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REPRO > Uterine Malignancy > Flashcards

Uterine Malignancy Flashcards

1
Q

When do endometrial polyps occur?

A
  • around/after menopause
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2
Q

What are the types of endometrial hyperplasia?

A

simple
complex
atypical (precursor of CA)

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3
Q

What is endometrial hyperplasia?

A
  • overgrowth of endometrial glands and stroma
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4
Q

Where is the endometrial polyp in the uterus on slide 4

A
  • at the fundus
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5
Q

Describe appearance of the polyp.

A

smooth shiny surface

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6
Q

Describe the microscopy of Simple endometrial hyperplasia.

A
  • incr. in volume of stroma and glands
  • normal nuclear fts/cytology
  • glands NOT crowded
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7
Q

Describe complex endometrial hyperplasia.

A
  • glands are very crowded

- –normal cytology

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8
Q

What is it if the cells are atypical and crowded glands are seen?

A
  • atypical endometrial hyperplasia
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9
Q

When is a complex atypical hyperplasia considered to be malignant?

A
  • once glands fuse= Malignancy
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10
Q

Most common endometrial CA?

A

endometroid ca

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11
Q

IS post-menopausal bleeding bad?

A
  • yes

- at risk of CANCER

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12
Q

Which enodmetrial CA is at risk of spreading elsewhere?

A

-serous CA

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13
Q

What are the diff. types of endometrial ca?

A
  • clear cell (high grade)
  • Serous CA (high grade)
  • Endometroid Ca
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14
Q

Where is the endometrial tumor likely to spread to?

A
  • directly into the MYOMETRIUM and CERVIX —-once its in the OUTER path of myometrium- this is concerning; d.t presence of LARGE blood vessels
  • Lymphatic
  • Hematogenous
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15
Q

Most endometrial ca is _______

A

well differentiated and ADENOCARCINOMAS

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16
Q

What drives the growth of endometrium?

A
  • estrogen
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17
Q

Why is obesity a risk factor of endometrialk cancer?

A
  • adipocytes express aromatase that CONVERTS ovarian androgens into estrogens
  • when they are obese SEX- hormone binding globulin levels are lower; SO HIGH unbound, active hormone
  • altered insulin axn; insulin-binding globulin levels also reduced= HIGH free insulin levels –>Insulin/insulin-like growth factors (IGF) exert proliferative effect on endometrium.
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18
Q

Is LYNCH syndrome a RISK factor of endometrial cancer?

A
  • YES

- HIGH RISK OF COLORECTAL CANCER, ENDOMETRIAL cancer and probability of developing ovarian cancer

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19
Q

How to test for Lynch Syndrome?

A
  • immunohistochemistry staining of the TUMOR for mismatch repair proteins (identifies tumors d.t Lynch $)
  • Lynch syndrome tumours also show microsatellite instability (MSI), a characteristic of defective mismatchrepair.

Testing cancer tissue for MSI can be useful.

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20
Q

What occurs after receiving positive lynch $ with genetic testing?

A
  • genetic counselling follows if positive
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21
Q

Which is more common out of Type I or TYPE II tumors?

A
  • serous Type II tumors
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22
Q

How may type ii tumors spread t the peritoneum?

A
  • SPREADS along the fallopian tubes to the peritoneal surfaces = extra-uterine disease
  • therefore spreads EARLY to the peritoneal cavity
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23
Q

Does endometrial ca have good prognosis?

Which type is most aggressive - Serous or Endometroid?

A
  • yes because it is usually CONFINED to the uterus at presentation
  • SEROUS!
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24
Q

Why is Grade 3 endomtrial cancer aggressive?

A
  • has more mutations

- forgotten how to behvae (poorly differentiated)

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25
Q

At what stage does the tumor reach the serosa

—what occurs to it then?

A
  • At stage IIIA

- —reaches serosa and/or the fallopian tubes, ovaries and ligaments of the uterus

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26
Q

Metastases to para-aortic and pelvic LN occurs at what stage?

A
  • IIIC
27
Q

If the tumor arises from the endometrial stromal; what is it called?

A
  • endometrial stromal sarcoma
28
Q

What is a carcinosarcoma?

A
  • carcinoma that has gone rogue
  • produces MESENCHYMAL tissue (forms cartilage/bone/all malinant tissues )—-mixed tumor with MALIGNANT epithelial and stromal elements
29
Q

Which endometrial tumor has poor prognosis?

A
  • malignant, mixed MULLERIAN tumor
30
Q

How to recognize if Endometrial stromal Sarcoma is high grade?

A
  • incr. atypia

- proliferative activity

31
Q

How does endometrial stromal sarcoma present as?

A
  • abnormal uterine bleeding

- initial presentation may be as metastasis (mostly OVARY/LUNG)

32
Q

Which component of the carcinosarcoma gives the worst prognosis?

A
  • rhabdomyosarcomatous

heterologous elements seen in 50% of cases

33
Q

How common are leiomyomas?

A
  • VERY
  • –a.w menorrhagia, (d.t STRETCH of the ENDOMETRIUM- prone to bleeding)
  • infertility (inability for blastocyst to implant)
34
Q

How to know if the tumor is malignant?

A
  • under microscope; evidence of necrosis and hemorrhage
35
Q

Appearance fo leiomyoma under the microscope?

A
  • smooth muscle proliferation
  • foci of calcification, fibrosis may be seen
  • absence of necrosis and bleeding
36
Q

Is leiomyosarcoma common?

Who is at risk?

A

NO; only 1-2% of uterine malignancies

  • those >50y.o
37
Q

Symptoms of leiomyosarcoma?

A

abnormal vaginal bleeding, palpable pelvic mass and pelvic pain

38
Q

What is the prognosis of leiomyosarcoma?

A

POOOR

  • even if confined to uterus
  • —5 year survival rates 15-25%
39
Q

How does endometrial hyperplasia present as?

A

abnormal bleeding (dysfunctional UTERINE bleeding/postmenopausal bleeding)

40
Q

Describe the histological difference btwn simple and complex endometrial hyperplasia

A
  • stroma still visible in simple hyperplasia (as glands are not crowded)
  • not much stroma in COMPLEX hyperplasia and nuclei lined up along BM (Cigar shaped)
41
Q

Look at slide 10. What change is seen in the nuclei of complex atypical hyperplasia?

A

Nuclei is no longer lined up at the BM of the gland

42
Q

When is the peak incidence of endometrial CA?

A
  • 50-60 years old

- RARE under 40

43
Q

If endometrial ca presents in a young woman. What medical conditions should be considered?

A
  • Lynch $

- PCOS

44
Q

What is the precursor lesion of Endometroid carcinoma?

A
  • precursor ATYPICAL hyperplasia
45
Q

What is the precursor lesion of serous CA?

A

precursor serous intra-epithelial carcinoma

46
Q

Name the 2 main types of endometrial carcinoma.

A
  1. Endometroid (and Mucinous) -TYPE 1

2. Serous (and clear cell) - TYPE 2

47
Q

Which type of endometrial carcinoma is a.w unopposed estrogen?

A

TYPE 1
(the endometroid ca- mucinous)
—–

48
Q

Which type is most likely to affect post-menopausal women?

A

Serous (clear cell)- TYPE 2

49
Q

Which endometrial ca may have a mutated TP53?

A

Serous (clear cell)

—-has the mutation and OVEREXPRESSES it

50
Q

What mutations are a.w Type 1 Endometrial CA?

A
  • PTEN
  • KRAS
  • PIK3CA
51
Q

What is microsatelite instability?

A
  • condition of genetic hypermutability results from IMPAIRED DNA mismatch repair
  • —seen in Type I endometrial CA
52
Q

Why is Lynch $ a predisposition to cancer?

A
  • d.t INHERITANCE of a defective DNA mismatch repair gene

- autosomal dominant inheritance

53
Q

How to manage type II tumors?

A
  • with surgery (more extensive)

- adjuvant chemo-/radiotherapy

54
Q

What is seen histologically for Serous Carcinoma?

A
  • complex papillary and/or GLANDULAR architecture

- w/ diffuse, marked nuclear pleomorphism

55
Q

What s meant by pleomorphism?

A
  • cells of all shapes and sizes
56
Q

Describe serous carcinoma.

A
  • tufts and papillae (not glands)

- tubules with LOBSTER claw appearance containing highly pleomorphic tumor cells

57
Q

What does the prognosis of endometrial CA depend on?

A
  • Stage
  • Histological Grade
  • Depth of myometrial invasion
58
Q

Do you grade endometrial ca; if so what are the grades?

A

YES ; mainly for endometroid carcinoma

  • Gr.1: 5% of less solid
  • Gr. 3: >50% solid growth
59
Q

At what stage does the tumor INVADE the bladder/ bowel mucosa

A
  • Stage IV
60
Q

Why is endometrial stromal sarcoma high grade?

A
  • infiltrate myometrium

- lymphovascular spaces

61
Q

How does a carcinosarcoma look like grossly?

A
  • large, bulky tumor (fills the cavity)

- protrudes through the cervical canal

62
Q

Name myometrial lesions.

A
  1. Leiomyoma (V.COMMON)

2. Leiomyosarcoma (RARE)

63
Q

Describe the gross appearance of leiomyomas.

A
  • sharply circumscribed
  • FIRM
  • WHORLED cut surface
  • may occur singularly or MULTIPLE!
64
Q

Does leiomyosarcoma arise from leiomyoma?

A

NO

—-they arise de novo from the mesenchymal cells of the myometrium

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