Uterine pathology Flashcards
What are endometrial polyps and when do they tend to present?
Common
Often occur around/ after menopause
What are the different types of endometrial hyperplasia?
Simple
Complex
Atypical
What is the significance of atypical endometrial hyperplasia?
Precursor of endometrioid (adenocarcinoma)
What will endometrial hyperplasia present with?
Abnormal bleeding (dysfunctional uterine bleeding or post menopausal bleeding)
Describe simple endometrial hyperplasia
General distribution
Glands and stroma present
Glands are dilated but not crowded
Cytology normal
Describe complex endometrial hyperplasia
Focal distribution
Glands present
Crowded glands
Normal cytology
Describe atypical endometrial hyperplasia
Focal distribution
Glands crowded
Atypical cytology
What is the management of atypical hyperplasia?
Hysterectomy
Peak incidence of endometrial carcinoma?
50-60 years
Uncommon in under 40
What should you look for in endometrial cancer in women under 40?
PCOS
Lynch syndrome
What is the precursor for endometrioid carcinoma?
Atypical hyperplasia
What is the precursor for serous carcinoma of the endometrium?
Serous intraepithelial carcinoma
What is the macroscopic appearance of endometrial carcinoma?
Large uterus
Polypoid
What is the microscopic appearance of endometrial carcinoma?
Most are adenocarcinomas
Most are well differentiated
How will endometrial carcinomas spread?
Directly into myometrium and cervix
Lymphatics
Haematogenous
Are clear cell and serous carcinomas of the endometrium graded?
No; automatically high grade
What is a type 1 endometrial carcinoma?
Endometrioid
Related to unopposed oestrogen
Assoc with atypical hyperplasia
What is a type 2 endometrial carcinoma?
Serous and clear cell
Mutation in p53
Affects elderly post-menopausal women
What mutations are assoc with endometrioid (type 1) carcinomas?
PTEN
KRAS
PIK3CA
What is the main risk factor for endometrial ca?
Obesity
Why is there excess oestrogen in obese women?
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
How is insulin action altered in obese women?
Level of insulin binding globulins are reduced and free insulin levels are elevated
Insulin/ insulin like growth factors (IGF) exert proliferative effect on endometrium
What is the pathogenesis of lynch syndrome?
AD
Defective DNA mismatch repair which show microsatellite instability
What does lynch syndrome predispose you to?
Colorectal ca
Endometrial ca
How will serous and clear cell carcinomas of the endometrium spread?
Along fallopian tube mucosa and peritoneal surfaces so present with extrauterine disease
More aggressive than endometrioid carcinoma
How are clear cell/ serous carcinomas treated?
Surgery more extensive
Adjuvant chemo/radio
Lymphadenopathy
What is the histological appearance of serous carcinoma of the endometrium?
Complex papillary and/or glandular architecture with diffuse marked pleomorphism
What change is characteristic of clear cell carcinoma of the endometrium histologically/
Hobnail
What does the prognosis of endometrial carcinoma depend on?
Stage
Histological grade
Depth of myometrial invasion
What is the treatment of endometrial carcinomas?
Hysterectomy
Chemo/ radio
What are the different stages of endometrial ca?
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
What is an endometrial stromal sarcoma?
Tumour arising from endometrial stroma
What is a carcinosarcoma?
Mixed tumour with malignant epithelial and stromal elements
What are the different types of endometrial stromal sarcomas?
Low grade
High grade; increased atypia, proliferative activity
How will endometrial stromal sarcoma present?
Abnormal uterine bleeding but initial presentation may be mets (ovary or lung)
Describe a carcinosarcoma?
<5% of all uterine malignancies
Heterologous elements seen in 50% of cases (rhabdomyosarcoma, chondrosarcoma, osteosarcoma)
POOR outcome
Seen in very elderly women
What is a benign smooth muscle tumour of the myometrium?
Leiomyoma = fibroid
VERY COMMON
Pretty much every women will have a fibroid
Assoc with menorrhagia or infertility
What is the malignant form of a leiomyoma?
Leiomyosarcoma
What morphology will a leiomyosarcoma show?
Spindle cell
How will a leiomyosarcoma present?
Abnormal vaginal bleeding
Palpable pelvic mass
Pelvic pain
