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Repro and Sexual Health > Uterine pathology > Flashcards

Uterine pathology Flashcards

1
Q

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

A

Common

Often occur around/ after menopause

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2
Q

What are the different types of endometrial hyperplasia?

A

Simple
Complex
Atypical

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3
Q

What is the significance of atypical endometrial hyperplasia?

A

Precursor of endometrioid (adenocarcinoma)

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4
Q

What will endometrial hyperplasia present with?

A

Abnormal bleeding (dysfunctional uterine bleeding or post menopausal bleeding)

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5
Q

Describe simple endometrial hyperplasia

A

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

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6
Q

Describe complex endometrial hyperplasia

A

Focal distribution
Glands present
Crowded glands
Normal cytology

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7
Q

Describe atypical endometrial hyperplasia

A

Focal distribution
Glands crowded
Atypical cytology

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8
Q

What is the management of atypical hyperplasia?

A

Hysterectomy

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9
Q

Peak incidence of endometrial carcinoma?

A

50-60 years

Uncommon in under 40

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10
Q

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

A

PCOS

Lynch syndrome

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11
Q

What is the precursor for endometrioid carcinoma?

A

Atypical hyperplasia

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12
Q

What is the precursor for serous carcinoma of the endometrium?

A

Serous intraepithelial carcinoma

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13
Q

What is the macroscopic appearance of endometrial carcinoma?

A

Large uterus

Polypoid

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14
Q

What is the microscopic appearance of endometrial carcinoma?

A

Most are adenocarcinomas

Most are well differentiated

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15
Q

How will endometrial carcinomas spread?

A

Directly into myometrium and cervix
Lymphatics
Haematogenous

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16
Q

Are clear cell and serous carcinomas of the endometrium graded?

A

No; automatically high grade

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17
Q

What is a type 1 endometrial carcinoma?

A

Endometrioid
Related to unopposed oestrogen
Assoc with atypical hyperplasia

18
Q

What is a type 2 endometrial carcinoma?

A

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

19
Q

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

A

PTEN
KRAS
PIK3CA

20
Q

What is the main risk factor for endometrial ca?

A

Obesity

21
Q

Why is there excess oestrogen in obese women?

A

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

22
Q

How is insulin action altered in obese women?

A

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

23
Q

What is the pathogenesis of lynch syndrome?

A

AD

Defective DNA mismatch repair which show microsatellite instability

24
Q

What does lynch syndrome predispose you to?

A

Colorectal ca

Endometrial ca

25
Q

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

A

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

26
Q

How are clear cell/ serous carcinomas treated?

A

Surgery more extensive
Adjuvant chemo/radio
Lymphadenopathy

27
Q

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

A

Complex papillary and/or glandular architecture with diffuse marked pleomorphism

28
Q

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

A

Hobnail

29
Q

What does the prognosis of endometrial carcinoma depend on?

A

Stage
Histological grade
Depth of myometrial invasion

30
Q

What is the treatment of endometrial carcinomas?

A

Hysterectomy

Chemo/ radio

31
Q

What are the different stages of endometrial ca?

A

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

32
Q

What is an endometrial stromal sarcoma?

A

Tumour arising from endometrial stroma

33
Q

What is a carcinosarcoma?

A

Mixed tumour with malignant epithelial and stromal elements

34
Q

What are the different types of endometrial stromal sarcomas?

A

Low grade

High grade; increased atypia, proliferative activity

35
Q

How will endometrial stromal sarcoma present?

A

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

36
Q

Describe a carcinosarcoma?

A

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

37
Q

What is a benign smooth muscle tumour of the myometrium?

A

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

38
Q

What is the malignant form of a leiomyoma?

A

Leiomyosarcoma

39
Q

What morphology will a leiomyosarcoma show?

A

Spindle cell

40
Q

How will a leiomyosarcoma present?

A

Abnormal vaginal bleeding
Palpable pelvic mass
Pelvic pain

Repro and Sexual Health (77 decks)

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