female reproductive tract part 4 endometrium cont. Flashcards
what is endometrial hyperplasia?
increase in the number of endometrial glands relative to the stoma
it is a premalignant condition
what are the two types of endometrial hyperplasia?
typical - slight risk to progress to carcinoma
atypical - substantial risk to progress to carcinoma
what does typical endometrial hyperplasia look like?
glandular crowding +/- cystic change with no atypia
glands are more cyctic appearing
what does atypical hyperplasia look like
complex glandular proliferation with nuclear atypia
crowding increases, scant amount of stroma between glands
nuclei show hyperplasia and enlargement
risk factors for endometrial hyperplasia
unapposed estrogen increases risk
-obesity
- PCOS
- estrogen replacement therapy
- tamoxifen therapy
- estrogen producing tumors
- no children
- early period late menopause
unapposed- no progesterone
tamoxifen is proestrogenic in the _ but is antiestrogenic in the _
uterus
breasts (used for breast cancer)
endometrial cancer is most seen in _ (premenopausal/post menopausal) women
postmenopausal
75%
what is the most common symptoms of endometrial cancer
abnormal uterine bleeding
90%
what is the most common type of endometrial carcinoma
endometrial endometroid carcinoma
80-85 % of all endometrial carcinomas
endometrial endometroid carcinoma is driven by the _ pathway
hyperplasia pathway
typical hyperplasia to atypical hyperplasia and finally carcinoma
typical hyperplasia is a mutation in ?
PTEN
atypical hyperplasia is a mutation in ?
KRAS
how does endometriod carcinoma progess (slow, fast)
slow/indolent
serous carcinoma of the uterus is the second most common endometrial carcinoma they arise for then _ pathway and have an increased incidence in _ (race)
atrophic pathway- atrophic noncyclic endometrial tissue
african american (postmenopasual)
15& of all endometrial carcinomas
occur 10 years later than endometroid cancer
pathogenesis of serous carcinoma of the uterus
atrophic endometrium
TP53 aneuploidy
serous endometrial intraepithelial carcinoma
serous carcinoma
what is the main risk factor for serous carcinoma of the uterus?
Age which drives TP53 mutations
histology of a serous carcinoma of the uterus
papillary growth pattern with cytologic atypia
papillary growth has papillary projections with a fibrovascular core
histology of an endometrial endometroid carcinoma
like regular endometrium but very little to know stroma
can form a mass
unlike endometroid carcinoma of the uterus which is graded by the degree of _ , serous carcinomas are uniformly considered _ grade
solid component- endometroid
high grade- serous
what is a malignant mixed mullerian tumor (MMMT)
a rare, aggressive endometrial tumor that is found in african americans in the post menopausal sate
MMMT are comrpised of ?
malignant glands and malignant stroma
the malignant glands can be that of serous type of endometroid type
malignant stroma can be differentiated or diffentiated into things like cartilage, muscle, etc. - heterologous
what does heterologous mean?
this meains that the malignant stroma does not for sarcomatous elements found in other uterine sarcomas (chondrosarcoma, rhabdomyosarcoma)
poor prognositc feature- more aggressive
what are 2 examples of heterologous components in a malignant mixed mullerian tumor
chondrosarcoma (cartilage)
rhabdomyosarcoma (primitive muscle cells usually seen in the embryo)
must have malignant glands and malignant stroma
Lynch syndrome is inheritied in a _ _ fashion
autosomal dominant
what is the mutation in lynch syndrome
mutation in mismatch repair genes (MLH1 and MSH2) leading to microsatillite instability
***cant repair DNA mismatches which occur in repetitive sequences to form microsatilites
the microsatillite instability in lynch syndrome leads to an increased risk for?
colorectal cancers
endometrial (uterine ) and ovarian cancers of the endometroid type
endometroid carcinoma are type _
1
serous and malignant mixed mullerian tumors are type _
2
are the endometrial cancer in lynch syndrome type 1 or type 2
type 1
what is an adenosarcoma
this is a combination tumor of benign endometrial glands and malignant stroma
may be mistaken for a endometrial polyp on histology
what is a low grade endometrial stromal sarcoma
a malignant tumor that is comprised of small blue tumor cells recapitulating normal endometrial stromal cells
low grade endometrial stromal sarcomas invade where?
myometrium and lymph/vascular spaces
symptoms of low grade endometrial stromal sarcoma
abdominal pain, AUB
what is the key chromosomal abnormality associated with low grade endometrial stromal sarcoma
JAZF1 translocation that results in the fusion of SUZ12 gene
what is a leiomyoma?
a fibroid that is a tumor of the myometrium it is benign and is composed of smooth muscle and spindled cells
most common gynecological tumor in women
how do leiomyomas look
singular or more likely to be joined together
circumscribed
whte to white tan whorled sufraces
what does the histology of a leiomyoma look like?
intersecting fasciles of spindled shaped smooth muscle cells with pink eosinophillic cytoplasm
cigar chaped nuceli
common symtpoms of leiomyoma
uterine bleeding and infertility
leiomyomas may have a _ mutation
med 12
a lot of uterine smooth muscle tumors have a med12 mutation
what is a leiomyosarcoma
an uncommon malignant neoplasm of uterine smooth muscle
some leiomyosarcomas have a _ mutation similar to leiomyoma
med 12
usually not a direct progression though
are leiomyosarcomas aggresive?
yes, 50% of them metastasize to the lung, brain, bone etc.
on histology unline leiomyomas: leiomyosarcomas have what?
atypia, mitoses, and tumor necrosis
grossly what does a leiomyosarcoma look like ?
bulky, fleshy mass
