T3 L3:Pathology of the Female Reproductive Tract

Question 1

describe the body of the uterus

Answer 1

Look at slide 4 -(how was it )

Question 2

what is a prevalent symptom of endometrial cancer in post-menopausal women

Answer 2

bleeding

Question 3

describe the endometrium

Answer 3

Composed of glands in a specialised stroma with a specialised blood supply

Growth, maturation and regression of all three components is co-ordinated during each menstrual cycle

Question 4

what is endometrial cancer

Answer 4

Malignant neoplasm of glandular epithelium = adenocarcinoma

The predominant endometrial cancer arises in the glands of the endometrium

Question 5

what is morphology

Answer 5

Microscopic appearance

Question 6

list the sub-types of endometrial adenocarcinoma

Answer 6

Endometrioid

Serous

Clear cell

Mixed (components of the previous 3)

Undifferentiated

Carcinosarcomas

Question 7

how and why are endometrial adenocarcinomas named?

Answer 7

Endometrioid cancers show differentiation that resembles endometrial glands

Serous cancers were thought to resemble Fallopian tube epithelium

Clear cell cancers have clear cytoplasm

Question 8

what are the two groups of women with endometrial adenocarcinoma

Answer 8

Type 1 and 2

Question 9

wat are the characteristics of t1 endometrial adenocarcinomas?

Answer 9

type 1:
Cause-estrogenic stim & anovulatory

Age- 50-60’s

Morphologic types of tumour- Endometroid

Molecular genetic abnormalities-MSI,PTEN, PAX2 Loss

Precursor lesions-EIN, atypical hyperplasia

Prognosis and treatment- good

Question 10

wat are the characteristics of t2 endometrial adenocarcinomas?

Answer 10

type 1:
Cause- atrophic

Age- 60-70’s

Morphologic types of tumour- serous and mixed

Molecular genetic abnormalities-P53 mut, 1p deletion, PAX2 loss

Precursor lesions-EIC

Prognosis and treatment- Poor

Question 11

what are precursor lesions that transform into invasive squamous cell carcinoma called?

Answer 11

Cervical Intra-Epithelial Neoplasia (CIN)

The disease process is called dysplasia

Question 12

what are the risk factors for endometrial cancer

Answer 12

Endogenous hormones and reproductive factors

Excess body weight

Diabetes mellitus and insulin

Exogenous hormones & modulators

Ethnicity

Familial (Cowden’s syndrome; HNPCC)

Smoking not a risk

Question 13

aetiology of the factor of endogenous hormones

Answer 13

Excess exposure to estrogen unopposed by progestogens

Overweight increases estrogen levels in post menopausal women

Overweight can disrupt ovulation and progestogen production in pre menopausal women

Polycystic ovarian disease

Some rare ovarian neoplasms can produce estrogens

Question 14

factor of pregnancy

Answer 14

Pregnancy and parity reduce the risk of endometrial cancer

Mechanism includes the break from unopposed oestrogen during pregnancy and the removal of abnormal cells at delivery

Early menarche and late menopause increase risk (reduced by 7% for each year fewer)

Question 15

factors of diabetes and insulin

Answer 15

Women with diabetes mellitus have a two-fold increased risk of endometrial cancer

Hard to separate effect of insulin from excess body weight but a probably direct effect

Insulin and insulin-like growth factors may increase the effects of estrogen on the endometrium

Question 16

what are the exogenous hormones and modulators for HRT

Answer 16

Tamoxifen rr.20

unopposed estrogen RR 6.0

Question 17

factor of ethnicity

Answer 17

Less common in African-American women

Question 18

what are the 3 tumour specific parameters and what has majority of this covered?

Answer 18

Tumour type ✔

Tumour grade

Tumour stage

Question 19

Grading

Answer 19

Grading reflects how much a tumour resembles its parent tissue
Has to be done on tissue under a microscope
Many use a three-point system

Well differentiated Grade 1

Moderately differentiated Grade 2

Poorly differentiated Grade 3

Question 20

Tumour stage

Answer 20

For all neoplasms a T N M system exist
s
T for tumour: local spread

N for nodes: lymph node deposits

M for metastasis: metastatic deposits

For gynaecological tumours a different system called FIGO is usually used

Question 21

how does endometrial cancers spread

Answer 21

Because endometrium has its own stroma, initially malignant glands invade endometrial stroma

Then spreads into the myometrium

Down into the cervix

Where it reaches vessels and spreads via lymphatics or veins to nodes or vagina

Question 22

FIGO staging

Answer 22

Stage 1: Confined to corpus
Stage 2: Involving cervix
Stage 3: Serosa/Adnexa/Vagina/Lymph Nodes
Stage 4: Bladder, Bowel, Distant Metastasis

Question 23

Summary facts ( p1)

Answer 23

Over 80% of women with endometrial cancer present with post menopausal bleeding

Most ‘endometrial cancers’ arise from endometrial glands and are adenocarcinomas

There are several different types of adenocarcinoma – the most common is called endometrioid because it resembles endometrial glands

Question 24

summary facts (pt 2)

Answer 24

Other types of endometrial adenocarcinoma can be recognized microscopically

These may have distinct molecular abnormalities and behaviour

Recognizing different types of adenocarcinoma benefits patients since it informs likely prognosis and treatment

Question 25

Summary facts (pt 3)

Answer 25

Endometrioid cancer has a precursor lesion called atypical hyperplasia

Tumour grading estimates the degree to which the neoplasm matures and informs prognosis and treatment

Tumour staging demonstrates the extent to which a neoplasm has spread and informs prognosis and treatment

Question 26

summary facts pt 4

Answer 26

Incidence of endometrial cancer has been increasing in the last ten yearsRisk factors include:

• Endogenous hormones and reproductive factors
• Excess body weight
• Diabetes mellitus and insulin
• Exogenous hormones & modulators
• Ethnicity
• Familial (Cowden’s syndrome; HNPCC)

Mortality from endometrial cancer has been falling however, except for women over the age of 85