16. Uterus

Question 1

Why is oestrogen more associated with tumour growth than progesterone?

Answer 1

Oestrogen has more of a proliferative function, whereas progesterone is secretory

Question 2

What are the causes of endometritis?

Answer 2

Acute: delivery and miscarriage
Chronic: IUD, PID, TB

Question 3

What histiologic finding is diagnostic of endometritis?

Answer 3

Plasma cells in endometrium

Question 4

What is endometriosis?

Answer 4

Presence of endometrial tissue anywhere outside of the endometrium

Question 5

What is adenomyosis?

Answer 5

Endometrial tissue within the muscle wall

Question 6

What are common locations of endometriosis?

Answer 6

Ovaries, uterine ligaments but rarely cervix
Peritoneum
Umbilicus
Any abdominal incision

Question 7

What is needed to diagnose endometriosis?

Answer 7

2 of the following on biopsy:
Endometrial stroma
Glands
Haemorrhage/haemosiderin pigment

Question 8

What is the premalignant form of endometrial neoplasia?

Answer 8

Endometrial hyperplasia

Question 9

What are the causes of endometrial hyperplasia?

Answer 9

High oestrogen

PTEN tumour suppressor deletion

Question 10

How are premalignant neoplasms in the endometrium graded?

Answer 10

Architecture (glands): simple vs complex

Atypia: nuclear features

Question 11

What are the primary malignant tumours of the endometrium?

Answer 11

Endometroid adenocarcinoma
Serous carcinoma (looks like tubes)
Mucinous (looks like cervix/GIT)
SCC very rarely

Question 12

What are the risk factors for endometrial malignancy?

Answer 12

Post-menopausal
Tamoxifen
Cancer syndromes eg. Lynch syndrome

Question 13

How are malignancies in the endometrium graded?

Answer 13

Ratio of glands: stroma,

more glands is higher grade

Question 14

What type of architecture is seen in serous carcinomas of the endometrium?

Answer 14

Papillary: epithelial cells growing on a fibrovascular

Question 15

What is the treatment for endometrial malignancy?

Answer 15

Total abdominal hysterectomy and bilateral salphingal hysterectomy (tubes and ovaries often involved)
Lymph nodes
Peritoneal fluid also taken for cytology

Question 16

What is the pathological name for a fibroid?

Answer 16

Myometrial leiomyoma

Question 17

What effect does oestrogen have on fibroids?

Answer 17

Increases size

Rapid increase in pregnancy and shrink post menopause

Question 18

What is the appearance of fibroids?

Answer 18

Round, well circumscribed, white
Can be intramural, submucosal, subserosal
No haemorrhage or necrosis

Question 19

What malignant tumour can be found in the myometrium?

Answer 19

Leiomyosarcoma

Question 20

What are the features of a leiomyosarcoma?

Answer 20

Haemorrhage, necrosis
Intramural
Recur and mets to bones, lung, brain

Question 21

What cancer is associated with Lynch syndrome in the female GU tract?

Answer 21

Endometrial adenocarcinoma

Question 22

What stromal tumours can be found in the uterus, from most benign to most aggressive?

Answer 22

Stromal nodule
Stromal sarcoma (lymph invasion)
Undifferentiated endometrial sarcoma

Question 23

What is the difference between an adenosarcoma and a carcinosarcoma?

Answer 23

Adenosarcoma: benign glands and malignant mesenchyme
Carcinosarcoma: malignant glands and mesenchyme