Uterine Malignancy Flashcards
What are the 2 non-cancerous causes of dysfunctional uterine bleeding?
- Endometrial polyps
* Endometrial hyperplasia
Endometrial polyps are rare
FALSE- they are very common
When, in a woman’s life, are polyps most common?
Occur around the time of menopause and after menopause
What are the 3 different categories of endometrial hyperplasia?
- Simple
- Complex
- Atypical (precursor of carcinoma)
What is the cause of endometrial hyperplasia?
Cause is often unknown, but may be due to persistent oestrogen stimulation
Describe simple endometrial hyperplasia.
General which affects the entire endometrium, as they glands grow they become cystic
Describe complex endometrial hyperplasia
Usually focal and only affects part of the endometrium
If cells of endometrial hyperplasia are atypical, what can they also be said to be?
Complex + pre malignant
Why can hyperplasia look like ‘swiss cheese’ on histology?
Due to lots of cystic dilatations
In simple hyperplasia glands are cystically dilated because they continue to grow, why is this?
Common around the time on the menopause, if a woman doesn’t ovulate every months, she contines to secrete low levels of oestrogen which causes these glands to grow
Describe the histological appearance of complex atypical hyperplasia.
Glands are crowded
Cytology is atypical – cells are round instead of cigar-shaped, and they lose polarity in that nuclei don’t sit on the BM, but are higher up in the cells
When is the peak incidence of endometrial carcinoma?
Peak incidence in 50-60 year olds, uncommon in anyone under 40
Under what age is endometrial carcinoma uncommon?
Under 40 years
In a young woman (under 40 years) with endometrial carcinoma, what should you consider?
In young women, consider underlying predisposition e.g. polycystic ovary syndrome or Lynch syndrome
What are the 2 main groups of precursor lesions for endometrial carcinoma?
- Endometrioid carcinoma – precursor atypical hyperplasia
* Serous carcinoma – precursor serous intraepithelial carcinoma
How does endometrial cancer present?
Abnormal bleeding
Describe the macroscopic appearance of endometrial cancer.
- Large uterus
* Polypoid
Describe the microscopic appearance of endometrial cancer.
- Most are adenocarcinomas
* Most are well differentiated
Describe the spread of endometrial cancer.
- Directly into myometrium and cervix
- Lymphatic
- Haemotogenous
What are the 2 main clinical types of endometrial cancer.
- Endometrioid and Mucinous
2. Serous and Clear cell
What % of all endometrial cancers does ‘endometriosis and mucinous’ account for?
80%
What are ‘endometriosis and mucinous’ endometrial cancers related to?
Unopposed oestrogen
‘endometriosis and mucinous’ endometrial cancers are associated with ….
Endometrial hyperplasia
List 3 common gene mutations found in patients with ‘endometriosis and mucinous’ endometrial cancers?
- PTEN
- KRAS
- PIK3CA
Microsatellite instability is seen histologically in which cancer?
‘endometriosis and mucinous’ endometrial cancers
Who does serous and clear cell endometrial cancer affect?
Affect elderly post‐menopausal women
What type of endometrial cancer is very rare?
Clear cell