Uterine Malignancy Flashcards

1
Q

Define hyperplasia

A

Increase in cell number

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2
Q

What causes endometrial hyperplasia?

A

Unknown - persistent oestrogen stimulation?

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3
Q

How will endometrial hyperplasia present?

A

Abnormal bleeding

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4
Q

Describe simple hyperplasia

A

General distribution with dilated glands and stroma, with normal cytology

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5
Q

Describe complex hyperplasia

A

Focal distribution with crowded glands but normal cytology

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6
Q

Describe atypical hyperplasia

A

Focal distribution with crowded glands and atypical cytology - abnormal nuclei

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7
Q

What is the peak incidence of endometrial carcinoma?

A

50-60 years old

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8
Q

Name the two precursors to endometrial carcinoma

A

Atypical hyperplasia

Serous intraepithelial carcinoma

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9
Q

How does endometrial carcinoma present?

A

Abnormal bleeding - post menopausal

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10
Q

Where will endometrial carcinoma spread?

A

Directly to myometrium and cervix
Lymphatic
Haematogenous

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11
Q

Name the two types of endometrial carcinoma

A
  • serous and clear cell

- endometriod and mucinous

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12
Q

What grade is serous carcinoma?

A

Always high grade

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13
Q

Describe serous carcinoma

A

Almost always have a p53 mutation, complex papillary/glandular appearance with marked pleomorphism and inflammation

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14
Q

Describe clear cell carcinoma

A

Tubulocystic with no mutations

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15
Q

How does endometrioid carcinoma arise?

A

Unopposed oestrogen - no progesterone to inhibit growth

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16
Q

What mutations can be present in an endometrioid carcinoma?

A

PTEN, KRAS, PIK3CA

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17
Q

What does endometrioid carcinoma look like?

A

Closely packed back to back glands with an irregular saw tooth lumena

18
Q

State two key risk factors for endometrial carcinoma

A

Obesity

Lynch Syndrome

19
Q

Why is obesity a risk factor for endometrial carcinoma?

A

Adipocytes express aromatase which converts androgens to oestrogen and induces proliferation
SHBG is lower and therefore unbound hormone is higher

20
Q

Why is lynch syndrome a risk factor for endometrial carcinoma?

A

Inheritance of DNA mismatch repair gene by autosomal dominant inheritance characterised by micro satellite instability

21
Q

What has a worse prognosis endometrioid or serous?

A

Serous is more likely to spread into the peritoneal cavity

22
Q

Describe the staging of endometrial carcinoma

A

IA - no or <50% myometrial invasion
IB - >50% myometrial invasion
II - tumour invade cervical stroma
IIIA - tumour invades serosa of uterus
IIIB - vaginal invasion +/- parametrial involvement
IIIC - metastases to pelvis +/- para-aortic nodes
IV - invades bladder, bowel or distant mets

23
Q

Describe the grading of endometrial carcinoma

A

1 <5% solid growth
2 6-50% solid growth
3 >50% solid growth

24
Q

Other than endometrial carcinoma what other malignant tumours can arise from the uterus?

A

Endometrial stromal sarcoma
Carcinosarcoma
Leiomyosarcoma

25
Q

Describe a low grade endometrial stromal sarcoma

A

Similar appearance to normal stroma but can recur outside of the uterus

26
Q

Describe a high grade endometrial stromal sarcoma

A

Increased atypia, pleomorphism and proliferation

27
Q

How do endometrial stromal sarcomas present?

A

Abnormal uterine bleeding but initial presentation may be as metastases (lungs/ovary)

28
Q

What is carcinosarcoma?

A

Grade 3 endometrioid, serous, clear cell with elements of sarcoma

29
Q

What is meant by heterologous elements?

A

Don’t belong in the uterus

30
Q

What are the common heterologous elements?

A
  • rhabdomyosarcoma
  • chondrosarcoma
  • osteosarcoma
31
Q

What is the pathological name for a fibroid?

A

Leiomyoma

32
Q

How can fibroids present?

A

Menorrhagia
Infertility
Pressure symptoms

33
Q

Name six types of fibroid

A
Subserous - poke outwards
Intramural - within the wall (most common)
Submucous - push into the cavity 
Pedunculated - grow on a stalk 
Seedling - baby ones 
Cervical
34
Q

What is the malignant transformation of leiomyoma?

A

Leiomyosarcoma

35
Q

What is a leiomyosarcoma?

A

Malignant smooth muscle tumour commonly displaying haemorrhage and spindle cell morphology or necrosis

36
Q

What are the symptoms of leiomyosarcoma?

A

Abnormal vaginal bleeding
Palpable pelvic mass
Pelvic pain

37
Q

What investigations are done in suspected uterine malignancy?

A

Transvaginal ultrasound
Endometrial biopsy
Dilatation and curettage
Hysteroscopy

38
Q

How are uterine malignancies treated?

A

surgery
radiotherapy
high dose progesterone
chemotherapy

39
Q

What surgical treatments can be done in uterine malignancy?

A

Hysterectomy and bilateral sapling-oophrectomy

Lymphadenectomy

40
Q

Where do uterine malignancies tend to recur?

A

Vaginal vault

41
Q

If a patient is unsuitable for surgery what treatment is available?

A

Radiotherapy or high dose progesterone

42
Q

If a uterine malignancy is widespread what treatment is available?

A

Chemotherapy