Epidemiological and Histopathological Characterization of Endometrial Carcinoma: A Retrospective Cohort from Romania

<b>Background/Objectives</b>: Endometrial carcinoma is an emerging challenge for public health systems globally, especially in countries with a high development index. Traditionally, histopathological staging and grading have been the main criteria informing treatment modalities. More recently, clinically actionable molecular targets have been developed, following observations from the TCGA project and the ProMisE cohort. Although promising, the cost of these methods is an obstacle for some countries that lack well developed theranostics infrastructure in their public systems. This study aimed to contextualize our center's diagnostic experience from the perspective of histopathological diagnosis. <b>Methods</b>: This is a retrospective study that selected 109 cases of already diagnosed endometrial carcinoma from the interval of 2017-2023. We analyzed traditional parameters related to staging and grading, using the FIGO 2009 system as well as basic histological parameters (lymphovascular invasion, perineural invasion, necrosis). Excel and SPSS 26 were used for database management and correlations. Findings were contextualized using the more recent studies that reported on similar parameters. <b>Results</b>: Higher-grade tumors were associated with lymphovascular invasion (<i>p</i> = 0.04) and lymph node involvement (<i>p</i> = 0.0006), as well as deeper myoinvasion (<i>p</i> = 0.0018). Myoinvasion (<i>p</i> = 0.013) and lymphovascular invasion (<i>p</i> = 0.0001) were associated with advanced disease (FIGO III and IV). Our cohort showed a relative paucity (6.5%) of non-endometrioid endometrial carcinoma and presence of lymphovascular invasion (9.2%). Perineural invasion was found in 3 cases with extrauterine involvement. <b>Conclusions</b>: Histopathological diagnosis represents an integral component in informing clinical management for endometrial carcinoma and should serve as a means of triage for more expensive molecular techniques. It nevertheless presents reproducibility issues. Further efforts should focus on resolving such issues or possibly introducing less-researched parameters like perineural invasion.