Uterine Malignancy

Question 1

When do endometrial polyps often occur?

Answer 1

Around/after the menopause

Question 2

If a young woman gets endometrial cancer, what conditions should you bear in mind?

Answer 2

• PCOS

- Lynch syndrome

Question 3

Atypical hyperplasia is the precursor for which type of endometrial cancer?

Answer 3

Endometriod carcinoma

Question 4

Serous intraepithelial carcinoma is the precursor for which type of cancer?

Answer 4

Serous carcinoma

Question 5

Are endometrial carcinomas more likely to be adenocarcinomas or squamous?

Answer 5

ADENOCARCINOMA

Question 6

What is the myometrium?

Answer 6

Middle layer of the uterus wall

Question 7

How does an endometrial carcinoma spread?

Answer 7

• HAEMATOGENOUS

- directly into myometrium and cervix

Question 8

TP53 is often mutated in which type of endometrial cancer?

Answer 8

Serous (and clear cell)

Question 9

What does aromatase do?

adipocytes express aromatase

Answer 9

It converts ovarian androgens into OESTROGENS (this induces endometrial proliferation)

Question 10

Effect of insulin on the endometrium?

Answer 10

Insulin/insulin-like growth factors (IGF) exert a proliferative effect on the endometrium

Question 11

Insulin action in obese people and its role in endometrial cancer

Answer 11

Insulin action is often altered in obese women: The level of insulin-binding globulins is reduced and free insulin levels are elevated. Insulin/insulin-like growth factors (IGF) exert proliferative effect on endometrium.

Question 12

SHBG levels in obese people and its role in endometrial cancer?

Answer 12

Sex hormone-binding globulin levels are lower in obese women, and therefore the level of unbound, biologically active hormone is higher.

Question 13

Lynch syndrome inheritance

Answer 13

Autosomal Dominant

Question 14

How could you identify a tumour in Lynch syndrome

Answer 14

Immunohistochemistry staining (for mismatch repair proteins)

Question 15

Name a characteristic of defective mismatch repair

Answer 15

Microsatellite instability

Question 16

Characterised by a complex papillary and/or glandular architecture with diffuse, marked pleomorphism

Answer 16

Serous carcinoma

Question 17

How are endometriod carcinomas graded?

Answer 17

Primarily graded by their architecture

Question 18

Grade 1 endometriod carcinoma

Answer 18

5% or less solid growth

Question 19

Grade 2 endometriod carcinoma

Answer 19

6-50% solid growth

Question 20

Grade 3 endometriod carcinoma

Answer 20

> 50% solid growth

Question 21

Stage 1A endometrial carcinoma

Answer 21

no or less than 50% myometrial invasion

Question 22

Stage 1B endometrial carcinoma

Answer 22

> 50% myometrial invasion

Question 23

Stage II endometrial carcinoma

Answer 23

Tumour invades cervical stroma

Question 24

Stage IIIA endometrial carcinoma

Answer 24

Tumour invades serosa of uterus and/or adnexae

Question 25

Stage IIIB endometrial carcinoma

Answer 25

Tumour invades vagina and/or parametrium

Question 26

Stage IIIC endometrial carcinoma

Answer 26

Metastases to pelvic and/or para-arotic lymph nodes

Question 27

Stage IV endometrial carcinoma

Answer 27

Tumour invades bladder and/or bowel mucosa (IVA) and/or distant metastases (IVB)

Question 28

This tumour arises from endometrial stroma

Answer 28

Endometrial stromal sarcoma

Question 29

Mixed tumour with malignant epithelial and stromal elements

Answer 29

Carcinoma (Mullerian tumour)

Question 30

Most important prognostic factor in endometrial stromal sarcoma?

Answer 30

Stage

Question 31

Most common place where endometrial stromal sarcoma will metastasise to?

Answer 31

Ovary or lung

Question 32

In carcinosarcoma, the presence of a _____ component has the worst prognosis?

Answer 32

Rhabdomyosarcomatous

Question 33

Leiomyomata

Answer 33

Fibroids (singular: leiomyoma)

Question 34

What is the most common uterine sarcoma?

Answer 34

Leiomyosarcoma

Question 35

Cells seen in leiomyosarcoma

Answer 35

Spindle cells

Question 36

Endometriod carcinoma precursor?

Answer 36

Atypical hyperplasia

Question 37

Serous carcinoma precursor?

Answer 37

Serous intraepithelial carcinoma

Question 38

Type 1 Endometrial carcinoma?

Answer 38

Endometriod (and mucinous)

Question 39

Type 2 Endometrial carcinoma?

Answer 39

Serous (and clear cell)

Question 40

How could granulosa cell tumours present?

Answer 40

Precocious puberty, PMB etc (due to oestrogen production by the tumour!)

Question 41

Which ovarian tumour could present with thyrotoxicosis?

Answer 41

E.g. a dermoid cyst! (they are totipotential, could contain thyroid tissue, sebaceous material etc etc)

Question 42

How could thecal tumours present?

Answer 42

Hirsutism, virilisation (because of androgen production by the tumour!)

Question 43

What type of ovarian tumour in Meig's syndrome?

Answer 43

Fibroma

Question 44

What hormone could malignant germ cells produce?

Answer 44

HCG or AFP

Question 45

Exudate seen in ovarian cancer?

Answer 45

Malignant ascites with protein exudate