16. Uterus Flashcards
Why is oestrogen more associated with tumour growth than progesterone?
Oestrogen has more of a proliferative function, whereas progesterone is secretory
What are the causes of endometritis?
Acute: delivery and miscarriage
Chronic: IUD, PID, TB
What histiologic finding is diagnostic of endometritis?
Plasma cells in endometrium
What is endometriosis?
Presence of endometrial tissue anywhere outside of the endometrium
What is adenomyosis?
Endometrial tissue within the muscle wall
What are common locations of endometriosis?
Ovaries, uterine ligaments but rarely cervix
Peritoneum
Umbilicus
Any abdominal incision
What is needed to diagnose endometriosis?
2 of the following on biopsy:
Endometrial stroma
Glands
Haemorrhage/haemosiderin pigment
What is the premalignant form of endometrial neoplasia?
Endometrial hyperplasia
What are the causes of endometrial hyperplasia?
High oestrogen
PTEN tumour suppressor deletion
How are premalignant neoplasms in the endometrium graded?
Architecture (glands): simple vs complex
Atypia: nuclear features
What are the primary malignant tumours of the endometrium?
Endometroid adenocarcinoma
Serous carcinoma (looks like tubes)
Mucinous (looks like cervix/GIT)
SCC very rarely
What are the risk factors for endometrial malignancy?
Post-menopausal
Tamoxifen
Cancer syndromes eg. Lynch syndrome
How are malignancies in the endometrium graded?
Ratio of glands: stroma,
more glands is higher grade
What type of architecture is seen in serous carcinomas of the endometrium?
Papillary: epithelial cells growing on a fibrovascular
What is the treatment for endometrial malignancy?
Total abdominal hysterectomy and bilateral salphingal hysterectomy (tubes and ovaries often involved)
Lymph nodes
Peritoneal fluid also taken for cytology
What is the pathological name for a fibroid?
Myometrial leiomyoma
What effect does oestrogen have on fibroids?
Increases size
Rapid increase in pregnancy and shrink post menopause
What is the appearance of fibroids?
Round, well circumscribed, white
Can be intramural, submucosal, subserosal
No haemorrhage or necrosis
What malignant tumour can be found in the myometrium?
Leiomyosarcoma
What are the features of a leiomyosarcoma?
Haemorrhage, necrosis
Intramural
Recur and mets to bones, lung, brain
What cancer is associated with Lynch syndrome in the female GU tract?
Endometrial adenocarcinoma
What stromal tumours can be found in the uterus, from most benign to most aggressive?
Stromal nodule Stromal sarcoma (lymph invasion) Undifferentiated endometrial sarcoma
What is the difference between an adenosarcoma and a carcinosarcoma?
Adenosarcoma: benign glands and malignant mesenchyme
Carcinosarcoma: malignant glands and mesenchyme
