A 45 year old female presents with intermenstrual bleeding. Pelvic exam does not reveal any abnormalities, but on ultrasound you notice an endometrial mass in the fundus. The pathology report states: “Cystically dilated and hyperplastic endometrial glands with fibrous endometrial stroma; No atypia noted”. What is the most likely diagnosis?
Dx: Endometrial Polyp
A 59 year old female presents with uterine bleeding. Upon further work-up you diagnose endometrial hyperplasia. Your patient then asks, “what causes this?”. How do you respond?
Dx: Endometrial Hyperplasia
EH is a result of unopposed estrogen (Obesity, PCOS, estrogen replacement)
It can result in simple, complex, or atypical hyperplasia, with atypia being the most important predictor of progression to carcinoma.
A 32 year old female presents to you with concerns of having uterine cancer. She has read a lot on the internet about various types of endometrial cancer, and asks you, “what is the difference between EIN and endometrial hyperplasia?”
Endometrial hyperplasia is considered a polyclonal pathology where all endometrial cells are acted upon and proliferate. EIN is seen as a monoclonal pathology consisting of monoclonal neoplastic growths of genetically altered cells that have an increased risk of becoming endometroid endometrial adenocarcioma.
You diagnose a patient with endometrial adenocarcinoma. What are risk factors for this type of cancer and in what population does it usually occur?
Occurs mainly in pre- or perimenopausal women and is associated w/ obesity, hyperlipidemia, anovulation, infertility, and late menopause
A patient with an endometrial mass undergoes biopsy. You catch a glimpse of the pathology report and see “Psammoma bodies”. What is the most likely diagnosis? What 4 types of cancer do you see psammoma bodies in?
Dx: Serous adenocarcioma of the endometrium
1- Meningioma
2- Papillary Carcinoma of the thyroid
3-Serous carcinoma of ovary/endometrium
4-Mesothelioma
A 34 year old female patient presents with abnormal uterine bleeding and a pelvic mass. On biopsy there is little mitotic activity, no nuclear atypia, and the mass was said to be a “white-whorled” well-defined mass. What is the most likely diagnosis?
Dx: Leiomyoma (Fibroid)
Most common tumor of female genital tract and there are often multiple lesions, not just one.
A 37 year old female presents with abnormal uterine bleeding. A mass is found and biopsy shows Leiomyosarcoma. How does this differ from a leiomyoma? And what population is it most likely seen in?
Usually present as a single mass with hemorrhage and necrosis. They often show nuclear atypia with lots of mitoses. This is usually seen in POSTmenopausal women.
A 45 year old female presents to you with an endometrial mass later determined to be endometrial adenocarcinoma. What gene is usually implicated in the tumorigenesis of this lesion?
PTEN tumor suppressor gene
(ptENdometrial carcinoma)
Usually a result of deletion, mutation, and/or promoter hypermethylation
