Endometrial cancer differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Monalisa Dmello, M.B,B.S., M.D. [2]Roukoz A. Karam, M.D.[3]

Overview

In early stages endometrial cancer must be differentiated from diseases that cause abnormal uterine bleeding and endometrial thickening on ultrasound, such as endometrial hyperplasia, endometrial polyp and submucosal uterine leiomyoma. In advanced stages endometrial cancer must be differentiated from uterine sarcoma and uterine lymphoma.

Differentiating Endometrial Cancer From Other Diseases

• In early disease, uterine cancer must be differentiated from other diseases causing endometrial thickening:

• Benign endometrial proliferation
• Endometrial hyperplasia
• Endometrial polyp
• Submucosal uterine leiomyoma

• In advanced disease, uterine cancer must be differentiated from other diseases:

• Uterine sarcoma

• Endometrial stromal sarcoma (ESS)
• Leiomyosarcoma of the uterus
• Malignant mixed Mullerian tumour (MMMT) of the uterus

• Uterine lymphoma: rare

• Primary uterine lymphoma
• Secondary uterine involvement with lymphoma

• Cervical cancer with uterine invasion
• Metastasis to the uterus from a non gynecological malignancy: rare

Diseases	Clinical manifestations						Para-clinical findings				Pap Smear	Histopathology	Gold standard	Additional findings
	Symptoms				Physical examination
							Lab Findings		Imaging
	Menorrhagia	Post Menstrual Bleeding	Pelvic Pain	Other symptoms	Pelvic Mass	Abdominal Distension	Hb	CEA-19	Ultrasound	MRI
Uterine cancer	+	+					↓
Uterine sarcoma	+/-	+					↓
Uterine lymphoma	+/-	+/-					↓ or N
Uterine leiomyoma	+/-	+/-					↓ or N
Malignant mixedMullerian tumour (MMMT) of the uterus	+/-	+/-					↓
Cervical cancerwith uterine invasion	+	+					↓
Metastasis to the uterusfrom a non gynaecologcial malignancy	+	+					↓
Endometrial polyp	+	+					↓ or N
Endometrial hyperplasia	+	+					↓
Fetus	No Menstrual cycle	+/-					-
Uterine adenomyoma	-	-					↓
Hematometra	-	-					↓