Endometrial Tumors Flashcards
What is an endometrial polyp?
Benign stromal neoplasm in the endometrial cavity
Where do most endometrial polyps occur?
In the fundus of the uterus
An endometrial polyp is shown. What is typical clinical presentation?
Intermestrual bleeding
What is the cause of benign endometrial hyperplasia?
Abnormal estrogenic stimulation
By what is BEH characterized?
Diffuse, randomly distributed, architectural and cytologic changes
What are the 3 types of Endometrial Hyperplasia? What are the characteristics of each type?
- Simple Hyperplasia - Minimal glandular complexity/crowding and no cytologic atypia
- Complex Hyperplasia - Marked glandular complexity/crowding and no cytologic atypia
- Atypical hyperplasia - Cytologic atypia and marked glandular crowding
What are the two discrete entities of endometrial hyperplasia?
- Benign endometrial hyperplasia
- Endometrial Intraepithelial Neoplasia
What is endometrial intraepithelial neoplasia?
Monoclonal neoplasic growths of genetically altered cells with greatly increased risk of becoming the endometrioid type of endometrial adenocarcinoma
Endometrial Intraepithelial Neoplasia is shown. What are typical findings?
Tight clusters of ctyologically altered neoplastic endometrial glands with abundant cytoplasm and rounded nuclei
How are endometrial carcinoma classified?
Two types:
- Type I tumors (endometrioid carcinoma)
- Type II tumors (Nonendometrioid carcinoma)
Of two endometrial adenocarcinoma, which is more lethal?
Type II tumors (nonendometrioid)
What is the primary genetic driver for type I tumors? Type II tumors?
Usatellite instability; p53 alterations and loss of heterozygosity
What five main molecular alterations play a role in type I endometrial tumorgenesis?
- Usatellite instability
- PTEN (tumor suppressor) mutation
- k-RAS mutation
- Beta-catenin
- PIK3CA mutations
What three molecular changes contribute to type II endometrial tumorgenesis?
- p53 mutations
- Her2/neu amplification
- LOH on several chromosomes
Endometrioid adenocarcinoma is shown. Describe the grading scheme.
Grades 1-3 with 3 being the worst. The greater the solid tumor/glandular tumor ratio, the worse differentiation and the higher the grade
If an endometrioid adenocarcinoma contains squamous elements, what is the Dx?
Endometrioid Adenocarcinoma with squamous differentiation
Which type of endometrioid adenocarcinoma has the best Px? Why?
Endometrioid adenocarcinoma, secretory type; Probably because it is so well differentiated
What types of endometrial adenocarcinoma are associated with estrogen exposure?
Endometrioid, NOT nonendometrioid
Squamous cells are seen within an endometrioid adenocarcinoma. What is the Dx?
Endometrioid Adenocarcinoma with Squamous Differentiation
A Clear cell adenocarcinoma is shown. What do the clear cells contain? What other cells are seen?
Glycogen; Hobnail cells (Bulbous nuclei lining glandular lumina)
Carcinosarcoma is shown. What types of cells are intermingled?
Pleomorphic epithelial cells intermingled with cells of mesenchymal differentiation
What are the two major categories of endometrial stromal sarcoma?
Expansile or infiltrating
What are expansile lesions? What are infiltrating lesions?
Benign stromal nodules; Stromal sarcomas
What markers are used to ID endometrial stromal sarcomas?
CD-10 and Estrogen/Progesterone receptors
Periglandular cuffing by atypical stroma with mitotic activity is shown. Dx?
Uterine Adenosarcoma
What is the most common tumor of the female genital tract?
Leiomyoma
What are leiomyomas?
Benign tumors of smooth muscle origin
Leiomyoma is shown. How is it differentiated from the surrounding myometrium?
Leiomyoma and surrounding myometrium are cytologically identical but leiomyomas are distinguished by their circumscription, nodularity and denser cellularity
What is Intravenous Leiomyomatosis? What is the Px if it metastasizes?
Benign smooth muscle grows w/i uterine and pelvic veins; it does not metastasize
What is Leiomyosarcoma? How does it compare to Leiomyoma?
Malignancy of smooth muscle; Much less common than leiomyoma
Leiomyosarcoma is shown. What are typical findings that lead to Dx?
- Gross: Soft, necrotic
- Histo: Geographical necrosis, > 10 mitoses/HPF, nuclear atypia
