Minor serous or clear-cell components in early-stage endometrioid adenocarcinoma: is it ever insignificant?

Evaluation of: Quddus MR, Sung CJ, Zhang C, Lawrence WD. Minor serous and clear cell components adversely affect prognosis in ‘mixed-type’ endometrial carcinomas: a clinicopathologic study of 36 stage-I cases. Reprod. Sci. 17(7), 673–678 (2010).Endometrioid adenocarcinomas of the endometrium occasionally display a small proportion of serous or clear-cell adenocarcinoma, two of the high-grade histotypes. Since the adjuvant management for patients with low-grade, early-stage endometrioid adenocarcinoma is so different from the management of their counterparts with the serous or clear histotypes, this situation poses a significant conundrum. The article under evaluation compared the overall survival between patients with stage I endometrioid adenocarcinomas with a minor serous or clear-cell component, and an age- and stage-matched control group comprised of pure endometrioid, clear-cell and serous adenocarcinomas. Preliminary analyses suggest that these minor components, even in small proportions, may adversely impact the overall survival of patients with low-grade, stage I endometrioid adenocarcinoma, but a larger scale analysis that would allow for the accrual of sufficient patients to achieve statistical power is required.