Uterus and cervix Flashcards
Uterine lesion with atrophic and/or cystically dilated glands within fibrotic stroma with thick walled vessels
Endometrial polyp
Differential diagnosis:
Endocervical polyp (if mucinous glands)
Adenomyoma (if muscle instead of stroma)
Adenosarcoma (if atypical stromal cells)
Plan:
Correlate with clinical history, radiology, and hysteroscopic findings
Examine further blocks (ideally entire polyp, for any endometrial hyperplasia or carcinoma)
IPX to support Dx: Not required
No specific action required for this benign diagnosis
Endometrium with with irregularly shaped, back to back glands with minimal intervening stroma. Cytoplasm is more eosinophilic than in benign glands, and nuclei are enlarged, variable in size and shape, with loss of polarity and mitoses at all levels of epithelium. Vesicular chromatin concentrates to nuclear membrane, leaving prominent nucleolus.
Endometrioid endometrial carcinoma
Differential diagnosis:
Endometrial serous carcinoma
Endocervical adenocarcinoma
Endometrial stromal breakdown
Plan:
Correlate with clinical history, radiology, and hysteroscopic findings (?abnormal uterine bleeding ?thickened endometrium ?HPV)
Examine further blocks (e.g. for depth of invasion, relation to margins, FIGO grading)
IPX to support Dx: ER and PR, MMR
IPX to discount DDx: p53 and p16 (serous carcinoma would be positive for these, endocervical would be p16 positive, ER/PR negative)
Molecular (if available): POLE mutation
Next steps: Synoptic report, discuss at MDT
Uterus with smooth muscle proliferation that can be mistaken for leiomyoma, but with clefted spaces between the muscle bundles lined by cells forming gland-like or angiomatoid lumens.
Adenomatoid tumour
Plan:
Correlate with clinical history and radiology
IPX to support Dx: Calretinin, WT1
No specific action required for this benign diagnosis
Endometrium with gland to stroma ratio ~1:1. Glands are pseudostratified columnar tubules with mitoses.
Proliferative endometrium
Plan:
Correlate with clinical history, radiology, and uteroscopic impression
No specific action required for this benign diagnosis
Endometrium with subnuclear secretory vacuoles creating a ‘piano key’ appearance
Early secretory endometrium
Plan:
Correlate with clinical history, radiology, and uteroscopic impression
No specific action required for this benign diagnosis
Endometrium with marked stromal oedema (like naked nuclei floating in water), with ragged shaped glands containing abundant luminal secretions
Mid secretory endometrium
Plan:
Correlate with clinical history, radiology, and uteroscopic impression
No specific action required for this benign diagnosis
Endometrium with stromal oedema, tortuous shaped glands, and decidualisation of stroma surrounding spiral arterioles
Late secretory endometrium
Plan:
Correlate with clinical history, radiology, and uteroscopic impression
No specific action required for this benign diagnosis
Endometrium with haemorrhage and aggregates of stromal cells into ‘blue balls’
Endometrial stromal breakdown
Plan:
Correlate with clinical history, radiology, and uteroscopic impression
No specific action required for this benign diagnosis
Cervical squamous epithelium with full thickness lack of maturation, high N/C ratio, hyperchromasia
HSIL (CINIII)
Plan:
Correlate with clinical history and colposcopic impression (?high risk HPV history)
Examine further blocks / levels (e.g. for relation to margins, and to search for any invasive SCC component)
IPX: Not required for diagnosis. p16 would show diffuse ‘block-like’ positivity
Vulval lesion with bland spindle/stellate cells in myxoid stroma with prominent variably sized blood vessels with surrounding smooth muscle bundles. Unencapsulated with peripheral infiltration into fat, nerves, and skeletal muscle
Aggressive angiomyxoma
Differential diagnosis:
Superficial angiomyxoma
Angiomyofibroblastoma
Plan:
Correlate with clinical history and radiology (?size ?recurrent lesion ?radiologic extent of local infiltration)
Examine further blocks (e.g. for size, relation to margins)
IPX to support Dx: ER, PR, Desmin, HMGA2 (expect positive, both DDx are negative for HMGA2)
Uterine tumour with intersecting fascicles of parallel spindle cells, with increased cellularity, mitoses, cytologic atypia, and coagulative tumour necrosis.
Leiomyosarcoma
Differential diagnosis:
Consider leiomyoma variants (mitotically active, apoplectic, cellular, symplastic)
Inflammatory myofibroblastic tumour
Plan:
Correlate with clinical history and radiology
Examine further blocks (e.g. for size, relation to margins, areas of differing morphology)
IPX to support Dx: SMA, desmin (expect positive)
IPX to discount DDx: ALK
Next steps: Synoptic report, discuss at MDT
Cervix with lobular proliferation of bland endocervical glands (may be cystically dilated) within the stroma
Cervical tunnel clusters
Differential diagnosis:
Mesonephric rests / hyperplasia
Plan:
IPX to rule out DDx: GATA3
Endometrial curettings containing adipose tissue
Adipose tissue concerning for perforation
Differential diagnosis:
Artefactual (carry-over)
Plan:
Immediate phone call to clinician to discuss result and enquire as to health of patient
Labial cyst lined by mucinous or transitional epithelium. May exhibit focal squamous metaplasia. Adjacent mucinous glands may present in the cyst wall
Bartholin’s gland cyst
Uterus with tongues/nests of bland spindled to oval cells resembling normal endometrial stroma
Low grade endometrial stromal sarcoma
Differential diagnosis:
Endometrial stromal nodule (if not invasive)
Cellular leiomyoma / leiomyosarcoma
Plan:
Correlate with clinical history and radiology
Examine further blocks (e.g. for size, extent of invasion, areas of high grade morphology, relation to margin)
IPX to support Dx: CD10, ER and PR
IPX to discount DDx: SMA, desmin
Molecular to support Dx (not required): JAZF1-SUZ12 fusion
Next steps: Synoptic report, discuss at MDT
Endometrium with spindled stromal cells and presence of plasma cells within the stroma. Additionally, dense, basophilic, filamentous aggregates.
Chronic endometritis with actinomyces
Plan:
Correlate with clinical history and radiology (?history of instrumentation ?IUD)
Phone result through to clinician
