Repro L17 Uterine Malignancies
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25 terms
Terms | Definitions |
|---|---|
 Most common female genitalia cancer, what causes it? | endometrial carcinoma cause is not really known, high levels of estrogen play a role (is correlated with it) |
| What are endometrial polyps? | Localized proliferation of glands and stroma See thick-walled blood vessels and fibrotic pink stroma Cystically dilated gland |
| What is endometrial hyperplasia? What causes it? | Diffuse proliferation of glands and stroma Result of prolonged estrogen stimulation via anovulatory cycles, obesity, hormone-producing ovarian tumors |
| Simple vs complex endometrial hyperplasia in histo | Simple: Numerous glands, more compared to stroma, but simple and tubular Complex: glands become more complex with infoldings |
| Is endometrial hyperplasia associated with progression to carcinoma? | Most regress, but the complex w/ atypia type has greatest and much more risk of progressing to a Type 1 (estrogen dependent: endometrioid, adenocarcinoma w/ squamous differentiation, mucinous, squamous) carcinoma |
| Type 1 endometrial carcinomas | endometrioid adenocarcinoma w/ squamous differentiation mucinous squamous estrogen dependent, classic pathway |
| Type 2 endometrial carcinomas | serous clear cell non estrogen dependent, alternative pathway |
| Well differentiated endometrioid carcinoma, with squamous differentiation: histology | glands are back to back with little stroma, see cribriform glands Cells show atypia Squamous differentiation: keratin producing squamoids (type 1) |
| Precursor for type 2 endometrial carcinoma | Endometrial Intraepithelial Carcinoma (type 2: serous, clear cell) |
| Serous carcinoma: histology | Complex branching papillae lined by pleomorphic cells with high nuclear grade Tumor cell tufts (micropapillae) Psammoma bodies (concentric calcifications) Histology identical to ovarian serous ca Widespread lymphvascular permeation (type 2) |
| Clear cell carcinoma: histology | Different architectural patterns: 1) Solid--no papillae, glands 2) Papillary 3) Tubular 4) Cystic pleiomorphic, hyperchromatin |
| Type 1 vs type 2 endometrial carcinomas in: unopposed estrogen? menopausal status? grade? myometrial invasion? behavior? | type 1: has unopposed estrogen pre or post menopause low grade minimal myometrial invasion stable behavior type 2: no unopposed estrogen post menopause high grade deep myometrial invasion progressive behavior |
| Stages of endometrial cancer | Stage 1 - confined to uterine corpus Stage 2 - involves cervix Stage 3 - extends beyond ut/cx (adnexa or vagina) with or without mets to pelvic & para-aortic LN Stage 4 - bladder/bowel, distant mets, + intraabdominal or inguinal LN |
| Types of Uterine Sarcomas | -Endometrial stromal sarcoma -Leiomyosarcomas -Mixed tumors (Adenosarcoma, MMMT/Carcinosarcoma) |
| Levels of endometrial stromal sarcomas | Stromal nodule (Benign) Low grade endometrial stromal sarcoma Undifferentiated Endometrial sarcoma (formerly High grade endometrial stromal sarcoma) |
| Low grade stromal sarcoma gross appearance | Worms - distinctive gross appearance/may extend beyond uterus |
| Endometrial stromal sarcoma histology | Low grade: Clusters of small uniform cells infiltrate myometrium and fill lymphatic channels, minimal atypia, haphazardly organized Undifferentiated endometrial sarcoma: Significant cytologic atypia Hemorrhage and necrosis common Most have spread beyond uterus at time of diagnosis--aggressive Hi mitotic amounts of cells |
| Levels of endometrial smooth muscle tumors | Leiomyoma (Benign) Leiomyosarcoma benign does not convert into malignant |
| Leiomyosarcoma: gross and histo | gross: white and firm on outside, hemorrhagic and necrotic on inside histo: hypercellular spindles, pleiomorphic, lots of mitosis |
| Leiomyosarcoma: symptoms | Post menopausal bleeding, uterine enlargements, abdominal pain, constipation, urinary frequency |
| Adenosarcoma: histo, progression/malignancy | Epithelial component resembles proliferative endometrium w/slit like glands Mitoses common Epithelial component is BENIGN Stromal component is MALIGNANT Recurrence and distant mets occur after many years |
| Carcinosarcoma/Malignant Mixed Mullerian Tumor: gross | bulky masses, necrotic/hemorrhagic can extrude from the cervix |
| Carcinosarcoma/Malignant Mixed Mullerian Tumor: characs of glandular and stromal components | both gland and stroma are malignant Glandular component usually endometrioid carcinoma Stromal component can be HOMOLOGOUS or HETEROLOGOUS Homologous - differentiation is same as uterus : endometrial stroma or smooth muscle Heterologous - different from uterus : mesenchymal tissue found elsewhere: cartilage, skeletal muscle, fat Uniformly aggressive; appearance of stroma has no value in predicting outcome |
| Ovarian granulosa cell tumor: gross and histo | gross: fleshy cystic looking hemorrhage histo: cell with nuclei in groove down the middle |
| How is Tamoxifen used? | Used for breast cancer, survival with tamoxifen outweighs the risk of it causing secondary uterine cancer, so you give anyway and just monitor yearly with gyn exams It is an estrogen antagonist in the breast, agonist in the uterus |
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