Revised June 2011

1)  WHO/ISGP Classification of Endometrial Carcinoma

Endometrioid
	Typical
	Variants
		Villoglandular
		With squamous differentiation
		Secretory
		Ciliated
Serous papillary adenocarcinoma
Clear cell adenocarcinoma
Mucinous adenocarcinoma
Squamous cell carcinoma
Undifferentiated carcinoma
Mixed carcinoma
	(two of above histological types in which minor component accounts for 10% or more of the tumour)

Mixed Epithelial-Mesenchymal Tumors

a) Adenofibroma
b) Adenomyoma including atypical polypoid adenomyoma
c) Adenosarcoma, homologous and heterologous
d) Carcinofibroma
e) Carcinosarcoma (malignant mullerian mixed tumor), homologous and heterologous. This is now recognized as representing high grade, metaplastic adenocarcinoma and treated as such.

An endocervical curettage is required to rule out occult cervical involvement. If the cervix is involved refer for opinion for pre-hysterectomy pelvic irradiation.

In 1988 FIGO adopted a surgical staging system for cancer of the uterine corpus (section 3). Therefore, the responsibility for careful intraoperative exploration, documentation and the taking of peritoneal washings rests with the operating surgeon. It is felt that adequate exposure is best obtained using a vertical rather than a Pfannensteil or low transverse incision. Routine lymph node removal is recommended in some early stage patients, dependent upon grade, depth of invasion, and histology. Only those skilled and practiced in lymph node dissection should carry out such procedures (see Surgery Table 1).

Proper handling of a hysterectomy specimen by the pathologist is essential for evaluating the prognostic factors that may affect postoperative adjuvant treatment in patients with endometrial adenocarcinoma. The specimen should be opened (at 3 and 9 o'clock) extending from the external os up to the fundus and promptly placed in formalin for overnight fixation. Lack of prompt fixation has resulted in severely autolyzed hysterectomy specimens that have precluded accurate histologic grading, assessment of depth of invasion, etc. If the operation is performed late in the afternoon (especially if it is a Friday afternoon), and no pathologists are available to open and place the specimen in formalin, the gynecologist should be asked to perform this task. At the time of blocking the specimen, if no obvious tumor is seen on gross examination, the specimen should be well sampled (at least 8-10 sections of endomyometrium, including sections that include serosa). If there is an obvious deeply invasive tumor on gross examination, then only two or three sections of the tumor are needed to document the deepest extent of the tumor, and its relation to the serosa. Sections of the cervix and adnexa should of course be taken in both circumstances.

At the time of the staging laparotomy careful palpation of pelvic and para-aortic nodal areas should be carried out and any large lymph nodes should be biopsied. Formal dissection is not required in the setting of enlarged positive nodes as these patients will receive postoperative XRT and single modality diminishes the rate of lymphedema. Extensive retroperitoneal lymphadenectomy is not recommended as this may increase treatment morbidity if the patient has para-aortic radiation. The patient should be referred as soon as a diagnosis is made for planning of chemotherapy and radiotherapy.
Peritoneal washings should be performed in all cases during laparotomy.