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SBCP Pathology > Gynaecology: Uterus, Endometrium > Flashcards

Gynaecology: Uterus, Endometrium Flashcards

1
Q

What is the myometrium?

A

Thick wall of smooth muscle surrounding endometrium

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2
Q

Histology: Endometrial glands in endometrial stroma

A

Endometrium

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3
Q

Another name for leiomyomas?

A

Benign uterine fibroids

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4
Q

WHere do fibroids/leiomyomas occur?

A

Myometrium

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5
Q

How many women have fibroids?

A

Very common, up to 50% have them in reproductive years. Decrease in size after menopause

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6
Q

Symptoms of uterine fibroids? (5)

A

Abnormal bleeding
Pressure symptoms eg backache/Urinary frequency

Pelvic pain
Abdo. mass

Can be asymptomatic

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7
Q

Where is submucosal fibroid?

A

Just below endometrium, can project into cavity

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8
Q

Where is intramural fibroid?

A

In the middle of myometrium

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9
Q

Where is subserosal myometrium?

A

Just under external surface of uterus, can project into pelvic or abdo. cavity

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10
Q

Gross pathology of uterus: Multiple circumscribed lesions with characteristic white colour and very firm

A

BENIGN fibroids

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11
Q

Histology of fibroids?

A

Normal histology of myometrium&raquo_space; bland spindle shaped cells with surrounding eosinophillic cytoplasm. No mitotic figures or pleomorphism

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12
Q

What is adenomyosis?

A

Benign condition, symptoms include abnormal bleeding

Glands of endometrium and stroma have spread down to myometrium

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13
Q

Difference between simple and complex endometrial hyperplasia?

A

Simple: ratio of glands and stroma is equal

Complx: More glands than stroma

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14
Q

What is atypical endometrial hyperplasia?

A

Nuclear atypia is present. Pre-cancerous.

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15
Q

How many of atypical hyperplasias progress to cancer?

A

around 40%

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16
Q

How does endometrial hyperplasia present?

A

Abnormal uterine bleeding

17
Q

Tx of atypical endometrial hyperplasia

A

Hormones or hysterectomy

Typical endometrial hyperplasias rarely progress

18
Q

What is the most common gynacological malignancy? Endometrial/cervical/vulval?

A

Endometrial cancer

19
Q

When does endometrial cancer most often occur?

A

Post menopausal, peak age 50-70

20
Q

Symptoms of endometrial cancer

A

Post menopausal bleeding

21
Q

Associations with endometrial cancer? (7)

A
  • 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

22
Q

Which genetic bowel related cancer is associated with endometrial cancer?

A

Hereditary non-polyposis colorectal cancer (genetic)

23
Q

Two types of endometrial cancer?

A

Type 1 and 2

24
Q

Which is the most common overall type of endometrial cancer?

A

Type 1 (85%)

25
Q

Most common type 1 endometrial ca?

A

ENDOMETROID CARCINOMA

26
Q

Differences between type 1 and type 2 endometrial cancers? (most common type, most common cancer, estrogen link, HER, differentiation, stage, prognosis)

A

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

27
Q

What does type 2 endometrial cancer stain with in IHC staining?

A

p53 (tumour suppressor gene mutation)

28
Q

Gross appearance: Bulky tumour extending deep into myometrium

A

Endometrial cancer

29
Q

Prognostic factors for endometrial cancer

A
  • 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
30
Q

When are endometrial cancers staged?

A

On pathology post operatively

31
Q

Stage 1 endometrial cancer

A

Confined to uterine body or corpus

32
Q

Stage 2 endometrial cancer

A

Spread to cervix

33
Q

Stage 3 endometrial cancer

A

Spread to ovaries, fallopian tubes, or found in peritoneal washing

34
Q

Stage 4 endometrial cancer

A

Metastasis

35
Q

Tx of endometrial cancer?

A

Total abdominal hysterectomy, removal of both ovaries and fallopian tubes

Peritoneal washings

Adjuvant chemo or radiotherapy depending on stage, type etc.

36
Q

What is a leiomyosarcoma?

A

A malignant tumour arising from myometrium

High grade

37
Q

What is an endometrial stromal sarcoma? (ESS)

A

Malignant stromal endometrial tumour

Low grade

38
Q

What is a carcinosarcoma/malignant mixed Mullerian tumour (MMMT)?

A

A very aggressive tumour with both sarcoma and carcinomatous elements

39
Q

Difference between histology of leiomyoma and leiomyosarcoma histology?

A

Leiomyosarcoma has lots of nuclear pleomorphism and mitotic figures

SBCP Pathology (24 decks)

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