PAPILLARY CARCINOMA OF THE ENDOMETRIUM - MORPHOMETRIC PREDICTORS OF SURVIVAL

This study compares morphometric features of endometrial papillary car cinoma, serous and endometrioid types, in an effort to identify charac teristics that predict clinical outcome. Fifty-one consecutive patient s with papillary carcinoma were identified at NYU Medical Center from January 1979 through December 1991 and were followed through 1994. Mor phologic analysis was conducted by investigators (R.D. and K.M.) blind ed as to original diagnosis, depth of invasion, stage, and outcome. Of 25 variables analyzed, six were significantly associated with reduced survival, namely marked nuclear pleomorphism, multinucleated cells, h obnail cells, psammoma bodies, uneven papillary borders, and inflammat ion. Serous carcinomas showed a highly significant (p = 0.0001) associ ation with reduced length of recurrence-free survival, with a median s urvival of 27 months (mean +/- SE, 38.9 +/- 7.0) versus 95 months (106 .7 +/- 15.3) for patients with endometrioid types. Of six morphologic characteristics that correlated with reduced recurrence-free survival by univariate analyses, only one, nuclear pleomorphism, showed a signi ficant association with an adverse outcome in a multivariate regressio n analysis (p = 0.0020), even after adjustment for the effect of tumor stage. Therefore, we believe that the presence of marked nuclear pleo morphism should serve as the major criterion for making a diagnosis of serous carcinoma. In tumors with moderate nuclear pleomorphism, a dia gnosis of serous carcinoma is aided by the presence of multinucleated cells, uneven papillary borders, high nuclear/cytoplasmic ratio, apica l location of the nucleus, and hobnail cells. These features were sign ificantly associated with a diagnosis of serous carcinoma in our patie nts.