Female repro L6: Tumours Flashcards
Uterine Fibroid: Classification
- Submucous
- Intramural or interstitial
- Subserous
- Parasitic
- Intraligamentary
- Cervical fibroid
Uterine Fibroid: Pathology
- Multiple, discrete spherical or irregularly lobulated
- A thin pseudocapsule demarcates each fibroid
- – Composed of areolar tissue and compressed muscle fibers
- Buff-colored (pale yellow-brown color), rounded, smooth and firm on cut section
Microscopic findings
– Interlocking bundles of non-striated muscle fibers (whorled appearance)
– Individual cells are spindle-shaped, uniform in size and have elongated nuclei
– Varying amounts of connective tissue intermixed with smooth muscle layers
– Generally sparse vascularization
Etiology: unknown
Uterine leiomyoma are monoclonal tumors
– Evidence from G6PD studies reveal that each leiomyoma is unicellular in origin
Genetic factors have been elucidated
– Chromosomal abnormalities in 50% of cases
– Mutations in MED12 (TF) gene documented in 70% of fibroids
Uterine Fibroid: Degenerative changes
BENIGN DEGENERATION
- Hyaline degeneration
- – White with yellow, soft, and often gelatinous areas
- Cystic degeneration
- – Liquefaction following extreme hyalinization
- – Spontaneous evacuation of the cyst occasionally
- Carneous (red) degeneration
- – Commoner in pregnancy (occasionally during OCP treatment)
- – Self-limited pain, tenderness and mild fever
- – Beefy-red appearance due to venous thrombosis leading to congestion
- – Infarction and aseptic degeneration
- – Potential complications include preterm labor and rarely DIC
- Myxomatous (fatty) degeneration
- – Uncommon
- – Follow hyaline and cystic degeneration
- Septic degeneration
- – Circulatory inadequacy
- – Necrosis of central part of tumor
- – Superimposed infection
- – Acute pain, tenderness and fever
- Parasitic myoma
- Calcific degeneration
- – Most common in subserous tumors
- – Circulatory deprivation
- – Precipitation of calcium and phosphate within the tumor
- Atrophic degeneration
- – Symptoms and signs regress or disappear
- – Occurs at menopause or after pregnancy
BENIGN METASTASIZING LEIOMYOMA (CELLULAR MYOMA)
- Disseminated spread of myomas to distant locations
- – Peritoneum
- – Lungs
- – Distantvasculature
- Histological appearance is benign and mitotic rate is low
- Most cases follow a procedure - D & C, myomectomy and
- hysterectomy
- Often asymptomatic
- A theory of multifocal origin from smooth muscle in blood vessels anywhere in the body is also considered
SARCOMATOUS CHANGE
- Rare, seen in 1: 1000 of myomas
- Ultrastructural studies show that leiomyosarcoma is distinct from leiomyoma
Uterine Fibroid: Rare presentations
Polycythemia
– Autonomous erythropoietin production or
– Associated with ureteral obstruction • Hypercalcemia
– Elaboration of PTHrP
Hyperprolactinemia
– Ectopic production of prolactin
Pseudomeig phenomenon: Ascites
– Pedunculated or parasitic fibroid
– Elevated serum CA-125 levels
Uterine Artery Embolization (UAE)
- A non-surgical treatment option for symptomatic fibroid
- Advantages include shortened hospital stay, cheaper and fewer complications
- Performed by an interventional radiologist
- Access is gained through the common femoral artery for embolization of contralateral side
Contraindications: Absolute
- Pregnancy
- Active genitourinary infection
- Malignancy
- Significant immunosuppression
- Severe vascular disease
- Contrast media allergy
Contraindications: Relative
- Postmenopausal
- Current use of GnRH agonists
- Submucosal fibroid
- Extensive adenomyosis
- Previous internal iliac artery ligation
- Pedunculated fibroid
Risk Factors for Endometrial Cancer (RR)
- LONG-TERM EXPOSURE TO EXCESS ESTROGEN
- GENETIC SYNDROMES: HNPCC, Lynch, PTEN
- Nulliparity/Infertility
- Diabetes (RR 2)
- Hypertension
- Breast cancer
Endometrial Cancer
Histological Types: TYPE 1 TUMORS (80% )
- Endometroid adenocarcinoma
- Associated with unopposed estrogen exposure
- Favorable prognosis
- May be preceded by an intraepithelial neoplasm – Atypical and/or complex endometrial hyperplasia
Pathogenesis
Endometroid is associated with
- – Unopposed estrogen
- – Endometrial hyperplasia
- – A younger age at occurrence
Resemble proliferative endometrium more than secretory
Common genetic abnormalities identified in both endometrial hyperplasia and endometroid cancer include
- – Microsatellite instability
- – K-ras mutation
- – PTEN mutation or deletion
- – Defects in DNA mismatch
Sx
- Abnormal uterine bleeding
- Lower abdominal cramps
- Normal uterine size in early stage of disease – Endometrial thickness >5mm
- Uterine enlargement
- Fixed immobile uterus (parametrial extension)
- Enlarged ovaries (metastasis or rarely a co- existing tumor)
DISORDERS OF THE UTERINE CERVIX
- Benign cervical lesions
- Squamous Intraepithelial Neoplasia
- Invasive Cervical Cancer
BENIGN CERVICAL LESIONS
Nabothiancyst
- – An inclusion cyst of the transformation zone
- – Mucous glands of columnar epithelium covered by mataplastic squamous epithelium
- – No treatment required
Endocervical polyps
- Finger-like growth from cervical canal
- Short thick or long thin stalk
Symptoms and signs
- Abnormal vaginal bleeding
- Mucous discharge
SQUAMOUS INTRAEPITHELIAL LESIONS
- Describe findings on cytological smears
- Classified according to the Bathesda system (2001 revision)
– Atypical squamous cells (ASC)
- Undetermined significance (ASC-US)
- High-grade lesion can not be excluded (ASC-H)
– Low-grade squamous intraepithelial lesion (LSIL): Koilocytic atypia and CIN I
– High-grade squamous intraepithelial lesion (HSIL): CIN II, CIN III, CIS
Cervical Cancer: Pathology
- Squamous cell carcinoma: Exophytic, fungating tumor
- Adenocarcinoma: Endophytic tumor; barrel-shaped cervix
- Vagina and portio vaginalis of the cervix are lined by squamous epithelium before puberty
- Original squamo-columnar (SCJ) is at the external os
- Estrogen-inducedoutgrowthofendocervical columnar epithelium occurs during puberty
- New (active) SCJ formed just lateral to the external os
- Transformation zone (TZ) is the portion of the cervix between the new and original SCJ
- Cytologic instability at the TZ increases susceptibility to HPV infection
- Virions gain access to the transformation zone through minor abrasions
Ovarian Tumors: Functional
- Functional Ovarian Tumors: All benign
- Usually asymptomatic
- Slowly growing
- Presentation is usually for complications – Rupture, torsion, bleeding into a cyst
- Pain begins in iliac fossa and radiates to the flanks
- Cysts arise from invaginated epithelial surface
Ovarian Tumors: Germ cell Tumours
Germ - Cell Tumors: 2-3% of all ovarian tumors
Ovarian Tumors: Epithelial Ovarian Tumours
0-85% of ovarian tumors; Mesothelial cells derivatives; Tumor marker – CA-125
