Uterus (incl cervix)

Question 1

benign mimics of malignancy - endometrium

Answer 1

menstrual endometrium

papillary syncytial metaplasia

arias stella

Question 2

benign mimics of malignancy - myometrium

Answer 2

coagulative necrosis in leiomyoma

benign metastasizing leiomyoma

intravascular leiomyomatosis

Question 3

polyps

Answer 3

endometrial polyp

submucosal leiomyoma

adenomyoma

atypical polypoid adenomyoma

adenofibroma

adenosarcoma

Question 4

atypical polypoid adenomyoma (features)

Answer 4

APA: lower uterine segment, focal, atypical endometrial hyperplasia, squamous morules

Question 5

adenosarcoma vs adenofibroma

Answer 5

adenosarc: raised mitoses, stromal cellularity, stromal overgrowth, HG atypia

Question 6

spindle cell neoplasms

Answer 6

leiomyoma

endometrial stromal nodule

PEComa

undifferentiated uterine sarcoma

carcinosarcoma

Question 7

epithelioid neoplasms

Answer 7

carcinoma

adenomatoid tumour

epithelioid leiomyoma/sarcoma

endometrial stromal nodule/sarcoma

uterine neoplasm with sex cord-like elements (no stromal component, inhibin+)

PEComa

placental site

Question 8

biphasic lesions

Answer 8

endometrial polyp

adenofibroma/sarcoma

carcinosarcoma

adenomyoma/APA

Question 9

tumour cell necrosis vs hyaline necrosis

Answer 9

TCN: abrupt transition, ghosted tumour cells with atypical nuclei, karyorrhectic debris

Question 10

LG endometrial stromal sarcoma vs intravascular leiomyomatosis

Answer 10

LG ESS: diffuse CD10+, desmin+/-, keratin-

leiomyomatosis: always desmin+, CD10+/-, keratin+/-

NB: if ambiguous, call LG ESS

Question 11

endometrial stromal nodule vs stromal sarcoma

Answer 11

nodule: non-infiltrative, no intravascular component

Question 12

carcinosarcoma vs endometrial ca with spindle cell elements

Answer 12

endometrial ca: low grade, no marked spindle cell atypia

Question 13

adenoid cystic carcinoma

Answer 13

tubular, cribriform or solid

hyaline material with pallisaded epithelial cells

PNI and locally aggressive (as in salivary gland)

Question 14

benign mimics of malignancy - cervix (8)

Answer 14

T-CRAMMED

mesonephric remnants (bland, no desmoplasia)

microglandular hyperplasia (bland, no desmoplasia)

tuboendometrioid metaplasia

endometriosis

decidual change

Arias-Stella (nucleoli but no mitoses)

CMV/HSV

radiation

Question 15

tuboendometrioid metaplasia vs AIS

Answer 15

AIS: stratification, hyperchromasia, nuclear enlargement, mitoses

Question 16

malignant mimics of benign - cervix

Answer 16

minimal deviation adenoca (infiltrative, focal atypia)

early adenosarcoma (polypoid)

Question 17

clear cell adenocarcinoma DDX

Answer 17

microglandular hyperplasia

mesonephric remnants

Arias-Stella

metastatic RCC

Question 18

superficially invasive cervical SCC - criteria (4)

Answer 18

>=3mm depth

<=7mm width

not grossly visible

completely excised

(low potential for mets/recurrence if excision complete and no LVI)

Question 19

endometrial ca vs endocervical ca

Answer 19

endometrial: vimentin, ER+
endocervical: CEA, p16+

Question 20

Answer 20

Villoglandular adenocarcinoma (interlacing glands, cellular fibrous stroma)

Question 21

Answer 21

Adenoid basal carcinoma (peripheral palisading, central squamous differentiation)

Question 22

Answer 22

Uterine neoplasm with sex cord like elements

Question 23

Answer 23

Glassy cell carcinoma (subtype of adenosquamous ca): ground glass cytoplasm, inflammation (eosinophils and plasma cells)

Question 24

serous vs endometrioid vs clear cell ca

Answer 24

serous: p53 diffuse, wt+/-, er+/-, ki67 high
endometrioid: p53 patchy, wt1-, er+, ki67 low

clear cell: p53+/-, wt1-, er+/-, ki67 intermediate; HNF1-beta +

Question 25

leiomyoma vs leiomyosarcoma

Answer 25

tabulated criteria based on:

cell type (spindled, myxoid, epithelioid)

atypia (severity and distribution)

necrosis

mitotic rate