Uterine Pathology

Question 1

At what age does endometrial carcinoma incidence peak?

Answer 1

50-60 y/o

Question 2

Endometrial cancer is extremely uncommon in women aged under __?

Answer 2

40

Question 3

What are Type 1 endometrial carcinomas?

Answer 3

Endometroid and mucinous

Question 4

80% of endometrial carcinomas are Type __?

Answer 4

Type 1

Question 5

What three genes are often associated with endometrial carcinoma’s (type 1)

Answer 5

PTEN
KRAS
PIK3CA

Question 6

Where do type 1 endometrial cancers typically infiltrate?

Answer 6

The myometrium

Usually confined to the uterus at presentation

Question 7

What phenotype of endometrial cancers have a really good prognosis and why?

Answer 7

Mucinous phenotype

Often discovered at grade 1

Question 8

What is the standard treatment/management for Type 1 endometrial carcinomas

Answer 8

Surgery
- Hysterectomy
Adjuvant chemo/radiotherapy may be included

Question 9

When is a hysterectomy not appropriate for Type 1 Endometrial carcinoma/s

Answer 9

If the tumour has invaded the serosa

Question 10

What is a known risk factor for endometrial carcinomas and why?

Answer 10

Obesity

Inflammatory effect of unopposed oestrogen on the adipose tissue

Question 11

What hormone is strongly associated with endometrial carcinomas?

Answer 11

Oestrogen

Question 12

What DNA feature should you look for in Type 1 endometrial carcinomas

Answer 12

Microsatellite instability

Question 13

What impact does obesity have on insulin action?

Answer 13

Insulin binding globulins lowered

Free insulin levels increase

Question 14

What impact does insulin-like growth factors (IGF) have on the endometrium

Answer 14

Proliferative effect

Question 15

What is another name for Hereditary Non-Polyposis Colorectal Cancer

Answer 15

Lynch Syndrome

Question 16

What is significant about women who suffer from Lynch syndrome (HNPCC)

Answer 16

They have an increased risk of developing endometrial and ovarian carcinomas

Question 17

Mechanism of Lynch Syndrome (HNPCC) inheritance

Answer 17

Autosomal Dominant

Question 18

Post menopausal women do not respond o oestrogen levels increasing. true/False

Answer 18

False

Increased oestrogen will lead to hyperplasia of endometrial tissue in women pre and post menopause

Question 19

What endometrial tumours account for roughly 20% of all endometrial tumours?

Answer 19

Type 2

Serous and Clear cell

Question 20

How are endomtrial serous cell tumours characterised pathologically

Answer 20

complex papillary/glandular architecture

Marked nuclear polymorphism

Question 21

Mutations/overexpression of what gene are often associated with Type 2 endometrial carcinomas?

Answer 21

TP53

Question 22

Why are precursor lesions in serous endometrial carcinoma’s particularly serious?

Answer 22

Despite being pre malignant, they are intra-epithelial. Therefore they can grow and spread along the surface of the endometrium and travel up the fallopian tubes and invade the peritoneal surfaces

Question 23

Type 2 endometrial tumours are ____ aggressive than type 1?

Answer 23

More

Question 24

What are the management options for type 2 endometrial carcinomas?

Answer 24

Much more extensive surgery
- Hysterectomy, oophorectomy, salpingectomy etc
Adjuvant chemo-radiotherapy required

Question 25

What can occur if endometrial tumours breach the serosa?

Answer 25

They fall into the pouch of Douglas and become extrauterine

Question 26

Clear cell tumours of the endometrium are the same as clear cell tumours of the kidney. True/False

Answer 26

False

Question 27

What type of endometrial carcinomas are not formally graded?

Answer 27

Serous and Clear cell

Question 28

What type of endometrial tumours have an extremely poor prognosis?

Answer 28

Carcinosarcomas and Mixed tumours e.g. Malignant mixed Mullerian tumour contains both stromal and epithelial elements

Question 29

Define leiomyoma:

Answer 29

Smooth muscle tumour (aka fibroid) which is very common | Associated with menorrhagia and infertility

Question 30

What carcinoma is extremely rare and associated with spindle cell morphology?

Answer 30

``` Leiomyosarcoma Poor prognosis (even if confined to uterus) ```

Question 31

What is the survival rate of a leiomyosarcoma?

Answer 31

15-25% 5 year survival

Question 32

If a carcinosarcoma contains _______ components, this is the worst possible prognosis

Answer 32

Rhabdomyosarcoma components

Question 33

List some presenting symptoms for uterine fibroids:

Answer 33

``` (May be asymptomatic)OR Menorrhagia Pelvic Mass Pain and tenderness 'Pressure' symptoms ```

Question 34

What ethnicity are uterine fibroids more common in?

Answer 34

Afro-Caribbean population

Question 35

What investigations should you do for fibroids?

Answer 35

Hb if heavy bleeding USS is diagnostic MRI if requiring precise location

Question 36

Treatment options for fibroids:

Answer 36

``` Only if necessary/symptomatic Myomectomy Uterine Artery embolization Hysteroscopic Resection Hysterectomy if needed ```

Question 37

List 4 causes of tubal swelling:

Answer 37

Ectopic Pregnancy Hydrosalpinx Pyosalpinx Paratubal Cysts