The Uterus Flashcards
endometrial hyperplasia subtype with highest risk of cancer progression
complex hyperplasia with atypia
endometrial hyperplasia
- older age
- genetics (Lynch)
- xs estrogens
causes of xs estrogen stimulation
- PCOS/chronic anovulation
- obesity
- unopposed ERT
- estrogen secreting tumor
- tamoxifen therapy
- nulliparity/no breast-feeding
low risk endometrial hyperplasia tx
progestin therapy (thins endometrium)
high risk endometrial hyperplasia tx
hysterectomy
endometrial hyperplasia histo
atypical glands sep by stroma
endometrial cancer
atypical glands fused together without stroma
most comm gynecologic cancer in US
endometrial cancer
endometrial cancer tx
surgery (hysterectomy and bilateral salpingo-oophorectomy)
-poss pelvic and para-aortic lymph node sampling
staging of uterine CA
FIGO
- confined to uterus/invades myometrium
- cervix
- serosa/vagina/nodes
- bladder or bowel mucosa/ distant mets
endometrial polyps tx
-resection if irregular or post-menopausal bleeding
post-menopausal women have a higher risk of malignancy
endometriosis vs adenomyosis
both cause dysmenorrhea
adenomyosis is also assoc w/ menorrhagia
outside uterus and unlikely to cause AUB
endometriosis
inside uterine wall and more likely to cause AUB
adenomyosis
adenomyosis tx
hormonal
- LNG-IUD
- depo
hysterectomy if highly symp and completed child bearing
diffusely enlarged, globular uterus - feels soft
adenomyosis
leiomyomas
- benign tumor of myometrium
- usu multiple tumors
- premenopaousal women
leiomyomas tx if submucosal
tx for AUB
hysteroscopic resection
leiomyomas tx if large/intramural
- myomectomy
- hysterectomy (use GnRH agonist to shrink size before surgery)
- UAE, UFE (embolization)
GnRH agonist used to shrink leiomyoma before surgery
leuprolide
adenomyosis
- benign endometrial glands and stroma deeply within myometrium
- diffusely enlarged uterus (vs nodular enlargement of leiomyomas)
- pt present w abnml bleeding/dysmenorrhea/enlarged uterus
pathologic dx of endometriosis
- endometrial glands
- endometrial stroma
- hemosiderin
theories of endometriosis pathogenesis
Regurgitation theory**
Metaplastic theory
Metastatic theory
Stem cell differentiation
accepted theory of endometriosis
movement of mestrual tissue thru Fallopian tubes –> ovaries, peritoneum
most common tumor in female genital tract
leiomyoma
(fibroid)
benign tumor of smc
leiomyomas arise most commonly in the
myometrium
most common location of leiomyomas
intramural
cigar-shaped nuclei and abundant eos cytoplasm
leiomyoma
leiomyosarcoma
- rare
- DE NOVO
- peak at older age, post-menopausal
- abnml bleeding/pain/mass
- prognosis dec on stage
- spread is intraperitoneal to nodes and hematogenously to lungs, liver, or brain
features of leiomyosarcoma
- necrosis
- mitotic count inc
- cytological atypia
STUMP
smooth-muscle tumor of undetermined malignant potential
if hard to distinguish leiomyoma vs leiomyosarcoma
leiomyosarcoma histo
hypercellular pleomorphic nuclei hyperchromatic nuclei increased mitoses atypical mitoses (necrosis) (hemorrhage)
sm actin, desmin +
endometrial polyp malignant potential
CA may rarely be found within a polyp, but no evidence to suggest that polyps are premalignant
3 histological features of endometrial polyps
- dilated endometrial glands
- fibrotic stroma
- thick walled blood vessels
endometrial hypERplasia
via influence of high levels of unopposed estrogen
How would obesity lead to endometrial hypERplasia?
estrogens are formed in peripheral adipose tissue from androstenedione
xs estrogen –> endometrial hyperplasia
normal proliferative phase endometrium
gland:stoma ratio
<1:1
enlarged, crowded, poorly oriented nuclei
atypia
endometrial carcinoma risk fx
- age
- estrogen
- diabetes
- smoking
- genetic (LYNCH)
Mutations in type II endometrial cancer
K-ras, p53, HER2neu
2 types of ovarian carcinoma
- endometrioid
2. serous
type I endometrial carcinoma (endometrioid type)
- endometrial type epithelium
- estrogen-driven
- hypERplasia
- lower grade
- superficially invasive
- better prognosis
type II endometrial carcinoma (serous type)
- Fallopian tube type endothelium
- estrogen-INDEPENDENT
- driven by p53
- no hyperplasia
- deep invasion
- POOR PROGNOSIS, AGGRESSIVE
carcinosarcoma
malignant glands malignant stroma (homologous or heterologous)
carcinosarcoma, heterologous type
rhabdomyosarcoma
chondrosarcoma
