female reproductive tract part 4 endometrium cont.

Question 1

what is endometrial hyperplasia?

Answer 1

increase in the number of endometrial glands relative to the stoma

it is a premalignant condition

Question 2

what are the two types of endometrial hyperplasia?

Answer 2

typical - slight risk to progress to carcinoma

atypical - substantial risk to progress to carcinoma

Question 3

what does typical endometrial hyperplasia look like?

Answer 3

glandular crowding +/- cystic change with no atypia

glands are more cyctic appearing

Question 4

what does atypical hyperplasia look like

Answer 4

complex glandular proliferation with nuclear atypia

crowding increases, scant amount of stroma between glands

nuclei show hyperplasia and enlargement

Question 5

risk factors for endometrial hyperplasia

Answer 5

unapposed estrogen increases risk

-obesity
- PCOS
- estrogen replacement therapy
- tamoxifen therapy
- estrogen producing tumors
- no children
- early period late menopause

unapposed- no progesterone

Question 6

tamoxifen is proestrogenic in the _ but is antiestrogenic in the _

Answer 6

uterus

breasts (used for breast cancer)

Question 7

endometrial cancer is most seen in _ (premenopausal/post menopausal) women

Answer 7

postmenopausal

75%

Question 8

what is the most common symptoms of endometrial cancer

Answer 8

abnormal uterine bleeding

90%

Question 9

what is the most common type of endometrial carcinoma

Answer 9

endometrial endometroid carcinoma

80-85 % of all endometrial carcinomas

Question 10

endometrial endometroid carcinoma is driven by the _ pathway

Answer 10

hyperplasia pathway

typical hyperplasia to atypical hyperplasia and finally carcinoma

Question 11

typical hyperplasia is a mutation in ?

Answer 11

PTEN

Question 12

atypical hyperplasia is a mutation in ?

Answer 12

KRAS

Question 13

how does endometriod carcinoma progess (slow, fast)

Answer 13

slow/indolent

Question 14

serous carcinoma of the uterus is the second most common endometrial carcinoma they arise for then _ pathway and have an increased incidence in _ (race)

Answer 14

atrophic pathway- atrophic noncyclic endometrial tissue

african american (postmenopasual)

15& of all endometrial carcinomas

occur 10 years later than endometroid cancer

Question 15

pathogenesis of serous carcinoma of the uterus

Answer 15

atrophic endometrium
TP53 aneuploidy
serous endometrial intraepithelial carcinoma
serous carcinoma

Question 16

what is the main risk factor for serous carcinoma of the uterus?

Answer 16

Age which drives TP53 mutations

Question 17

histology of a serous carcinoma of the uterus

Answer 17

papillary growth pattern with cytologic atypia

papillary growth has papillary projections with a fibrovascular core

Question 18

histology of an endometrial endometroid carcinoma

Answer 18

like regular endometrium but very little to know stroma

can form a mass

Question 19

unlike endometroid carcinoma of the uterus which is graded by the degree of _ , serous carcinomas are uniformly considered _ grade

Answer 19

solid component- endometroid

high grade- serous

Question 20

what is a malignant mixed mullerian tumor (MMMT)

Answer 20

a rare, aggressive endometrial tumor that is found in african americans in the post menopausal sate

Question 21

MMMT are comrpised of ?

Answer 21

malignant glands and malignant stroma

the malignant glands can be that of serous type of endometroid type

malignant stroma can be differentiated or diffentiated into things like cartilage, muscle, etc. - heterologous

Question 22

what does heterologous mean?

Answer 22

this meains that the malignant stroma does not for sarcomatous elements found in other uterine sarcomas (chondrosarcoma, rhabdomyosarcoma)

poor prognositc feature- more aggressive

Question 23

what are 2 examples of heterologous components in a malignant mixed mullerian tumor

Answer 23

chondrosarcoma (cartilage)
rhabdomyosarcoma (primitive muscle cells usually seen in the embryo)

must have malignant glands and malignant stroma

Question 24

Lynch syndrome is inheritied in a _ _ fashion

Answer 24

autosomal dominant

Question 25

what is the mutation in lynch syndrome

Answer 25

mutation in mismatch repair genes (MLH1 and MSH2) leading to microsatillite instability ***cant repair DNA mismatches which occur in repetitive sequences to form microsatilites

Question 26

the microsatillite instability in lynch syndrome leads to an increased risk for?

Answer 26

colorectal cancers endometrial (uterine ) and ovarian cancers of the endometroid type

Question 27

endometroid carcinoma are type _

Answer 27

1

Question 28

serous and malignant mixed mullerian tumors are type _

Answer 28

2

Question 29

are the endometrial cancer in lynch syndrome type 1 or type 2

Answer 29

type 1

Question 30

what is an adenosarcoma

Answer 30

this is a combination tumor of benign endometrial glands and malignant stroma may be mistaken for a endometrial polyp on histology

Question 31

what is a low grade endometrial stromal sarcoma

Answer 31

a malignant tumor that is comprised of small blue tumor cells recapitulating normal endometrial stromal cells

Question 32

low grade endometrial stromal sarcomas invade where?

Answer 32

myometrium and lymph/vascular spaces

Question 33

symptoms of low grade endometrial stromal sarcoma

Answer 33

abdominal pain, AUB

Question 34

what is the key chromosomal abnormality associated with low grade endometrial stromal sarcoma

Answer 34

JAZF1 translocation that results in the fusion of SUZ12 gene

Question 35

what is a leiomyoma?

Answer 35

a fibroid that is a tumor of the myometrium it is benign and is composed of smooth muscle and spindled cells ## Footnote most common gynecological tumor in women

Question 36

how do leiomyomas look

Answer 36

singular or more likely to be joined together circumscribed whte to white tan whorled sufraces

Question 37

what does the histology of a leiomyoma look like?

Answer 37

intersecting fasciles of spindled shaped smooth muscle cells with pink eosinophillic cytoplasm cigar chaped nuceli

Question 38

common symtpoms of leiomyoma

Answer 38

uterine bleeding and infertility

Question 39

leiomyomas may have a _ mutation

Answer 39

med 12 ## Footnote a lot of uterine smooth muscle tumors have a med12 mutation

Question 40

what is a leiomyosarcoma

Answer 40

an uncommon malignant neoplasm of uterine smooth muscle

Question 41

some leiomyosarcomas have a _ mutation similar to leiomyoma

Answer 41

med 12 ## Footnote usually not a direct progression though

Question 42

are leiomyosarcomas aggresive?

Answer 42

yes, 50% of them metastasize to the lung, brain, bone etc.

Question 43

on histology unline leiomyomas: leiomyosarcomas have what?

Answer 43

atypia, mitoses, and tumor necrosis

Question 44

grossly what does a leiomyosarcoma look like ?

Answer 44

bulky, fleshy mass