T3 L3: Pathology of the female reproductive tract

Question 1

What is the physiology of post menopausal bleeding with endometrial cancer?

Answer 1

The necrosis of the tumour causes shedding of the blood vessels and therefore bleeding

Question 2

Give examples of endometrial adenocarcinoma subtypes by morphology

Answer 2

Endometrioid
Serous
Clear cell
Mixed
Undifferentiated
Carcinosarcomas

Question 3

What is morphology?

Answer 3

How it appears under a microscope

Question 4

Which is the most common type of endometrial cancer?

Answer 4

Endometrioid Adenocarcinoma

It resembles endometrial glands

Question 5

What do serous endometrial cancers look like?

Answer 5

They resemble fallopian tubes

Question 6

What do clear cell endometrial cancers look like?

Answer 6

They have no cytoplasm

Question 7

What are the 4 subtypes of endometrial cancer published by the cancer genome atlas?

Answer 7

• Ultramutated cancers, DNA polepsilon mutations (7%)
• Hypermutated cancers, defective mismatch repair and microsatellite instability (28%)
• Endometrial cancers with low frequency of DNA copy number alterations (39%)
• Endometrial cancers with high frequency of DNA copy number alterations (26%)

Question 8

What is the precursor lesion to an invasive squamous cell carcinoma?

Answer 8

Cervical intra-epithelial Neoplasia (CIN)

The disease process is called dysplasia

Question 9

What are the risk factors for endometrial cancer?

Answer 9

Exogenous hormones and reproductive factors 
Excessive body weight
Diabetes mellitus and insulin
Exogenous hormones and modulators
Ethnicity
Familial
Early menarche and late menopause 

Smoking is not a risk

Question 10

What is the effect of pregnancy and parity on endometrial cancer?

Answer 10

It reduces the risk

Mechanisms: there is a break from unopposed oestrogen during pregnancy and the removal of abnormal cells during delivery

Question 11

What effect does ethnicity have on endometrial cancer developemt?

Answer 11

US studies show African American develop endometrial cancer less commonly but are more likely to die from it

Question 12

How are neoplasms graded?

Answer 12

Grade 1: well differentiated
Grade 2: Moderately differentiated
Grade 3: Poorly differentiated

Question 13

How are neoplasms staged?

Answer 13

T- tumour N- nodes M- metastasis

FIGO is usually used for gynaecological tumours
Stage 1: Confined to corpus
Stage 2: Involving cervix
Stage 3: Serosa, Adnexa, Vagina, Lymph nodes
Stage 4: Bladder, Bowel, Distant metastasis