Gynaecology: Uterus, Endometrium Flashcards
What is the myometrium?
Thick wall of smooth muscle surrounding endometrium
Histology: Endometrial glands in endometrial stroma
Endometrium
Another name for leiomyomas?
Benign uterine fibroids
WHere do fibroids/leiomyomas occur?
Myometrium
How many women have fibroids?
Very common, up to 50% have them in reproductive years. Decrease in size after menopause
Symptoms of uterine fibroids? (5)
Abnormal bleeding
Pressure symptoms eg backache/Urinary frequency
Pelvic pain
Abdo. mass
Can be asymptomatic
Where is submucosal fibroid?
Just below endometrium, can project into cavity
Where is intramural fibroid?
In the middle of myometrium
Where is subserosal myometrium?
Just under external surface of uterus, can project into pelvic or abdo. cavity
Gross pathology of uterus: Multiple circumscribed lesions with characteristic white colour and very firm
BENIGN fibroids
Histology of fibroids?
Normal histology of myometrium»_space; bland spindle shaped cells with surrounding eosinophillic cytoplasm. No mitotic figures or pleomorphism
What is adenomyosis?
Benign condition, symptoms include abnormal bleeding
Glands of endometrium and stroma have spread down to myometrium
Difference between simple and complex endometrial hyperplasia?
Simple: ratio of glands and stroma is equal
Complx: More glands than stroma
What is atypical endometrial hyperplasia?
Nuclear atypia is present. Pre-cancerous.
How many of atypical hyperplasias progress to cancer?
around 40%
How does endometrial hyperplasia present?
Abnormal uterine bleeding
Tx of atypical endometrial hyperplasia
Hormones or hysterectomy
Typical endometrial hyperplasias rarely progress
What is the most common gynacological malignancy? Endometrial/cervical/vulval?
Endometrial cancer
When does endometrial cancer most often occur?
Post menopausal, peak age 50-70
Symptoms of endometrial cancer
Post menopausal bleeding
Associations with endometrial cancer? (7)
- Obesity
- Hypertension
- Diabetes
- Tamoxifen
- ENdogenous oestrogens eg PCOS, secretory ovarian tumours
- EXogenous unapposed orestrogens (this is why oestrogen is not given as hormone replacement)
-SYndromes eg HNPCC
Which genetic bowel related cancer is associated with endometrial cancer?
Hereditary non-polyposis colorectal cancer (genetic)
Two types of endometrial cancer?
Type 1 and 2
Which is the most common overall type of endometrial cancer?
Type 1 (85%)
Most common type 1 endometrial ca?
ENDOMETROID CARCINOMA
Differences between type 1 and type 2 endometrial cancers? (most common type, most common cancer, estrogen link, HER, differentiation, stage, prognosis)
Most common: Type 1 (85%)
Most common cancer: Type 1 endometroid carcinoma, type 2 serous carcinoma
Oestrogen link: Type 1 has association
HER: type 1 is +, Type 2 is -
Stage: Type 2 more aggressive and advanced
Prognosis: Type 2 worse prognosis
What does type 2 endometrial cancer stain with in IHC staining?
p53 (tumour suppressor gene mutation)
Gross appearance: Bulky tumour extending deep into myometrium
Endometrial cancer
Prognostic factors for endometrial cancer
- Type 2 worse than type 1
- Tumour grade (for type 1 endometroid)
- Depth of myometrial invasion
- Cervical involvement
- Lymphovascular permeation
- Peritoneal washings (tumour cells in peritoneum)
- Lymph nodes
When are endometrial cancers staged?
On pathology post operatively
Stage 1 endometrial cancer
Confined to uterine body or corpus
Stage 2 endometrial cancer
Spread to cervix
Stage 3 endometrial cancer
Spread to ovaries, fallopian tubes, or found in peritoneal washing
Stage 4 endometrial cancer
Metastasis
Tx of endometrial cancer?
Total abdominal hysterectomy, removal of both ovaries and fallopian tubes
Peritoneal washings
Adjuvant chemo or radiotherapy depending on stage, type etc.
What is a leiomyosarcoma?
A malignant tumour arising from myometrium
High grade
What is an endometrial stromal sarcoma? (ESS)
Malignant stromal endometrial tumour
Low grade
What is a carcinosarcoma/malignant mixed Mullerian tumour (MMMT)?
A very aggressive tumour with both sarcoma and carcinomatous elements
Difference between histology of leiomyoma and leiomyosarcoma histology?
Leiomyosarcoma has lots of nuclear pleomorphism and mitotic figures
