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Serous endometrial intra-epithelial carcinoma: an observational study
  1. Ciska Slaager1,2,
  2. Ward Hofhuis1,
  3. Klaas J Hoogduin3,
  4. Patricia C Ewing-Graham4 and
  5. Heleen J van Beekhuizen2,5
  1. 1 Department of Gynecology, Franciscus Gasthuis en Vlietland, Rotterdam, The Netherlands
  2. 2 Department of Gynecology, Erasmus Medical Center, Rotterdam, The Netherlands
  3. 3 Department of Pathology, Pathan B.V, Franciscus Gasthuis en Vlietland, Rotterdam, The Netherlands
  4. 4 Department of Pathology, Erasmus MC, Rotterdam, Zuid-Holland, The Netherlands
  5. 5 Erasmus MC Cancer Institute, Rotterdam, The Netherlands
  1. Correspondence to Ciska Slaager, Department of Gynecology, Franciscus Gasthuis en Vlietland, Rotterdam 3045PM, The Netherlands; c.slaager{at}


Background Serous endometrial intra-epithelial carcinoma is described as a malignant, superficial spreading lesion with risk of extra-uterine spread at time of diagnosis, and poor outcome.

Objective To evaluate the surgical management of patients with serous endometrial intra-epithelial carcinoma and its impact on oncologic outcomes and complications.

Methods This Dutch observational retrospective cohort study evaluated all patients diagnosed with pure serous endometrial intra-epithelial carcinoma in the Netherlands, between January 2012 and July 2020. The pathological examination was reviewed by two pathologists with expertise in gynecological oncology. Clinical data were obtained when the diagnosis was confirmed. Primary outcome is progression-free survival, secondary outcomes are duration of follow-up, adverse events related to surgery, and overall survival.

Results A total of 23 patients from 13 medical centers were included, of whom 15 (65.2%) presented with post-menopausal blood loss. In 17 patients (73.9%) the intra-epithelial lesion was present in an endometrial polyp. All patients underwent hysterectomy, of whom 12 patients (52.2%) were surgically staged. None of the staged patients showed extra-uterine disease. Two patients received adjuvant brachytherapy. There were no recurrences of disease (median follow-up duration of 35.6 months (range 1.0–108.6) and no disease-related deaths in this cohort.

Conclusion In patients with serous endometrial intra-epithelial carcinoma, median progression-free survival reached nearly 3 years and no recurrences have been reported. Our results do not endorse World Health Organization 2014 advice to treat serous endometrial intra-epithelial carcinoma as high-grade, high-risk endometrial carcinoma. Full surgical staging might possibly lead to overtreatment.

  • gynecologic surgical procedures
  • pathology
  • endometrial neoplasms

Data availability statement

Data are available upon reasonable request. All data are available when requested for; available throught contacting the first author.

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Data availability statement

Data are available upon reasonable request. All data are available when requested for; available throught contacting the first author.

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  • Contributors CS, HJvB, WH, and KJH were involved in the conception and design of the study. Data retrieval was coordinated by CS. Pathological examination was revised by KJH and PCE-G together with CS. Analysis was conducted by CS. The manuscript was drafted by CS. HJvB, WH, PCE-G, and KJH contributed to the interpretation of the analysis and writing of the manuscript. CS is the guarantor of this study. All authors approved the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.