216. Pathology of Uterus, Endometrium Flashcards
Anovulatory Cycles
- what is it
- histo
Most frequent cause of dysfx uterine bleeding
due to hormonal imbalances (menarche, perimp), endo disorders, ovarian lesions (Tumors, PCOS), metabolic disturbance
Histo: proliferative glands WITH stromal breakdown (dyssynchronization, no P to cause secretory differentiation)
Chronic Endometritis
- cause
- histo
Cause: PID, retained POC, IUD, TB, other infection (ascending bacterial)
Histo: stromal change (spindling), plasma cells (eccentric nuclei with clockface chromatin and perinuclear hof-clearing)
Endometrial Polyps
- what are they
- CP
- histo
exophytic masses protruding into endometrial cavity
CP: asx or cause bleeding
Histo: epithelium on 3 sides, prominent blood vessels, fibrotic stroma, dilated/irregularly shaped glands
Adenomyosis
- what is it
- prevalence
- CP
Endometrial glands/stroma within myometrium (like endometriosis but confined to myometrium)
Seen in up to 20% uteri
CP: menometrorrhagia, dysmenorrhea, dyspareunia, pelvic pain, asx
Endometriosis
- what is it
- common sites
- CP
- histo
- gross
- theories of pgen (4)
“Ectopic” endometrial tissue outside uterus
Sites: ovary, pelvis, bowel
Sx: infertility, dysmenorrhea, pelvic pain
Histo: 2/3 of endometrial glands, endometrial stroma, evidence of hemorrhage (hemosiderin-laden macrophages)
Gross: Chocolate cysts
Pgen:
- Regurgitation: retrograde menstruation (occurs in unaffected women)
- Benign metaplastic theory (lymph/vascular spread)
- Metaplastic theory: metaplasia of peritoneum
- Extrauterine stem/progenitor cell theory - stem cells from bone marrow migrate to other areas and differentate
Endometrial hyperplasia
- what is it, assoc, genes
- classification and features of each class
Precursor to most common type of endometrial Ca
- high gland-to-stroma ratio (>1:1)
- assoc with prolonged E stim without P
- > 20% have inactivation of PTEN tumor suppressor gene
Hyperplasia without atypia: glandular crowding (irregular shape and size), glands may be back to back but still with intervening stroma, NO nuclear atypia, only 1-3% get atypic
Atypical Hyperplasia: glandular crowding and irregularity, nuclear atypia (prominent nucleolus), 23-48% have carcinoma at hysterectomy
tx: hysterectomy or P tx (maintain fertility)
Type 1 Endometrial Carcinoma
- name
- demographic
- RF, precursor
- genes
- behavior
- Grading structure
- Histo/Gross
Endometrioid Carcinoma
- early age 55-65 yo
- RF: unopposed E, obesity, DM
- precursor: endometrial hyperplasia
- genes: PTEN!!!, ARID1alpha, PIK3CA, KRAS
- behavior: more indolent, lymphatic spread
- Grading: 1,2,3 depending on solid growth
Gross: exophytic or endophytic masses, with or w/o myometrial invasion
Histo: complex fused glands replacing normal endometrium, superficial invasion into myometrium, fused glands with no stroma (CRIBIFORMING), if FIGO grade 2/3: solid nests with NO gland spaces!
Type 2 Endometrial Carcinoma
- name
- demographic
- RF, precursor
- genes
- behavior
- grading structure
- Histo/Gross
Serous Carcinoma
- late age: 65-75yo
- RF: endometrial ATROPHY (always presents on background of atrophy)
- precursor: endometrial intraepithelial carcinoma (EIC)
- genes: p53!!!!, aneuploidy
- most commonly high grade, aggressive spread
- tumor cells can detach travel thru fallopian tubes and implant on peritoneal surfaces
Histo: papillary (fibrovascular core lined by tumor cell projections) or glandular growth patterns with MARKED NUCLEAR ATYPIA (high N:C, large dark nuclei with prominent nucleoli, numerous atypical mitoses)
Carcinosarcoma of Endometrium
- what is it
- gross
- histo
What is the tx for all endometrial carcinoma?
Carcinoma: high grade, often serous
Sarcoma: homologous (smooth m; endometrial stroma; normal native tissue proliferation) or heterologous (cartilage, skeltal m., bone, nonnative tissue)
Gross: large polypoid tumors
Histo: malignant glands (carcinoma) + malignant stroma (sarcoma) with weird mitoses
Tx: hysterectomy +/- radiation +/- chemotherapy
may give P therapy to young women FIGO 1 to get pregnant
Endometrial Stromal Tumors
- nodule: gross, gene, histo
- sarcoma: what is it, gene, histo, behavior
Nodule
- benign neoplasm, well circumscribed
- gene: JAZF1:JJAZ1 fusion protein due to Ch translocation
- Histo: well-circumscribed, normal endometrial stromal tumor cells (small bland ovoid cells with little cytoplasm, small blood vessels)
Sarcoma
- infiltrative growth, usually low grade (tumor cells look normal)
- genes: Same JAZF1:JJAZ1 fusion
- Histo: invasive tumor nests (tongue-like projection into myometrium) with normal endometrial stromal cells
- behavior: recurrence common, late distant mets may occur
Smooth muscle tumors
- Leiomyoma: what is it, sx, genes, gross, histo
- Leiomyosarcoma: what is it, histo, demographics, genetics, behavior
Leiomyoma
- fibroid: benign smooth muscle tumors, may be multiple
- sx: asx, abnormal bleeding, urinary frequency, pelvic pain, infertility
- genes: MED12 (rearrangements of 12q/6p)
- rarely transform to malignant
- gross: well-circumscribed, round mass, variable size, firm rubbery tan-white, whorled cut surface, located anywhere in uterus (submucosal, intramural, subserosal)
Histo: vaguely whorled, smooth muscle bundles at various angles, spindle cells with ovoid nuclei, minimal mitoses/atypia
Leiomyosarcoma
Histo: 2/3 of mitotic activity, tumor necrosis, atypia
- invasive endophytic tumor or polypoid exophytic tumor
- age: 40-60yo
- genetics: complex, variable karyotypes
- behavior: often recur, can mets to lung/bone, low 5yr survival
