Uterine Pathology II Flashcards
type 1 endometrium epithelium adenocarcinoma
glandular - endometroid
type 2 endometrium epithelium adenocarcinoma
surface - non-endometroid
-papillary serous carcinoma
MMMT - carcinomcarcinoma
myometrium neoplasms
leiomyoma
leiomyosarcoma
endometroid adenocarcinoma
type 1
80% of endometrial cancer
peak age 45-55yo
with conditions of unopposed estrogen
mutations of endometroid adenocarcinoma
type 1
PTEN - mutation
KRAS - microsatellite instability
conditions of unopposed estrogen
exogenous estrogen 10 years endogenous - ovarian tumor estrogen from peripheral conversion of androgen - PCOS, obesity, androgen tumor infertility diabetes HTN
abnormal bleeding, prolonged periods of 6 month duration
endometroid adenocarcinoma - type 1
grade of endometroid adenocarcinoma
based on number of lumens
tamoxifen
risk fx for type 1 - endometroid adenocarcinoma of uterus
absence of PTEN stain
type 1 - endometroid adenocarcinoma
non-endometroid adenocarcinoma
type 2
- all high grade and aggressive**
- early lymph spread
papillary serous carcinoma
15% of endometrial carcinomas
post-menopausal disease**
cancer of endometrium post-menopause
type 2
mutation in p53
non-endometroid adenocarcinoma of endometrium - type 2
MMMT
malignant mixed mullerian tumor
carcinosarcoma
bulky polypoid mass
distinct epithelial and mesenchymal components**
papillary architecture
serous carcinoma - type 2 non-endometroid adenocarcinoma
positive p53
non-endometroid adenocarcinoma
precursor to type 1
hyperplasia / EIN
precursor to type 2
endometrial intraepithelial carcinoma
african america, thin, atrophy
type 2 endometrial cancer
grade and stage of endometrium cancer
grade - differentiation
1 - well
2 - moderate
3 - poor
stage - location 1 - corpus uteri 2 - corpus and cervix 3 - extends outside uterus 4 - outside true pelvis or mucosa of bladder/rectum
all type II nonendometroid carcinomas
high grade
carcinosarcoma
MMMT
adenocarcinoma and sarcoma together
bad - aggressive
surgery for uterine carcinoma
unless grade 1 type 1 endometroid adenocarcinoma
and fertility preservation
or poor surgical candidate
trial for hormone therapy
type 1 endometroid adenocarcinoma
fertility preservation
poor surgical candidate
do therapy instead of surgery**
post-menopausal bleeding
common presentation of type 1 endometroid adenocarcinoma
omenectomy
if non-endometroid adenocarcinoma (type 2) - serous
OR carcinosarcoma
ifosfamide
adjuvant therapy - if carcinomsarcoma with rhabdomyosarcoma elements
candidate for lynch syndrome screening
age <50 bethesda guieline criteria tumor with lymphocytes lower uterine origin concurrent ovarian cancer
stroma cancer of uterus
B9 stromal nodule
endometrial stroma sarcoma
adenosarcoma
2 and 3 - bad - malignant
large sessile polyp protruding through cervical os
adenosarcoma
endometrial stromal nodule
benign - but need to differentiate from sarcoma
spindle cell neoplasma
endometrial stromal sarcoma
5 year survival 50%
CD10 IPX stain
endometrial stromal sarcoma
sheets of blue cells
stromal cells
-endometrial stromal sarcoma
MED12 mutation
unique to smooth m
-leiomyoma
and leiomyosarcoma
leiomyoma
benign smooth muscle neoplasm
fibroid
leiomyoma vs. leiomyosarcoma
both have MED 12 mutation
distinguish by number of mitotic figures**
mets for leiomyosarcoma
blood vessels - hematogenous spread
location of leiomyoma
determines the symptoms
- bleeding - submucosa
- pelvic fullness - large mass
- urinary frequency - pressure against bladder
- infertility and miscarriage may occur
MED12 with numerous mitotic figures on histo
leiomyosarcoma
dilation and curettage
dilation of cervix
scraping of uterine wall
salpingitis
inflammation of fallopian tube
with PID
acute bacterial salpingitis
suppurative - pus
60% gonnococcus
40% chlamydia
-differentiate with culture
pyosalpinx and hydrosalpinx
tube scar shut - with salpingitis
complications of saplingitis
adhesions
infertility
ectopic pregnancy
paratubal cysts
arise in mullerian remnants
at fimbriated end of tube or in broad ligament
translucent, thin walled, unicameral
aka hydatid cysts of morgagni
ectopic pregnancy
abnormal implantation
-with PID, adhesions, or endometriosis
tube ruptures 12 weeks - hemorrhage life threatening
section of tube - shows chorionic villi
most common site of ectopic
ampulla of tube 70%
endometrium hypersecretory with no chorionic vili
possible ectopic pregnancy
high risk for ectopic
previous ectopic tubal surgery tubal ligation IUD use PID multiple sex partners smoking
methotrexate
tx option for ectopic - destroys fetal tissue
fallopian adenocarcinoma
possible source of high grade serous carcinoma of ovary
