Endometrial cancer differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Qurrat-ul-ain Abid, M.D.[2]; Monalisa Dmello, M.B,B.S., M.D. [3]Roukoz A. Karam, M.D.[4]


In early stages endometrial cancer must be differentiated from diseases that cause abnormal uterine bleeding and endometrial thickening on ultrasound, such as endometrial hyperplasia, endometrial polyp, and submucosal uterine leiomyoma. In advanced stages endometrial cancer must be differentiated from uterine sarcoma and uterine lymphoma.

Differentiating Endometrial Cancer From Other Diseases

Diseases Clinical manifestations Para-clinical findings Gold standard
Symptoms Physical examination
Lab Findings Imaging Pap Smear Histopathology
Bleeding Pelvic Pain/pressure/


Other Abdomino-pelvic examination Hb B-HCG CA-125 Ultrasound MRI
Endometrial cancer[2][3][4][5] ± +
  • Atypical glandular cells
Endometrial malignant cells
  • Low grade Type I
  • High grade Type II


± +
  • Shows details of uterine mass boundaries, extent and spread
  • Negative
Diseases Bleeding Pelvic Pain/pressure/


Other Pelvic examination Hb B-HCG CA-125 Ultrasound MRI Pap Smear Histopathology Gold standard
Uterine leiomyoma[10][11][12] + ↓ or Nl
  • Hypoechoic, well-circumscribed round masses
  • Location of fibroid: Submucosal, intramural, subserosal, and cervical fibroids
  • Normal
  • Imaging and histologic analysis
Uterine carcinosarcomas (Malignant mixed mullerian tumour (MMMT) of the uterus)[13][14][15][16] ± +
  • Heterogenous bulky polypoid mass with intense enhancement
  • Biphasic:
Cervical cancer[17][18] ±

Pressure-related bowel and bladder symptoms

  • To evaluate tumor size, extent and parametrial invasion
  • Usually not needed for diagnosis
  • To evaluate tumor size, local extent and staging
  • Low-grade squamous intraepithelial lesions (LSILs)
  • High-grade squamous intraepithelial lesions (HSILs)
  • Atypical glandular cells (AGC)
  • Endocervical adenocarcinoma in situ (AIS)
Diseases Bleeding Pelvic Pain/pressure/


Other Pelvic examination Hb B-HCG CA-125 Ultrasound MRI Pap Smear Histopathology Gold standard
Metastasis ±
  • Not recommended
  • It may show the malignant cells of the primary site
Endometrial polyp[19][20]
  • Asymptomatic
  • Endometrial polyp prolapses (visible on speculum examination protruding through cervical os)
  • Normal sized uterus with smooth surface
+ or Nl
  • MRI will show polyp size and dimension in detail
  • Not required for diagnosis
  • Normal
Endometrial hyperplasia[21][22][23][24]
  • Asymptomatic
  • Determines endometrial thickness
  • Rules out other abnormalities
  • Non-neoplastic changes:
  • Disordered endometrial growth
  • Benign hyperplasia
  • Simple hyperplasia
  • Complex hyperplasia without atypia
  • Precancerous changes:
  • Endometrial intraepithelial neoplasms
  • Atypical complex hyperplasia
Uterine adenomyosis[25][26][27] ±
  • Diffusely enlarged tender boggy uterus with smooth surface
  • Uterus may develop masses
Diseases Bleeding Pelvic Pain/pressure/


Other Pelvic examination Hb B-HCG CA-125 Ultrasound MRI Pap Smear Histopathology Gold standard
Hematometra (blood within the uterine cavity)



Cramping cyclic pain

  • Not required
  • Normal
  • Biopsy is not required for diagnosis
Gestational trophoblastic disease[30][31] + ± +
  • Dilated grape like structures
  • Diffuse hydropic swelling
  • Multiples echoes
  • Cystic spaces invading edometrium and myometrium (in case of invasive disease)
  • MRI defines the extent of primary lesion, invasion and distant metastasis
  • Trophoblastic cells
  • Dilated grape like villous structures
  • Invasive malignant lesions
  • Imaging
  • Histologic diagnosis
Incomplete abortion + N/↓ ± +↓
  • Not required for the diagnosis
  • Not required for the diagnosis
  • Imaging
  • Histologic diagnosis
  • Absent menstrual cycle
  • May have intermenstrual bleeding
+ +
  • Normal or may show cervical cells
Uterine lymphoma[1][32][33][34] + - -
Diseases Bleeding Pelvic Pain/pressure/


Other Pelvic examination Hb B-HCG CA-125 Ultrasound MRI Pap Smear Histopathology Gold standard


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