Table 3.
Histopathologic finding(s) | Ancillary pathologic test(s) (IHC/ISH) | Associated molecular abnormality | Intervention/Management implications |
---|---|---|---|
Endometrial: Lower uterine segment location; endometrioid or undifferentiated histotype; mucinous differentiation; tumor-infiltrating lymphocytes; peri-tumoral lymphocytes Ovarian: endometrioid or clear cell histotype; tumor- infiltrating lymphocytes |
Immunohistochemistry for MLH1, MSH2, MSH6, PMS2; MLH1 promoter methylation analysis | DNA mismatch repair deficiency due to: 1) germline mutations in MLH1, MSH2, MSH6, PMS2 or EPCAM 2) somatic mutations or MLH1 promoter methylation |
1) Genetic counseling and family screening for Lynch syndrome 2) Consider immune therapy e.g. checkpoint inhibitors for recurrent disease |
Endometrial: High grade; frequent lymphovascular space invasion; endometrioid, clear cell, undifferentiated or carcinosarcoma histotype; conspicuous tumor- infiltrating lymphocytes and/or peri-tumoral lymphocytes; morphologic heterogeneity/ambiguity; bizarre/giant tumor cell nuclei Ovarian: endometrioid histotype; morphologic heterogeneity |
POLE mutations | Consider immune therapy e.g. checkpoint inhibitors for recurrent disease Consideration of avoidance of overtreatment in adjuvant setting |
|
Ovarian: Variant (solid, endometrioid, and transitional cell carcinoma, SET-like) morphology; tumor-infiltrating lymphocytes; necrosis | Homologous recombination deficiency e.g. BRCA1/2 mutations | Consider germline BRCA1/BRCA2 testing and PARP inhibitor therapy in recurrent setting | |
Ovarian: Serous borderline tumors with eosinophilic cells; cuboidal and columnar cells that line papillae and bud from their surfaces | BRAF VE1 immunohistochemistry | MAPK pathway activation | Presence of V600E BRAF mutation may portend improved prognosis |