down growth of endometrial tissue into and between the smooth muscle fascicles of the uterus
grossly the uterus may be enlarged and may have a rounded appearance
patients may be asymptomatic or may present with menorrhagia or pelvic pain
Microscopically what do we seen in adenomyosis?
endometrial glands and stroma in the myometrium
What is endometrial hyperplasia? why do we get it? what is it due to?
it is increased proliferation of the endometrial glands relative to the stroma resulting in increased gland to stroma ratio and abnormalities in the epithelial growth.
It is linked to prolonged and unopposed estrogen stimulation of the endometrium such as anovulation, increased estrogen production or exogenous estrogen administration.
It can culminate in endometrial carcinoma.
Linked to PTEN inactivation
PTEN is linked with
Endometrial hyperplasia and endometrial cancer
In which disease do we see different histology that actually has a name and what are they? Which ones are worse than others and why?
simple endometrial hyperplasia w and w/o atypia
complex endometrial hyperplasia w and w/o atypia
Complex hyperplasia with atypia is worse because there is a 20% probability of endometrial carcinoma vs 1-2% in others
What is the difference histologically between complex and simple w and w/o atresia in endometrial hyperplasia?
Simple: round or tubular contours that are mystically dilated
complex: crowded with branching and budding
with atypia: prominent nucleoli, vesicular nuclei and loss of nuclear polarity
w.o atypia: uniform cells similar to those of the proliferative endometrium of the menstrual cycle
What is the treatment for endometrial hyperplasia?
cyclic progestin therapy
high dose progestin therapy
What is the most common invasive cancer of the female reproductive tract in the USA?
When is the peak incidence for endometrial carcinoma?
What are the risk factors to endometrial carcinoma?
basically unopposed estrogen like: obesity. DM, high fat diet, high socioeconomic status, tamoxifen use, unopposed estrogen replacement therapy
What are the types of endometrial carcinomas and what makes them different?
Type 1: group associated with increase estrogen levels and endometrial hyperplasia and these patients can have increased levels of estrogen due to obesity. anovulatroy cycles, ovarian estrogen secreting tumors and estrogen replacing therapy.
Well differentiated and of endometrium type: better prognosis
Type 2: associated with normal estrogen levels.
develop at an older age.
they are less differentiated and more aggressive
arise in background of atrophy rather than hypertrophy such as type 1.
Kras associated with
type 1 endometrial carcinoma
P53 associated with
type 2 endometrial carcinoma
oncogene associated with type 2 endometrial carcinoma
Most common carcinoma cell type of the cervix? endometrium? ovary?
endometrium: endometriod but clear can occur
What histological criteria needs to be there for endometrial adenocarcinoma?
confluent glands with ctibform growth
extensive intraglanduar papillary growth
despoplastic stromal response- rx of tissue to tumor
You hear a patient has serous or clear cell endometrial carcinoma. What grade is she
What is the grading of endometrial cancer?
G1: 95% of tumor forms glands
3: less than 50
What is the treatment for endometrial cancer?
What is the most common type of uterine tumor?
How do leiomyomas present?
abnormal uterine bleeding
can cause problems during pregnancy
What causes leyoimiomas?
Patient hears leyoimyoma and asks if she is going to die? What do you tell her?
it is benign and rarely if ever transforms
What happens to large leiomyomas?
large tumors may degenerate and develop sod yellow or red areas
What is the microscopic appearance of leiomyomas?
fascicles of spindled cells with oval nucleus and infrequent mitoses that resemble the normal myometrium but are more numerous