Uterine pathology

Question 1

What are endometrial polyps and when do they tend to present?

Answer 1

Common

Often occur around/ after menopause

Question 2

What are the different types of endometrial hyperplasia?

Answer 2

Simple
Complex
Atypical

Question 3

What is the significance of atypical endometrial hyperplasia?

Answer 3

Precursor of endometrioid (adenocarcinoma)

Question 4

What will endometrial hyperplasia present with?

Answer 4

Abnormal bleeding (dysfunctional uterine bleeding or post menopausal bleeding)

Question 5

Describe simple endometrial hyperplasia

Answer 5

General distribution
Glands and stroma present
Glands are dilated but not crowded
Cytology normal

Question 6

Describe complex endometrial hyperplasia

Answer 6

Focal distribution
Glands present
Crowded glands
Normal cytology

Question 7

Describe atypical endometrial hyperplasia

Answer 7

Focal distribution
Glands crowded
Atypical cytology

Question 8

What is the management of atypical hyperplasia?

Answer 8

Hysterectomy

Question 9

Peak incidence of endometrial carcinoma?

Answer 9

50-60 years

Uncommon in under 40

Question 10

What should you look for in endometrial cancer in women under 40?

Answer 10

PCOS

Lynch syndrome

Question 11

What is the precursor for endometrioid carcinoma?

Answer 11

Atypical hyperplasia

Question 12

What is the precursor for serous carcinoma of the endometrium?

Answer 12

Serous intraepithelial carcinoma

Question 13

What is the macroscopic appearance of endometrial carcinoma?

Answer 13

Large uterus

Polypoid

Question 14

What is the microscopic appearance of endometrial carcinoma?

Answer 14

Most are adenocarcinomas

Most are well differentiated

Question 15

How will endometrial carcinomas spread?

Answer 15

Directly into myometrium and cervix
Lymphatics
Haematogenous

Question 16

Are clear cell and serous carcinomas of the endometrium graded?

Answer 16

No; automatically high grade

Question 17

What is a type 1 endometrial carcinoma?

Answer 17

Endometrioid
Related to unopposed oestrogen
Assoc with atypical hyperplasia

Question 18

What is a type 2 endometrial carcinoma?

Answer 18

Serous and clear cell
Mutation in p53
Affects elderly post-menopausal women

Question 19

What mutations are assoc with endometrioid (type 1) carcinomas?

Answer 19

PTEN
KRAS
PIK3CA

Question 20

What is the main risk factor for endometrial ca?

Answer 20

Obesity

Question 21

Why is there excess oestrogen in obese women?

Answer 21

Adipocytes express aromatase that will convert ovarian androgens into oestrogens which induce endometrial hyperplasia
SHBG reduced in obese women; increased levels of unbound biologically active hormone

Question 22

How is insulin action altered in obese women?

Answer 22

Level of insulin binding globulins are reduced and free insulin levels are elevated
Insulin/ insulin like growth factors (IGF) exert proliferative effect on endometrium

Question 23

What is the pathogenesis of lynch syndrome?

Answer 23

AD

Defective DNA mismatch repair which show microsatellite instability

Question 24

What does lynch syndrome predispose you to?

Answer 24

Colorectal ca

Endometrial ca

Question 25

How will serous and clear cell carcinomas of the endometrium spread?

Answer 25

Along fallopian tube mucosa and peritoneal surfaces so present with extrauterine disease More aggressive than endometrioid carcinoma

Question 26

How are clear cell/ serous carcinomas treated?

Answer 26

Surgery more extensive Adjuvant chemo/radio Lymphadenopathy

Question 27

What is the histological appearance of serous carcinoma of the endometrium?

Answer 27

Complex papillary and/or glandular architecture with diffuse marked pleomorphism

Question 28

What change is characteristic of clear cell carcinoma of the endometrium histologically/

Answer 28

Hobnail

Question 29

What does the prognosis of endometrial carcinoma depend on?

Answer 29

Stage Histological grade Depth of myometrial invasion

Question 30

What is the treatment of endometrial carcinomas?

Answer 30

Hysterectomy | Chemo/ radio

Question 31

What are the different stages of endometrial ca?

Answer 31

Stage 1 = uterus (1A and 1B; > 50% invasion of myometrium) 2; cervical stroma 3; local and/or regional spread (A; serosa of uterus, B; vagina, C; pelvic and/or para-aortic nodes) 4; invasion of bladder and/ or bowel mucosa and/or distant mets

Question 32

What is an endometrial stromal sarcoma?

Answer 32

Tumour arising from endometrial stroma

Question 33

What is a carcinosarcoma?

Answer 33

Mixed tumour with malignant epithelial and stromal elements

Question 34

What are the different types of endometrial stromal sarcomas?

Answer 34

Low grade | High grade; increased atypia, proliferative activity

Question 35

How will endometrial stromal sarcoma present?

Answer 35

Abnormal uterine bleeding but initial presentation may be mets (ovary or lung)

Question 36

Describe a carcinosarcoma?

Answer 36

<5% of all uterine malignancies Heterologous elements seen in 50% of cases (rhabdomyosarcoma, chondrosarcoma, osteosarcoma) POOR outcome Seen in very elderly women

Question 37

What is a benign smooth muscle tumour of the myometrium?

Answer 37

Leiomyoma = fibroid VERY COMMON Pretty much every women will have a fibroid Assoc with menorrhagia or infertility

Question 38

What is the malignant form of a leiomyoma?

Answer 38

Leiomyosarcoma

Question 39

What morphology will a leiomyosarcoma show?

Answer 39

Spindle cell

Question 40

How will a leiomyosarcoma present?

Answer 40

Abnormal vaginal bleeding Palpable pelvic mass Pelvic pain