Endometrium

Question 1

What are the three types of endometriosis?

Answer 1

Superficial peritoneal endometriosis
Ovarian endometriosis
Deep infiltrating endometriosis - rarely undergoes malignant transformation

First 2 uncommonly assoc with malignancy

Question 2

Increased production of estrogen and retinoic acid by endometriotic stromal cells is due to this enzyme in the stroma

Answer 2

Aromatase

Question 3

This is the likely precursor to endometriosis related ovarian carcinoma

Answer 3

Atypical endometriosis

Question 4

True or false: polyps are responsive to estrogen, but show little or no response to progesterone

Answer 4

True

Question 5

This tumor suppressor gene can be found mutated in both endometrial hyperplasia and endometrial endometrioid carcinoma

Answer 5

PTEN

Question 6

This is the most common invasive cancer of the female, genital tract

Answer 6

Endometrial carcinoma

Question 7

Which signaling pathway is most affected in endometrioid carcinoma? Through mutations in what genes?

Answer 7

PI3K/AKT pathway
1. PTEN
2. PIK3CA
3. KRAS
4. ARID1A

Question 8

True or false: the mutations found in carcinosarcomas involve the same genes that are mutated in endometrial carcinoma, whereas alterations typical of sarcomas or absent, suggesting that these tumors or carcinoma’s that have acquired the capacity for a mesenchymal differentiation

Answer 8

True

Question 9

Where do paratubal cyst and hydatids of morgagni arise from

Answer 9

Mullerian duct remnants

Question 10

Endometrial stromal nodule
Criteria
Molecular
Ihc

Answer 10

Finger like projections should be less than three in number and less than 3 mm in their maximum extension
- JAZF1-JJAZ1
+ CD10
- caldesmon

Question 11

Low grade endometrial, stromal, sarcoma (LG ESS)
Morpho
Mutation

Answer 11

With tongue like growth
JAZF1– SUZ12
+ ER, PR, CD10, beta catenin

Question 12

HG ESS
IHC
molecular

Answer 12

• er, pr, CD10
  + cyclin D1, CD117
  YWHAE-NUTM2

Question 13

Uterine tumor resembling ovarian sex cord tumor (UTROSCT)
Morpho
Behavior
Ihc

Answer 13

Well, circumscribed neoplasm, resembling ovarian sex cord tumor without endometrial stroma component
Benign
NCOA2/3 translocations
+ WT-1
+/- inhibin, calretinin and melanA

Question 14

Perivascular epithelioid cell tumor (PECOMA)
Features to evaluate malignancy

Answer 14

Greater than or equal to 5 cm
HG atypia
>1mitosis/50 hpfs
Necrosis
Lymphovascular invasion

Less than three = benign or uncertain malignant potential
More than or equal to three = malignant

Question 15

Atypical polypoid adenomyoma (APA)
Most common location
Molecular
IHC
Prognosis

Answer 15

Lower uterine segment
MLH – 1 promoter methylation
Fibromuscular stroma is p16 positive versus desmoplastic stroma of invasive carcinoma, which is P 16 negative
May progress to EIN or adenocarcinoma

Question 16

mixed epithelial and mesenchymal tumor with a benign epithelial component and trauma is low grade malignant, which looks like phyllodes tumor

Answer 16

Adenosarcoma

Question 17

Stains for cervical vs endometrial carcinoma

Answer 17

EM- ER and vimentin
C - p16 and CEA

Question 18

Ihc of EM vs cervical stroma

Answer 18

EM - CD10 dominant
Cervix - CD34 dominant

Question 19

True or false: monodermal or specialized teratoma are always unilateral

Answer 19

True

Struma ovarii
Carcinoid
Strumal carcinoid = mixed