Uterus path II Flashcards
What are the cancers that arise in the epithelium of the endometrium
hyperplasia/EIN
adenocarcinoma
what are the types of adenocarcinomas of endometrium
type I- glandular
non endometroid which is type II- surface
types of type II-surface endometrial adenocarcinomas
papillary serous carcinoma
MMMT carcinosarcoma
majority of endometrial CA are what type
endometroid adenocarcinoma- type I
endometroid adenocarcinomas present when
45-55 y.o
endometroid adenocarcinoma is assoc with what
exogenous E endogenous E E from peripheral conversion of androgen infertility DM and HTN
what mutations can occur with endometroid adenocarcinom
PTEN mutations
microsatellite instability in KRAS gene assoc with HNPC lynch syndrome
presentation of endometroid adenocarcinoma
abrnomal bleeding, spotting or staining
how does endometroid adenocarcinoma spread
direct extension, late spread to nodes and distance mets
risk factors for endometrial cancer
increasing age E therapy tamoxifen therapy early menarch late menopause >55 obestiy DM lynch syndrome
what do the grades of endometroid adenocarcinoma relate to
percent that is solid
with a Bx of the endometrium is suspect adenocarcinoma what should you stain for
PTEN
if adenocarcinoma in endometrium has p53 mutation what is it
serious carcinoma, non-endometroid (type II)
how should you follow a non-endometroid adenocarcinoma (type II)
high grade, 2/3 with aggressive course
early spread in lymph and into fallopian tubes to peritoneal cavity
follow closely!!
has papillary architecture
What are MMMT tumors
malignant mixed mullerian tumors, carcinosarcomas
bulky polypoid mass
epithelial and mesenchymal components
when does non endometroid adenocarcin type II usually arise
65-75 y.o
clinical setting of those affected with non endometroid adenocarcinoma
atrophy, thin physique
common in african americans
morpholocy of the non endometroid adenocarcinoma
serous, clear cell with mixed mullerian features
non endometroid adenocarcinoma is a precursor ro what
endoetiral intraepithelial carcinoma
which lynch syndrome genotype is most closely relate dot endometrial cancer
MLH1
What is grade 3 adenocarcinoma
poorly differentiated >50% solid growth
what is stage 1 adenocarcinoma
carcinoma confined to corpus uteri itself
what is stage 3 adenocarcinoma
outside uterus but not outside true pelvis
what is satge 4 adenocarcinom
outside true pelvis, may involve mucosa of bladder or rectum
stage 2 adenocarcinoma
involves corpus and cervix
what is stage IIIC endometrial cancer
spread to lymph nodes in pelvis or around aorta
if endometrial cancer has spread to lymph nodes what is 5 yr survival
60%
what is 5 yr survival of type II endometrial adenocarcinoma
20%
how does type I adenocarcinom of endometrium present
post menopausal bleeding, Bx and curettage
Tx enometrial adenocarcinoma
surgery
chemo and radiation if stage III or IV
biologics in trials
When do you use hormone therapy instead of surgery for uterine carcinoma
grade 1 endometroid adenocarcinoma AND fertility preservation
or Grade 1 endometroid adenocarcinoma AND poor surgical candidate
What are the stromal neoplasms of the uterus
benign stromal nodule
endometrial stroma sarcoma
adenosarcoma
what are the neoplasms of the uterus myometrium
leiomyoma
leimyosarcoma
how do adenosarcomas of the endometrium present
large sessile polyps that may protrude through cervical os
histo show malignant stroma with benign glands
what is an endometrial stromal nodule
benign mass without clinical importance
need to differentiate from sarcoma
what is an endometrial stromal sarcoma
spindle cell sarcoma, no glands
predilection for lymphatic invasion
how do you confrim endometrial stromal sarcoma
IPX stain for CD10
what is prognosis of endometrial stomal sarcoma
5 yr survival 50%
what is a leiomyoma
benign smooth muscle neoplasm “fibrinoid”
What is mutaiton in leiomyomas and leiomyosarcomas
MED12 gene
what are Sx of leiomyomas
(depends on location) bleeding- submucosal pain- infarction/large mass urinary frequency- pressure on bladder infertility miscarriage in 2nd trimester!
what is a leiomyosarcoma
malignant smooth muscle neoplasm
can invade uterine wall or polypoid mass in lumen
how do we Dx a leiomyosarcoma
high mitotic rate >10HPF, cytologc atypia and tumoral necrosis
peak incidence of leiomyosarcoma
40-60 yrs
where do leiomyosarcomas mets to
blood vessel invasion
