Endometrial Tumors

Question 1

What is an endometrial polyp?

Answer 1

Benign stromal neoplasm in the endometrial cavity

Question 2

Where do most endometrial polyps occur?

Answer 2

In the fundus of the uterus

Question 3

An endometrial polyp is shown. What is typical clinical presentation?

Answer 3

Intermestrual bleeding

Question 4

What is the cause of benign endometrial hyperplasia?

Answer 4

Abnormal estrogenic stimulation

Question 5

By what is BEH characterized?

Answer 5

Diffuse, randomly distributed, architectural and cytologic changes

Question 6

What are the 3 types of Endometrial Hyperplasia? What are the characteristics of each type?

Answer 6

1. Simple Hyperplasia - Minimal glandular complexity/crowding and no cytologic atypia
2. Complex Hyperplasia - Marked glandular complexity/crowding and no cytologic atypia
3. Atypical hyperplasia - Cytologic atypia and marked glandular crowding

Question 7

What are the two discrete entities of endometrial hyperplasia?

Answer 7

1. Benign endometrial hyperplasia
2. Endometrial Intraepithelial Neoplasia

Question 8

What is endometrial intraepithelial neoplasia?

Answer 8

Monoclonal neoplasic growths of genetically altered cells with greatly increased risk of becoming the endometrioid type of endometrial adenocarcinoma

Question 9

Endometrial Intraepithelial Neoplasia is shown. What are typical findings?

Answer 9

Tight clusters of ctyologically altered neoplastic endometrial glands with abundant cytoplasm and rounded nuclei

Question 10

How are endometrial carcinoma classified?

Answer 10

Two types:

1. Type I tumors (endometrioid carcinoma)
2. Type II tumors (Nonendometrioid carcinoma)

Question 11

Of two endometrial adenocarcinoma, which is more lethal?

Answer 11

Type II tumors (nonendometrioid)

Question 12

What is the primary genetic driver for type I tumors? Type II tumors?

Answer 12

Usatellite instability; p53 alterations and loss of heterozygosity

Question 13

What five main molecular alterations play a role in type I endometrial tumorgenesis?

Answer 13

1. Usatellite instability
2. PTEN (tumor suppressor) mutation
3. k-RAS mutation
4. Beta-catenin
5. PIK3CA mutations

Question 14

What three molecular changes contribute to type II endometrial tumorgenesis?

Answer 14

1. p53 mutations
2. Her2/neu amplification
3. LOH on several chromosomes

Question 15

Endometrioid adenocarcinoma is shown. Describe the grading scheme.

Answer 15

Grades 1-3 with 3 being the worst. The greater the solid tumor/glandular tumor ratio, the worse differentiation and the higher the grade

Question 16

If an endometrioid adenocarcinoma contains squamous elements, what is the Dx?

Answer 16

Endometrioid Adenocarcinoma with squamous differentiation

Question 17

Which type of endometrioid adenocarcinoma has the best Px? Why?

Answer 17

Endometrioid adenocarcinoma, secretory type; Probably because it is so well differentiated

Question 18

What types of endometrial adenocarcinoma are associated with estrogen exposure?

Answer 18

Endometrioid, NOT nonendometrioid

Question 19

Squamous cells are seen within an endometrioid adenocarcinoma. What is the Dx?

Answer 19

Endometrioid Adenocarcinoma with Squamous Differentiation

Question 20

A Clear cell adenocarcinoma is shown. What do the clear cells contain? What other cells are seen?

Answer 20

Glycogen; Hobnail cells (Bulbous nuclei lining glandular lumina)

Question 21

Carcinosarcoma is shown. What types of cells are intermingled?

Answer 21

Pleomorphic epithelial cells intermingled with cells of mesenchymal differentiation

Question 22

What are the two major categories of endometrial stromal sarcoma?

Answer 22

Expansile or infiltrating

Question 23

What are expansile lesions? What are infiltrating lesions?

Answer 23

Benign stromal nodules; Stromal sarcomas

Question 24

What markers are used to ID endometrial stromal sarcomas?

Answer 24

CD-10 and Estrogen/Progesterone receptors

Question 25

Periglandular cuffing by atypical stroma with mitotic activity is shown. Dx?

Answer 25

Uterine Adenosarcoma

Question 26

What is the most common tumor of the female genital tract?

Answer 26

Leiomyoma

Question 27

What are leiomyomas?

Answer 27

Benign tumors of smooth muscle origin

Question 28

Leiomyoma is shown. How is it differentiated from the surrounding myometrium?

Answer 28

Leiomyoma and surrounding myometrium are cytologically identical but leiomyomas are distinguished by their circumscription, nodularity and denser cellularity

Question 29

What is Intravenous Leiomyomatosis? What is the Px if it metastasizes?

Answer 29

Benign smooth muscle grows w/i uterine and pelvic veins; it does not metastasize

Question 30

What is Leiomyosarcoma? How does it compare to Leiomyoma?

Answer 30

Malignancy of smooth muscle; Much less common than leiomyoma

Question 31

Leiomyosarcoma is shown. What are typical findings that lead to Dx?

Answer 31

* Gross: Soft, necrotic * Histo: Geographical necrosis, _\>_ 10 mitoses/HPF, nuclear atypia