Pathology of the Female Reproductive Tract 3 Flashcards
Endometrial cancer
Over 80% of women with endometrial cancer present with post menopausal bleeding.
- It means that post menauposal bleeding must be investigated .
- the tip fo tumour has become ischemic and necrotic
- the dark discoloration is hwree it has been bleeding into the vascular space of the tumour
- the tumour fragments and the blood can break off and pass down through the endocervical canal
Normal lining endometrium
endometrium
- Composed of glands in a specialised stroma with a specialised blood supply
- Growth, maturation and regression of all three components is co-ordinated during each menstrual cycle
Endometrial Cancer
The endometrium is the epithelium of the uterus
•The predominant endometrial cancer arises in the glands of the endometrium
•Malignant neoplasm of glandular epithelium = adenocarcinoma
-so the most predominant type of endometrial cancer is adenocarcinoma
Compare normal endometrium and adenocarcinoma
On-Left-hand side we have some endometrium from the proliferative phase which is before ovulation.
- Abnormal differentiation here is reflected by the fact that we are not seeing this nice and today architecture with glandular formation.
- we are instead seeing this hint of these round structures forming in the middle of the tumour.
- we can see scatered mitotic figures which indicates that the figure is proliferating
- the nuclei are dark staining
Adenocarcinomas
Adenocarcinomas are malignant neoplasms arising in glandular epithelium.
- Adenocarcinomas arising at different sites in the body have different risk factors, pathogenesis, appearances, genetic abnormalities, behaviour, prognosis and treatment.
- Among adenocarcinomas arising at a single site there are multiple subtypes, initially divided by different appearances and increasingly supplemented by understanding molecular genetic pathogenesis.
Subtypes of endometrial adenocarcinoma by morphology*
endometrial cancer/adenocarcinoma have different subtypes which can be identified by morphology (the appearance of the tumour under a microscope). they include;
•Endometrioid (most common) - the glands were though to resemble the original endometrial gland.
•Serous
•Clear cell
•Mixed (components of the previous 3)
•Undifferentiated / Dedifferentiated
•Carcinosarcomas (although they arise from the endometrial cells, they can show some coexistent in the mesenchymal differentiation).
*morphology means microscopic appearance
Why the adenocarcinoma subtypes are named endometrioid, serous, clear cell
-Endometrioid cancers show differentiation that resembles endometrial glands
-Serous cancers were thought to resemble Fallopian tube epithelium
-Clear cell cancers have clear cytoplasm
Adenocarcinoma
- Adenocarcinoma subtypes with similar appearance and the same names occur at other sites.
- eg there is a clear cell carcinoma of the ovary just as there is aclelar cell carcinoma of the ovary.
- They are NOT the same disease
- If a tumour has spread to other sites it can be very difficult to work out which is the site of origin and which is the site of metastasis
adenocarcinoma contd
- We know that there are different microscopic morphologic types of endometrial adenocarcinoma.
- Does the appearance of the tumours reflect any biological difference in their cause and behaviour?
Demographic and histologic studies suggest two groups of women with endometrial adenocarcinoma
•The two groups differ with respect to
–Cause
–Age
–Morphologic types of tumour
–Molecular genetic abnormalities
–Precursor lesions
–Prognosis and treatment
Molecular Pathology
- The cancer genome atlas (TCGA) published an integrated genomic classification of endometrial cancer in 4 groups
- Based on integrated genomic, transcriptomic and proteomic characterisation of c370 endometrial carcinomas
TCGA Endometrial Cancers
Precursor lesions
•In the cervix, the precursor lesion to invasive squamous cell carcinoma is
•Cervical Intra-Epithelial Neoplasia (CIN)
•The disease process is called dysplasia
•We detect CIN by
–screening for HR HPV infection,
–looking for abnormal cells,
–examining the cervix by colposcopy
–Treating eg by LLETZ (Loop electrical excision procedure)
We know much less about precursor lesions in the endometrium
- It is assumed that the common (endometrioid) form of endometrial carcinoma has its origin in a lesion called atypical hyperplasia.
- This is supported by temporal, genetic and morphologic continuity with endometrioid endometrial adenocarcinoma.
-TEMPORAL EVIDENCE (the lesion, if left untreated, will progress to something else).
Hyperplasia (from ancient Greek ὑπέρ huper, “over” + πλάσις plasis, “formation”), or hypergenesis, is an increase in the amount of organic tissue that results from cell proliferation. It may lead to the gross enlargement of an organ,
-the endometrium in the image is from a post-menopausal woman because its very thin and its not showing features of proliferation.
Endometrial carcinoma by age of diagnosis
-it is peaking in women postmenopausal
Grading of endometrial carcinoma
