Primary endometrial gastric (gastro-intestinal)-type carcinoma: A practical approach

Pathol Res Pract. 2023 Jan:241:154271. doi: 10.1016/j.prp.2022.154271. Epub 2022 Dec 6.


The latest WHO classification of the female genital tract tumors introduces a new type of carcinoma: the primary gastric-type (or gastro-intestinal type) carcinoma of the endometrium. This type of neoplasm tends to have a poor outcome, making its correct diagnostic important. As little is known about this entity and given its quite challenging diagnosis, we aim to review existing data about it and propose a practical diagnostic approach. There are currently 11 cases published in 8 articles fitting the precise definition of a primary gastric-type carcinoma of the endometrium. Three main differential diagnoses must be excluded before considering this tumor: endometrioid adenocarcinoma with mucinous (Müllerian-type) differentiation, endocervical primary, and gastro-intestinal primary. Morphological aspects of this tumor can be heterogeneous and confusing; in this context, immunochemistry can be helpful to highlight the gastric or intestinal differentiation, but also to eliminate a mucinous endometrioid adenocarcinoma of Müllerian-type, by the constant negativity of estrogen receptors. A metastasis of a primary gastro-intestinal tract carcinoma must also be excluded by clinical, endoscopic and imaging work-up. Finally, an endometrial extension of a primary endocervical gastric-type carcinoma should be ruled out by complete sampling of the cervix. Intestinal type endocervical adenocarcinoma is easier to eliminate since this is an HPV-associated neoplasm.

Keywords: Endometrial; Gastric; Gastro-intestinal; Intestinal; Mucinous.

Publication types

  • Review

MeSH terms

  • Adenocarcinoma* / pathology
  • Biomarkers, Tumor
  • Carcinoma, Endometrioid* / pathology
  • Endometrial Neoplasms* / pathology
  • Endometrium / pathology
  • Female
  • Humans
  • Uterine Cervical Neoplasms* / pathology


  • Biomarkers, Tumor