To the Editor:
I read with interest the study by Murray et al. on unusual epithelial and stromal changes in endometrioid carcinoma (1). These authors cite my publication (2) on diffusely infiltrating adenocarcinoma of the endometrium as an example of a morphologic type with no stromal reaction. However, we noted a stromal reaction in many of these cases as indicated in the following quote from our article: “An interesting feature seen in three of the five cases with diffuse infiltrating pattern of growth was the presence of neutrophils and eosinophils in and around the infiltrating tumor glands. Another feature of interest was the presence of lymphocytic infiltrate around tumor glands. This infiltrate was marked in two cases, but it was found at least focally in all cases with a diffuse infiltrating pattern of growth.” The tumors examined by Longacre and Hendrickson in a follow-up study (3) differed from those reported by us, as minimal or absent stromal or inflammatory cell response was a selection criterion for that study.
Khush Mittal, MD
1. Murray SK, Young RH, Scully RE. Unusual epithelial and stromal changes in myoinvasive endometrioid adenocarcinoma: a study of their frequency, associated diagnostic problems, and prognostic significance. Int J Gynecol Pathol 2003; 22:324–33.
2. Mittal KR, Barwick KW. Diffusely infiltrating adenocarcinoma of the endometrium. A subtype with poor prognosis. Am J Surg Pathol 1988; 12:754–8.
3. Longacre TA, Hendrickson MR. Diffusely infiltrative endometrial adenocarcinoma: an adenoma malignum pattern of myoinvasion. Am J Surg Pathol 1999; 23:69–78.