Uterine Malignancy Flashcards
When do endometrial polyps often occur?
Around/after the menopause
If a young woman gets endometrial cancer, what conditions should you bear in mind?
- PCOS
- Lynch syndrome
Atypical hyperplasia is the precursor for which type of endometrial cancer?
Endometriod carcinoma
Serous intraepithelial carcinoma is the precursor for which type of cancer?
Serous carcinoma
Are endometrial carcinomas more likely to be adenocarcinomas or squamous?
ADENOCARCINOMA
What is the myometrium?
Middle layer of the uterus wall
How does an endometrial carcinoma spread?
- HAEMATOGENOUS
- directly into myometrium and cervix
TP53 is often mutated in which type of endometrial cancer?
Serous (and clear cell)
What does aromatase do?
adipocytes express aromatase
It converts ovarian androgens into OESTROGENS (this induces endometrial proliferation)
Effect of insulin on the endometrium?
Insulin/insulin-like growth factors (IGF) exert a proliferative effect on the endometrium
Insulin action in obese people and its role in endometrial cancer
Insulin action is often altered in obese women: The level of insulin-binding globulins is reduced and free insulin levels are elevated. Insulin/insulin-like growth factors (IGF) exert proliferative effect on endometrium.
SHBG levels in obese people and its role in endometrial cancer?
Sex hormone-binding globulin levels are lower in obese women, and therefore the level of unbound, biologically active hormone is higher.
Lynch syndrome inheritance
Autosomal Dominant
How could you identify a tumour in Lynch syndrome
Immunohistochemistry staining (for mismatch repair proteins)
Name a characteristic of defective mismatch repair
Microsatellite instability
Characterised by a complex papillary and/or glandular architecture with diffuse, marked pleomorphism
Serous carcinoma
How are endometriod carcinomas graded?
Primarily graded by their architecture
Grade 1 endometriod carcinoma
5% or less solid growth
Grade 2 endometriod carcinoma
6-50% solid growth
Grade 3 endometriod carcinoma
> 50% solid growth
Stage 1A endometrial carcinoma
no or less than 50% myometrial invasion
Stage 1B endometrial carcinoma
> 50% myometrial invasion
Stage II endometrial carcinoma
Tumour invades cervical stroma
Stage IIIA endometrial carcinoma
Tumour invades serosa of uterus and/or adnexae
Stage IIIB endometrial carcinoma
Tumour invades vagina and/or parametrium
Stage IIIC endometrial carcinoma
Metastases to pelvic and/or para-arotic lymph nodes
Stage IV endometrial carcinoma
Tumour invades bladder and/or bowel mucosa (IVA) and/or distant metastases (IVB)
This tumour arises from endometrial stroma
Endometrial stromal sarcoma
Mixed tumour with malignant epithelial and stromal elements
Carcinoma (Mullerian tumour)
Most important prognostic factor in endometrial stromal sarcoma?
Stage
Most common place where endometrial stromal sarcoma will metastasise to?
Ovary or lung
In carcinosarcoma, the presence of a _____ component has the worst prognosis?
Rhabdomyosarcomatous
Leiomyomata
Fibroids (singular: leiomyoma)
What is the most common uterine sarcoma?
Leiomyosarcoma
Cells seen in leiomyosarcoma
Spindle cells
Endometriod carcinoma precursor?
Atypical hyperplasia
Serous carcinoma precursor?
Serous intraepithelial carcinoma
Type 1 Endometrial carcinoma?
Endometriod (and mucinous)
Type 2 Endometrial carcinoma?
Serous (and clear cell)
How could granulosa cell tumours present?
Precocious puberty, PMB etc (due to oestrogen production by the tumour!)
Which ovarian tumour could present with thyrotoxicosis?
E.g. a dermoid cyst! (they are totipotential, could contain thyroid tissue, sebaceous material etc etc)
How could thecal tumours present?
Hirsutism, virilisation (because of androgen production by the tumour!)
What type of ovarian tumour in Meig’s syndrome?
Fibroma
What hormone could malignant germ cells produce?
HCG or AFP
Exudate seen in ovarian cancer?
Malignant ascites with protein exudate
