Gyn Path 2 & Cervical Cancer CPC Flashcards
What is cause of endometrial hyperplasia?
Unopposed estrogen
What is clinical presentation of endometrial hyperplasia? When does it typically present?
Presents with abnormal bleeding during perimenopausal years
What are risk factors for endometrial hyperplasia? Big list
Tamxoifen, ovarian lesions (PCOS), obesity, HTN, diabetes, nulliparity, early age menarche, late menopause, cigarette smoking
What are protective factors for endometrial hyperlasia? (4)
Progesterone: large number of births, old age at first birth, long birth period, short premenopausal delivery-free period
What is gross appearance of endometrial hyperplasia?
Fleshy diffuse endometrium processes
What are histological features of hyperplasia (general)?
Increase in glands
Irregularities in gland shape and size
Mitotic activity
What are classifications of endometrial hyperplasia? What is risk for each for transformation?
Simple without atypia=1%
Complex without atypic=8%
Simple with atypia=3%
Complex with atypia=29%
What makes hyperplasia complex?
Amount of stroma, complexity of glands
Describe histological changes for:
- Simple hyperplasia without atypia
- Complex hyperplasia without atypia
- Complex hyperplasia with atypia
Simple/no atypia: more glands and they are of variable size…but nuclei are normal
Complex/no atypia: increased glands that are branching, decreased stroma but nuclei are still normal
Complex/atypia: Lots of glands, branching, little stroma, nuclei are large, speckled with prominent nucleoli
What is risk of cancer if hysterectomy performed immediately after diagnosis of hyperplasia?
Does not change! May be due to undetected carcinoma when hysterectomy performed
How do you distinguish endometrial hyperplasia from carcinoma? (4)
Myometrial invasion
Desmoplastic response: more fibrotic infiltrate of glands
Cribriform blands–confluent glands
Extensive papillary pattern
What is most common malignant tumor of female genital tract? What are risk factors?
Endometrial carcinoma– the risk factors are the same as for endometrial hyperplasia
What is the breakdown of type 1 vs. type 2 endometrial carcinomas?
Type 1: 80%
Type 2: 20%
What are the differences between type I and type II endometrial carcinoma?
Grade, Indolent vs. aggressive PTEN/K-Ras/MSI vs. P53 Cell type Precursor: hyperplasia vs. intraepithelial carcinoma Estrogen dependence Pre/perimenopausal vs. postmenopausal
What is the gross appearance of Endometrial carcinoma?
Polypoid, invasion of myometrium
Describe the histological appearance of type I endometrial carcinoma
Confluent proliferation of glandular epithelium
Increased nuclei size, decreased stroma, mitoses, branching, chromatin
Describe the histological appearance of serous type II endometrial carcinoma: glands and cells
Complex papillae or irregular gaping glands
Cells: nuclear atypic, macronuclei, abnormal mitoses, psammoma bodies (calcifications)
How can you detect type II endometrial carcinoma using IHC?
Stain for p53 to detect intraepithelial carcinoma
Describe the histological appearance of clear cell type II carcinoma
Clear vacuolated cytoplasm
Markedly atypical nuclei
How is endometrial carcinoma staged?
I: confined to uterus (endometrium, less than half of myometrium, more than half)
II: cervical involvement
III: serosa, adnexa, vaginal/pelvic lymph nodes
IV: bowel/bladder/distant
What is the prognosis for endometrial cancer? Is it worse for any specific group?
Overall: 75-80%
Localized: 90% survival
Prognosis is significantly worse for african americans
What are the types of cervical cancer? What is their frequency?
80% squamous
15% adenocarcinoma
5% other
What are symptoms/signs of cervical cancer? (2)
Abnormal vaginal bleeding
Post-coital bleeding
What are risk factors for cervical cancer? (5)
HPV infection (16/18) Multiple sexual partners Cigarette smoking Early sex Immunosuppression
