Uteral diseases Flashcards
What type of cancer could arise in the endometrium?
- Since it has glands, then ADENOCARCINOMA it is
What are the types of cancer that could arise in the myometrium?
The myometrium is made up of smooth muscle, and thus, we will have leiomyoma and leiomyosarcoma
What is meant by endometriosis?
It is the presence of ectopic endometrial tissue (glands and stroma) in a location outside the uterus
Where can the endometrial tissue in endometriosis grow?
1) Pelvic sites (ovaries, pouch of Douglas, uterine ligament, fallopian tube, rectovaginal septum)
2) Distant areas of the peritoneal cavity or the perium umbilical tissue
3) Distant sites like (lymph nodes, lungs, heart, skeletal smooth muscle and the bones)
What is the pathogenesis of endometriosis?
- We have 6 theories in total, of which 3 state that it starts at the endometrium and the other 3 state that it has a non-endometrial origin
1) Endometrial origin:
- Regurgitation theory and stem cell implantation propose that something escaped the uterus through the backflow of menstrual blood and implanted outside. The difference between these theories is that the regurgitation theory suggests that endometrial cells/glands have traveled, while the stem cell theory suggests that stem cells have escaped and developed to become an endometrium
- Benign metastasis theory: they suggest that endometrial tissue made its way into the BV’s and spread in that way
2) Non-endometrial origin:
1) Extrauterine stem cells, where the endometrial cells originated from the bone marrow and not the endometrium
2) Mullerian remnant abnormalities: Mullerian duct is an embryological structure in which most of the female genitalia develops, and thus the remnant of it outside the endometrium could develop into an endometrium
3) Metaplastic theory: Coelomic epithelium is a germinal epithelium related to the genito-urinary ridge, and it can give rise to any organ
- All of what we discussed to how endometriosis make its way, but how does it survive?
1) Endometriotic tissue has increased levels of PGE2 and VEGF and Matric metalloproteinases. they also make high levels of aromatase which leads to a local production of estrogen from androgens which increases the survival of endometrial tissue
Describe the gross picture of endometriosis
- Dark red to bluish nodules
- It might form cystic structures (chocolate cyst in ovary)
What is the microscopic photo of endometriosis?
1) Endometrial glands
2) Cellular endometrial stroma
3) Hemorrhage (hemosiderin-laden macrophages)
What are the complications of endometriosis?
1) Associated with malignancy
2) Infertility
What is adenomyosis?
It is the presence of endometrial glands and stroma within the myometrium
- It is caused by the installation of endometrium within the myometrium
What is the gross picture of adenomyosis?
Trabeculated cut surface of the uterine wall
What is the microscopic photo of adenomyosis?
Nests of endometrial stroma and gland in the myometrium
What is meant by endometrial hyperplasia?
- Increase in the number of glands in the endometrium due to prolonged excess estrogen relative to progestin
What are the causes of endometrial hyperplasia?
1) Estrogen supplementation without counterbalancing progestin
2) Tamoxifen: Hormonal treatment for breast cancer.
3) PCOS: Increase in circulating androgens peripherally converted into estrogen
4) Obesity: Aromatase enzyme in adipose tissue → peripheral hyperestrogenism
5) Ovarian estrogen-secreting stromal tumors: Granulosa cell tumor, thecoma, Sertoli-Leydig cell
6) Mutation of PTEN (FOUND IN ENDOMETRIAL HYPERPLASIA AND CARCINOMAS)
Mutation in which gene can cause endometrial hyperplasia and carcinomas?
PTEN mutation
What are the types of endometrial hyperplasia?
1) Hyperplasia without Atypia
2) Hyperplasia with atypia (AKA: Endometrial intraepithelial neoplasia)
What is the gross picture of endometrial hyperplasia?
Thickened endometrium and increased in volume
What is the microscopic photo of endometrial hyperplasia?
1) Increase in the number of glands relative to the stroma (3:1) and the stromal tissue must be present between the glands
2) Non-atypical hyperplasia (Mild glandular crowding and cystic dilation)
3) Stratified cells with enlarged nuclei
What is the pathogenesis of endometrial carcinoma?
We have two types (type-1 and type-2):
- Type-1:
1) Affects females 55-65 years
2) Usually it is predisposed by Etrogen stimulation that is not inhibited, obesity, HTN, diabetes
3) The lesion starts as a endometrial hyperplasia
4) We can find mutations in PTEN and KRAS
- Type-2:
1) Affects females in the age 65-75 years
2) It is predisposed by the atrophy of the endometrium
3) It is caused by mutations in P53
What is the microscopic photo of type-1 endometrial carcinoma?
Endometrial adenocarcinoma
What is the microscopic photo of type-2 endometrial carcinoma?
1) Serous (fallopian tube like epiuthelium)
2) Clear cell
What is the mutation that could predispose type-1 endometrial carcinoma?
Mutations in:
1) PTEN
2) KRAS
What is the mutation that could predispose Type-2 endometrial carcinoma?
P53 mutation
Describe the gross photo of endometrial carcinoma
1) Localized polypoid tumor
2) Diffuse tumor involving the endometrial surface
What is the microscopic photo of endometrial carcinoma?
1) Endometrial stromal invasion
2) Lympho-vascular invasion
3) Myometrial invasion
