Malignancy: Uterus Flashcards
Adenosarcoma
Tumor of mixed origin. Epithelial component composed of benign glands; only the mesenchymal portion is malignant
Can have sarcomatous overgrowth; more aggressive with metastatic potential
Less aggressive than MMMT
Endometrial stromal sarcoma
2 types: low-grade and high grade (undiff). Composed of oblong, round or spindled cells only. No epithelial component.
Endometrial adenocarcinoma
Histologic grade is an important predictor of both the depth of invasion and regional LN mets.
Grade 1: <5% solid component (non-squamous)
Grade 2: 5 to 50% of solid component
Grade 3: >50% solid component
Nuclear atypia may upgrade.
Serous and clear cell carcinoma
High grade by definition due to poor prognosis
Secretory carcinoma
Low grade with excellent clinical outcomes (grade 1 always)
Arias Stella rxn
-either currently pregnant or recently pregnant. Not indication of whether intrauterine or ectopic
DDx: Clear cell carcinoma (most likely in post-menopausal woman)
Low grade endometrial stromal sarcoma vs endometrial stromal nodule
Deep myometrial invasion in former (tongues of spindle cells infiltrating into the myometrium) and vascular invasion
Hysterectomy needed to make distinction
+ CD10; neg desmin amd h-caldesmon
[smooth muscle tumors usually CD10 neg; pos desmin and h-caldesmon]
DDx: cellular leiomyoma, intravenous leiomyomatosis, leiomyosarcoma, adenosarcoma, MMMT, PEComa
Leiomyosarcoma
Coagulative necrosis is the most important factor in determining malignancy
In absence of necrosis, mitosis > 10 mits/10 hpf is needed with diffuse moderate to severe atypia
High mitotic rate alone or pleomorphism alone or increased cellularity alone are all insufficient to make diagnosis
Usually single (vs leiomyomas are often multiple) Leoprolide admin can have necrosis
Carcinosarcoma or malignant mixed mullerian tumor
elderly, post-menopausal women
Large, bulky, polypoid lesion; may prolapse into vagina
Epithelial and mesenchymal elements with deep myometrial invasion
2 types: homologous and heterologous
Difference in origin of stroma: homologous > endometrial stroma; heterologous > bone, catrilage, fat
epithelial component: usually glandular, but can be squamous or undifferentiated
Risk factors for poor prognosis in endometrioid endometrial adenocarcinoma
Increased Ki-67 Low p21 levels Microsatellite instability high survivin expression Increased p53 activity