abstract

Background: Globally, uterine corpus tumors significantly increase women’s mortality and morbidity. Histopathological examination plays a crucial role in effectively managing patients with these tumors. Aims: This study aims to explore uterine tumors and tumor-like lesions, with a secondary objective specifically focusing on categorizing their histopathological characteristics using the 2020 World Health Organization classification of uterine corpus tumors. Moreover, the study seeks to analyze the clinical parameters of patients afflicted by these tumors and tumor-like lesions to discover possible correlations between histopathological findings and clinical features. Materials and Methods: A study involving a retrospective and prospective analysis over 3.5 years, encompassing 430 cases of histopathologically confirmed uterine corpus tumors and tumor-like lesions. Results: The tumors and tumor-like lesions in our study were classified into three main categories: benign tumors (95.2%), which were the most prevalent; malignant tumors (4.5%); and borderline tumors (0.3%). Among the benign tumors, leiomyoma was the most common, accounting for 91.1% of cases, with intramural leiomyomas being the most prevalent subtype at 60.2%. Most of the patients diagnosed with these tumors were multiparous female patients (95.6%), aged between the fourth and fifth decades of life (80%), and commonly presented with menorrhagia (42.5%). Hyalinization was the most frequently observed secondary change (24.2%), and cellular leiomyoma was the most common histological variant (N = 4). Endometrial carcinoma was the sole type identified in our study for malignant tumors. These patients were mainly in the age group of 60–69 years (47%), multiparous (88.2%), and presented with post-menopausal bleeding (41.2%). Grade I endometrioid carcinoma was the predominant histopathological type, accounting for 88.2% of the malignant cases. Among the other lesions identified in our study, there was one case of STUMP (smooth muscle tumor of uncertain malignant potential) and 15 cases of adenomyoma. Endometrial polyp (N = 57, 95%) was the most common type among the tumor-like lesions. In their fifth decade, these polyps were predominantly found in multiparous female patients (N = 50, 87.7%). Menorrhagia was the most common presentation; most polyps were solitary and sessile. Additionally, we observed a single case of papillary proliferation of the endometrium with mucinous, ciliated, and clear cell metaplasia without any atypia and two instances of Arias-Stella reaction. Conclusion: Benign tumors were more common than malignant tumors in the uterine corpus. Among these, leiomyoma was the most frequently observed benign lesion, whereas endometrial carcinomas were the predominant malignant lesions. It is essential to emphasize that certain specific lesions, such as endometrial polyps, metaplasia, and Arias-Stella reaction, can mimic malignant tumors even upon careful histopathological examination. Therefore, being aware of these tumor-like lesions is crucial. Histopathology plays a vital role in accurately diagnosing various tumors and tumor-like lesions in the uterine corpus.