Scenario
- 72 yo female presented to physician with post-menopausal bleeding
- 6/21/2024 Transvaginal US was done which revealed a large, 9.7 cm, endometrial mass with differential diagnosis of large polyp, endometrial hyperplasia, or endometrial malignancy
- 7/12/2024 CT Abd/Pelvis was done with endometrial thickening better seen on US, no evidence lymphadenopathy
- 8/17/2024 TAH-BSO done: Large endometrial polyp, 9.0 cm, with spectrum of simple hyperplasia to focal atypical hyperplasia/endometrial intraepithelial neoplasia (EIN), no peritoneal washings or nodes present
Question: How would you assign pathological staging?
- pT BLANK pNX cM0 – Stage 99
- pT0 pNX cM0 – Stage 99
- pT1 cN0 cM0 – Stage 1
- pT1 pNX cM0 – Stage 99
Answer: pT1 cN0 cM0 – Stage 1
Rationale:
Endometrial intraepithelial neoplasm or EIN became reportable in 2021 and is assigned to histology 8380/2 but is staged as an invasive disease just as Endometrial Intraepithelial Carcinoma (EIC). Refer to the AJCC Cancer Staging Manual, 8th Edition Chapter 53 Corpus Uteri-Carcinoma and Carcinosarcoma “Summary of Changes” table at the beginning of the Chapter. There is no Tis category because AJCC is staying in sync with FIGO, this case would be assigned as a T1.
Additionally, Corpus Uteri is one of the rare circumstances when cN0 can be used in pathological staging when no nodes are removed. Refer to AJCC Cancer Registrar Education, Critical Clarifications Document entitled Node Status for information on what Chapters allow the pathologic N category to be assigned as cN0.