This uterus is not enlarged, but there is an irregular mass in the upper fundus that proved to be endometrial adenocarcinoma on biopsy. Such carcinomas are more likely to occur in postmenopausal women. Thus, any postmenopausal bleeding should make you suspect that this lesion may be present.

There are two forms of endometrial carcinoma:

• Type 1

• Most common type

• Related to conditions associated with hyperestrogenism: obesity, anovulatory cycles, infertility, late menopause, atypical hyperplasia

• Better prognostic features of moderate differentiation and superficial invasion

• Endometrioid microscopic pattern with glandular, cribriform, and papillary features

• Associated with PTEN gene mutation

• Type II

• Less than 10% of endometrial carcinomas

• Arises with endometrial atrophy

• Poor prognostic features of poor differentiation and greater invasiveness

• Serous microscopic pattern with papillary features with glands having irregular luminal borders; high mitotic rate

• Associated with TP53 gene mutation