Skip to main content

Advertisement

SpringerLink
Log in

Dynamic contrast-enhanced MR imaging of uterine endometrial carcinoma with/without squamous differentiation

  • Pelvis
  • Published:
Abdominal Radiology Aims and scope Submit manuscript

Abstract

Purpose

Endometrial carcinoma with strong enhancement on dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) is suggestive of high-grade type II endometrial carcinoma. However, low-grade type I endometrial carcinoma may also sometimes show strong enhancement. We hypothesized that squamous differentiation would contribute to the strong enhancement at the early phase on DCE-MRI-like uterine cervical squamous cell carcinoma and compared the DCE-MRI findings of endometrial carcinoma with and without squamous differentiation.

Methods

DCE-MRI of endometrial carcinoma including 41 low-grade type I endometrial carcinomas without squamous differentiation (LG), 39 low-grade type I endometrial carcinomas with squamous differentiation (LGSD), and 20 high-grade type II endometrial carcinomas (HG) was retrospectively evaluated.

Results

Significant difference in the time–intensity curves was found between LG and HG and LG and LGSD, whereas no significant difference was seen between HG and LGSD. Curve type 3 (initial signal rise which is steeper than that of the myometrium) was more frequent in HG (60%) and LGSD (77%) than in LG (34%).

Conclusion

It should be recognized as a pitfall that high-grade type II endometrial carcinoma and low-grade type I endometrial carcinoma with squamous differentiation may show similar early strong enhancement on DCE-MRI.

Graphical abstract

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Bosse T, Lortet-Tieulent J, Davidson B, Raspollini MR, Euscher ED, Singh N, Liu CR. (2020) Endometrioid carcinoma of the uterine corpus. In: the WHO Classification of Tumours Editorial Board (ed.) WHO Classification of Tumours: Female Genital Tumours, 5th edn. World Health Organization, Lyon, pp 252–255

  2. Ellenson LH, Ronnett BM, Soslow RA, Lastra RR, Kurman RJ. (2019) Endometrial carcinoma. In: Kurman RJ, Ellenson LH, Ronnett BM. (eds.) Blaustein's Pathology of the Female Genital Tract, 7th edn. Springer, Cham, pp 473-533

    Chapter  Google Scholar 

  3. Bokhman JV. (1983) Two pathogenetic types of endometrial carcinoma. Gynecol Oncol 15:10-17

    Article  CAS  PubMed  Google Scholar 

  4. Boronow RC, Morrow CP, Creasman WT, Disaia PJ, Silverberg SG, Miller A, Blessing JA. (1984) Surgical staging in endometrial cancer: clinical-pathologic findings of a prospective study. Obstet Gynecol 63:825-832

    CAS  PubMed  Google Scholar 

  5. Prat J. (2004) Prognostic parameters of endometrial carcinoma. Hum Pathol 35:649-662

    Article  PubMed  Google Scholar 

  6. Lukanova A, Lundin E, Micheli A, Arslan A, Ferrari P, Rinaldi S, Krogh V, Lenner P, Shore RE, Biessy C, Muti P, Riboli E, Koenig KL, Levitz M, Stattin P, Berrino F, Hallmans G, Kaaks R, Toniolo P, Zeleniuch-Jacquotte A. (2004) Circulating levels of sex steroid hormones and risk of endometrial cancer in postmenopausal women. Int J Cancer 108:425-432

    Article  CAS  PubMed  Google Scholar 

  7. Todo Y, Kato H, Kaneuchi M, Watari H, Takeda M, Sakuragi N. (2010) Survival effect of para-aortic lymphadenectomy in endometrial cancer (SEPAL study): a retrospective cohort analysis. Lancet 375:1165-1172

    Article  PubMed  Google Scholar 

  8. Frumovitz M, Singh DK, Meyer L, Smith DH, Wertheim I, Resnik E, Bodurka DC. (2004) Predictors of final histology in patients with endometrial cancer. Gynecol Oncol 95:463-468

    Article  PubMed  Google Scholar 

  9. Fukunaga T, Fujii S, Inoue C, Kato A, Chikumi J, Kaminou T, Ogawa T. (2015) Accuracy of semiquantitative dynamic contrast-enhanced MRI for differentiating type II from type I endometrial carcinoma. J Magn Reson Imaging 41:1662-1668

    Article  PubMed  Google Scholar 

  10. Yamashita Y, Takahashi M, Sawada T, Miyazaki K, Okamura H. (1992) Carcinoma of the cervix: dynamic MR imaging. Radiology 182:643-648

    Article  CAS  PubMed  Google Scholar 

  11. Thomassin-Naggara I, Bazot M, Darai E, Callard P, Thomassin J, Cuenod CA. (2008) Epithelial ovarian tumors: value of dynamic contrast-enhanced MR imaging and correlation with tumor angiogenesis. Radiology 248:148-159

    Article  PubMed  Google Scholar 

  12. Abulafia O, Triest WE, Sherer DM. (1999) Angiogenesis in malignancies of the female genital tract. Gynecol Oncol 72:220-231

    Article  CAS  PubMed  Google Scholar 

  13. Brasch RC, Li KC, Husband JE, Keogan MT, Neeman M, Padhani AR, Shames D, Turetschek K. (2000) In vivo monitoring of tumor angiogenesis with MR imaging. Acad Radiol 7:812-823

    Article  CAS  PubMed  Google Scholar 

  14. Dobrzycka B, Mackowiak-Matejczyk B, Kinalski M, Terlikowski SJ. (2013) Pretreatment serum levels of bFGF and VEGF and its clinical significance in endometrial carcinoma. Gynecol Oncol 128:454-460

    Article  CAS  PubMed  Google Scholar 

  15. Hirano Y, Kubo K, Hirai Y, Okada S, Yamada K, Sawano S, Yamashita T, Hiramatsu Y. (1992) Preliminary experience with gadolinium-enhanced dynamic MR imaging for uterine neoplasms. Radiographics 12:243-256

    Article  CAS  PubMed  Google Scholar 

  16. Yamashita Y, Harada M, Sawada T, Takahashi M, Miyazaki K, Okamura H. (1993) Normal uterus and FIGO stage I endometrial carcinoma: dynamic gadolinium-enhanced MR imaging. Radiology 186:495-501

    Article  CAS  PubMed  Google Scholar 

  17. Joja I, Asakawa M, Asakawa T, Nakagawa T, Kanazawa S, Kuroda M, Togami I, Hiraki Y, Akamatsu N, Kudo T. (1996) Endometrial carcinoma: dynamic MRI with turbo-FLASH technique. J Comput Assist Tomogr 20:878-887

    Article  CAS  PubMed  Google Scholar 

  18. Reijnen C, van Weelden WJ, Arts MSJP, Peters JP, Rijken PF, van de Vijver K, Santacana M, Bronsert P, Bulten J, Hirschfeld M, Colas E, Gil-Moreno A, Reques A, Mancebo G, Krakstad C, Trovik J, Haldorsen IS, Huvila J, Koskas M, Weinberger V, Minar L, Jandakova E, Snijders MPLM, van den Berg-van Erp S, Küsters-Vandevelde HVN, Matias-Guiu X, Amant F; ENITEC-consortium; Massuger LFAG, Bussink J, Pijnenborg JMA. (2019) Poor outcome in hypoxic endometrial carcinoma is related to vascular density. Br J Cancer. 120:1037-1044

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Ye Z, Ning G, Li X, Koh TS, Chen H, Bai W, Qu H. (2022) Endometrial carcinoma: use of tracer kinetic modeling of dynamic contrast-enhanced MRI for preoperative risk assessment. Cancer Imaging. 22:14

    Article  PubMed  PubMed Central  Google Scholar 

  20. Zinovkin DA, Pranjol MZI, Petrenyov DR, Nadyrov EA, Savchenko OG. (2017) The Potential Roles of MELF-Pattern, Microvessel Density, and VEGF Expression in Survival of Patients with Endometrioid Endometrial Carcinoma: A Morphometrical and Immunohistochemical Analysis of 100 Cases. J Pathol Transl Med. 51:456-462

    Article  PubMed  PubMed Central  Google Scholar 

  21. Fasmer KE, Bjørnerud A, Ytre-Hauge S, Grüner R, Tangen IL, Werner HM, Bjørge L, Salvesen ØO, Trovik J, Krakstad C, Haldorsen IS. (2018) Preoperative quantitative dynamic contrast-enhanced MRI and diffusion-weighted imaging predict aggressive disease in endometrial cancer. Acta Radiol. 59:1010-1017

    Article  PubMed  Google Scholar 

  22. Jansen JF, Koutcher JA, Shukla-Dave A. (2010) Non-invasive imaging of angiogenesis in head and neck squamous cell carcinoma. Angiogenesis. 13:149-160

    Article  PubMed  PubMed Central  Google Scholar 

  23. Arakawa A, Tsuruta J, Nishimura R, Sakamoto Y, Korogi Y, Baba Y, Furusawa M, Ishimaru Y, Uji Y, Taen A, Ishikawa T, Takahashi M. (1996) Lingual carcinoma. Correlation of MR imaging with histopathological findings. Acta Radiol 37:700-707

    Article  CAS  PubMed  Google Scholar 

  24. Tomao F, Papa A, Rossi L, Zaccarelli E, Caruso D, Zoratto F, Benedetti Panici P, Tomao S. (2014) Angiogenesis and antiangiogenic agents in cervical cancer. Onco Targets Ther. 3;7:2237-48

    Article  Google Scholar 

  25. Stafl A, Mattingly RF. (1975) Angiogenesis of cervical neoplasia. Am J Obstet Gynecol. 121:845-851

    CAS  PubMed  Google Scholar 

  26. Vici P, Mariani L, Pizzuti L, Sergi D, Di Lauro L, Vizza E, Tomao F, Tomao S, Mancini E, Vincenzoni C, Barba M, Maugeri-Saccà M, Giovinazzo G, Venuti A. (2014) Emerging biological treatments for uterine cervical carcinoma. J Cancer. 5:86-97

    Article  PubMed  PubMed Central  Google Scholar 

  27. Smith-McCune KK, Weidner N. (1994) Demonstration and characterization of the angiogenic properties of cervical dysplasia. Cancer Res. 54:800-804

    CAS  PubMed  Google Scholar 

  28. Chinen K, Kamiyama K, Kinjo T, Arasaki A, Ihama Y, Hamada T, Iwamasa T. (2004) Morules in endometrial carcinoma and benign endometrial lesions differ from squamous differentiation tissue and are not infected with human papillomavirus. J Clin Pathol 57:918-926

  29. Lucas E, Carrick KS. (2022) Low grade endometrial endometrioid adenocarcinoma: A review and update with emphasis on morphologic variants, mimics, immunohistochemical and molecular features. Semin Diagn Pathol 39:159-175

    Article  PubMed  Google Scholar 

  30. Zaino RJ, Kurman R, Herbold D, Gliedman J, Bundy BN, Voet R, Advani H. (1991) The significance of squamous differentiation in endometrial carcinoma. Data from a Gynecologic Oncology Group study. Cancer 68:2293-2302

    Article  CAS  PubMed  Google Scholar 

  31. Zaino RJ, Kurman RJ. (1988) Squamous differentiation in carcinoma of the endometrium: a critical appraisal of adenoacanthoma and adenosquamous carcinoma. Semin Diagn Pathol 5:154-171

    CAS  PubMed  Google Scholar 

  32. Yan B, Zhao T, Liang X, Niu C, Ding C. (2018) Can the apparent diffusion coefficient differentiate the grade of endometrioid adenocarcinoma and the histological subtype of endometrial cancer? Acta Radiol 59:363-370

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiology, Tokushima University, 3-18-15, Kuramoto-Cho, Tokushima, 7708503, Japan

    Mayumi Takeuchi & Masafumi Harada

  2. Department of Radiological Technology, Tokushima Bunri University, 1314-1, Shido, Sanuki-City, Kagawa, 7692193, Japan

    Kenji Matsuzaki

  3. Division of Pathology, Tokushima University Hospital, 2-50-1, Kuramoto-Cho, Tokushima, 7708503, Japan

    Yoshimi Bando

Authors
  1. Mayumi Takeuchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kenji Matsuzaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yoshimi Bando
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Masafumi Harada
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mayumi Takeuchi.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Ethical approval

All procedures performed in this study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

For this type of study formal consent is not required, and the written informed consent of the patient was obtained for the MR examination.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Takeuchi, M., Matsuzaki, K., Bando, Y. et al. Dynamic contrast-enhanced MR imaging of uterine endometrial carcinoma with/without squamous differentiation. Abdom Radiol 48, 2494–2502 (2023). https://doi.org/10.1007/s00261-023-03934-w

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00261-023-03934-w

Keywords

Search

Navigation