REGUB Path - Uterus (ii)
Carcinoma
epithelial derived
2 subsets
type 1: oestrogen dependent
younger patients (40s-60s, but even 30s)
better prognosis
preexisting hyperplasia
microsat instability, mutations in KRAS, PTEN, beta-catenin
type 2: non-oestrogen dependent
worse prognosis
older women
P53 mutations, LOH of several chromo
endometrioid adenocarc
most common
usually low grade + stage - good prognosis - surgery usually curative
affects perimenopausal women (40-60)
grading based on gland architecture (more aggressive tumours have less glands + are increasingly solid) + nuclear features
a/w squamous metaplasia
clear cell carc - related to endometrioid, but more mutations - worse prognosis
serous carc
most have papillary architecture
high grade pleomorphic nuclei - SMUDGE CELLS
serious - worse prognosis - rapid spread along tubes
consider drop down mets (ovarian primary - or there could be simply 2 primaries)
60+ y/o
often on surface of polyps
mucinous carc (rare)
a/w PTEN
tumour suppressor gene
chromo 10q33
regulates cell prolif + apoptosis
normal endometrium: high levels in prolif phase, absent in mid-late secretory phase
lost in 97% of cancers
isolated -ve glands may be earliest precursors
Carcinosarcoma
Malignant mixed mullerian tumour
epithelial (glands) + non-epithelial (mesenchymal - spindle cells [cart/muscle]) elements
malignant stroma between glands
particularly aggressive
usually polypoid
common in elderly patients with hx of radiation (e.g. for cervical cancer) 10-15 yrs ago
Staging
depth of invasion
if tumour invades outer 1/2 of myometrium, worse prognosis due to access to blood vessels
involvement of other organs (e.g. cervix)
Leiomyoma
fibroid
benign smooth muscle tumour (of myometrium)
clonal abnormalities
DOES NOT TRANSFORM TO A LEIOMYOSARCOMA
round, well-circumscribed, unencapsulated, white, whorled myometrial mass(es)
intramural, submucosal or subserosal
no haemorrhage or necrosis
grow slowly
tx: cannula in fem art - PVA (poly vinyl alcohol) beads to try shrink them) - giant cell reaction
Leiomyosarcoma
haemorrhage/necrosis
mitoses, necrosis, atypia, pleomorphism
NO PRECURSOR - starts malignant
round, intramural
usually 40-60 y/o
recur + met (lung, bone, brain)
single large mass >5cm, usually >10cm, irregular, infiltrating
not white
outgrows its blood supply - necrosis in centre
Stromal tumours
pure stroma
yellow - potentially hormone-producing
stromal nodule: benign, well-circumscribed
stromal sarcoma: infiltrative margin, lymphatic invasion, may recur in approx 11-12 yrs
undifferentiated endometrial sarcoma: aggressive