gynae path - uterus Flashcards
what is the uterus composed of
endometrium
* glands
* stroma
myometrium
what are the indications for uterine biopsies
endometrium
* infertility
* bleeding
* thickened on imaging
uterus/related mass
* lesion on imaging
* as wider part of resection
pathology with the uterine corpus
what are the uterine tumours
- endometrial epithelial tumours and precursors
- tumour like lesions - polyp
- mesenchymal tumours are specific to the uterus
- mixed epitheial and mesenchymal tumours
- miscellaneous
things that predispose/are associated with endometrial hyperplasia
anything with a strong oestrogen drive
perimenopause
persistent anovulation
PCOS
ovarian granulosa cell tumours
oestrogen therapy
atypia
what is endometral hyperplasia
increase in number of glands above the stroma
epi of endometrial cancer
most common gynae malignancy in developed countries
RFs
nulliparity
obesity
DM
excessive oestrogen stimulation
factors that effect Px and plan for therapy for endometrial cancer
histological subtype
tumour grade
tumour stage
lymphovascular space invasion
what are the histological subtypes for endometrial cancer
endometrioid
serous
clear cell
undifferentiated
mixed cell
mesonephric/mesonephric like
squamous cells
mucinous
carcinoma
mutations associated with endometroid ca
mutations associated with clear cell ca
PTEN
CTNNB1
Her-2 amplification
mutations associated with serous carcinoma
p53 in 80%
PI3KCA mutations in 15% Her-2 amplification
features of endometroid carcinoma
oestrogen dependant
associated with atypical endometrial hyperplasia
low grade and high grade tumours
through accumulation of mutations
features of serous and clear cell carcinomas
- older, postmenopausal
- less oestrogen dependent
- happen in atrophic endometrium
- high grade, deeper invasion, higher stage
what are the high grade endometrial cancers
serous
clear cell
mixed
undifferentiated
dedifferentiated
carcinosarcoma
grade of endometrioid carcinoma
using FIGO - grade 1-3 depending on:
* architecture - % of gland formation
* cytological atypia
what factors does the grade of endometrial cancer effect
what are the FIGO stages
‘The cancer genome atlas’ groups for endometrioid endometrial cancer
features of POLE mutant cases of endometrioid endometrial cancer ie ‘The cancer genome atlas’ gp 1
appear to be high grade
however POLE gene mutation -> better Px
important to know to give the right care!
features of ‘The cancer genome atlas’ gp 2 endometrial endometrioid ca
MSI hypermutated
loss of mismatch repair function because mutation in gene for this
genes: MLH1, MSH2, MSH6, PMS2
- mutation/silence of DNA mismatch repair genes by hypermethylation -> microsatellite instability (MSI)
- -> alteration in length of short, repetitive DNA sequences called microsatellites
- -> increase in rate of mutations -> tumorigenesis
rx for group 1 (POLE) and 2 (MSI) endometrioid endometrial cancer
hypersensitive to immune checkpoint inhibitor, anti-PD1 because tumours have:
* high mutation load that -> more neo-antigens
* higher number of tumour infiltrating lymphocytes
features of group 4 ‘the cancer genome atlas’ endometrioid endometrial cancer
serous like
p53 mutations
high copy number alterations
contain mainly serous cells, have some endometrioid cells
mainly grade 3, some 1 and 2
p53 immunohistochem approaches 100% sensitivity as surrogate for detection of mutations
