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Category Archives: Uterus
Endometrial Stromal Sarcoma
Endometrial Stromal Sarcoma
Endometrial Stromal Nodule
Gross: yellow, well defined
Histology: bland stromal cells, concentrically arranged around blood vessel
- no venous or lymphatics invasion
Low Grade Endometrial Stromal Sarcoma
Gross: yellow, well defined
Histology: low power: sharply defined tumour islands with pointy edges
- occasional mitoses
- vascular invasion
- arborizing vasculature, hyalinized stroma
Endometrial Stromal Sarcoma Immunohistochemistry
- CD10 positive
Endometrial Stromal Sarcoma Differential diagnosis
- epithelioid leiomyosarcoma (this is CD10 – and h-caldesmon + desmin +)
Undifferentiated Uterine Sarcoma
- no features of differentiation
- high grade, numerous mitoses
Endometrial Adenocarcinoma
Endometrial Adenocarcinoma
Endometrioid Adenocarcinoma of Uterus
What are the different variants?
- villoglandular
- adenoma malignum
- secretory (subnuclear vacuolization, resembles POD2)
- ciliated (cilia, differential diagnosis is cilia cell metaplasia)
Histology: thin, long, delicate fronds with pseudostratified endometrium (villoglandular)
- low grade nuclei
Differential diagnosis:
- serous papillary endometrial adenocarcinoma (p53 negative in villoglandular endometrial adenocarcinoma)
- endometrial vs. cervical endometrioid adenocarcinoma:
use the immunohistochemistry panel (vimentin +, CEA -, ER +, HPV -, p16 -)
Serous Adenocarcinoma of Uterus
Histology: short papillae with fibrovascular cores, slit like glands
- high grade nuclei and multiple mitoses
- psammoma bodies
Immunohistochemistry: p53 positive in > 70% of nuclei (differential diagnosis of endometrial)
Clear Cell Adenocarcinoma of Uterus
Histology:
- high grade nuclei
- hobnail cells
SS: PAS positive glycogen in cytoplasm
Mucinous Adenocarcinoma of Uterus
Histology: endocervical-type lining of glands with pseudostratification
- need > 50% differentiation
Special Stains: mucicarmine, Alcian blue
Grading: same as endometrial
Rare Endometrial Cancer Types
Squamous
Mixed
Small cell neuroendocrine carcinoma
- like other small cell carcinoma
Endometrial Adenocarcinoma Genetics
Endometrioid: mutations and MSI in PTEN, k-ras and β-catenin
Non-endometrioid: mutations in p53
Endometrial Adenocarcinoma Invasion
Muscular invasion (deep or associated granulation tissue) vs.
1) Expansion of endometrial-myometrial junction
2) Adenomyosis
Endometrial Adenocarcinoma Treatment
Endometrioid: total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAH-BSO)
{+/- surgical staging (pelvic and para-aortic nodes & peritoneal cytology)}
Serous: TAH-BSO and surgical staging and adjuvant therapy
Posted in Uterus
Tagged adenocarcinoma, adenoma malignum, Ciliated Endometrioid Adenocarcinoma, Clear Cell Adenocarcinoma, Clear Cell Adenocarcinoma of Uterus, Endometrial adenocarcinoma, Endometrial Adenocarcinoma Genetics, Endometrial Adenocarcinoma Invasion, Endometrial Adenocarcinoma Treatment, endometrial cancer, Endometrial Cancer Genetics, endometrial carcinoma, Endometrioid Adenocarcinoma, Endometrioid Adenocarcinoma of Uterus, Endometrioid Cancer, mucinous adenocarcinoma, Mucinous Adenocarcinoma of Uterus, Mucinous cancer, Secretory Endometrioid Adenocarcinoma, Serous Adenocarcinoma, Serous Adenocarcinoma of Uterus, villoglandular
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Endometrial Carcinoma
Endometrial Carcinoma
Features of Endometrial Carcinoma
1. glands back to back
2. desmoplastic reaction
3. endometrial stromal foam cells (seen in hyperplasia too)
Risk Factors for Endometrial Carcinoma
- estrogen use, tamoxifen
- obesity, Diabetes, Hypertension, Polycystic ovarian syndrome,
- functioning granulosa cell and thecoma tumours
- gonadal dysgenesis (Turner syndrome)
Posted in Uterus
Tagged diabetes, Endometrial adenocarcinoma, endometrial carcinoma, Endometrial Carcinoma Risk Factors, Estrogen, Features of Endometrial Carcinoma, gonadal dysgenesis, granulosa cell tumor, hypertension, Polycystic ovarian syndrome, Risk Factors for Endometrial Carcinoma, Tamoxifen, Thecoma, Turner syndrome
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Endometrium Hyperplasia
Endometrium Hyperplasia
Endometrial Hyperplasia
Different types, histoloy, risk of progression to carcinoma
Simple Hyperplasia
- gland to stroma ratio, glands have a random orientation, usually round to cystically dilated glands with slight irregular contours -lined by proliferative endometrium (1%)
Complex Hyperplasia
- markedly crowded glands, irregular and serrated outlines with outpouching, thin rim of endometrial stroma surrounds glands (3%)
Simple Hyperplasia with Atypia
- (8%)
Complex Hyperplasia with Atypia
- (29%)
Posted in Uterus
Tagged complex hyperplasia, Complex Hyperplasia with Atypia, endometrial hyperplasia, Endometrium Hyperplasia, Hyperplasia, simple hyperplasia, Simple Hyperplasia with Atypia
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Endometrial Polyp
Endometrial Polyps
Typical:
Histology: endometrial glands and fibrotic stroma, glands out of sync with endometrium, large blood vessels, often prolapse, can get endometrial hyperplasia and cancer
Adenomatous Polyps
Histology: abundant smooth muscle is typical, endometrial polyp
Atypical Adenomatous Polyp
Histology: architecture cytologic atypia (mitoses, nuclei)
- squamous morules – swirling smooth muscle
Differential Diagnosis: muscle invasive adenocarcinoma, adenomyosis (has endometrial stroma present)
Posted in Uterus
Tagged Adenomatous Polyps, Atypical Adenomatous Polyp, Endometrial Polyps
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Endometritis
Endometritis
Causes:
TB, Sarcoid, Coccidimyocosis, actinomyces, herpes, CMV, Schistosomiasis, fungus, foreign body, xanthogranulomatous
Acute Endometritis
Cause: retained products of conception (POC), instrumentation, abortion
Organisms: gonorrhea, chlamydia, actinomyces
Histology: must have microabcess formation (neutrophils in glands and stroma)
Chronic Endometritis
Histology: plasma cells (often seen with spindled stroma) and lymphoid follicles (can be seen in normal)
Xanthogranulomatous Endometritis
Cause: secondary to pyometra or hematometra
Histology: foamy macrophages or hemosiderin-laden macrophages
IUD Intrauterine Device
Pathology: tubo-ovarian abcess, chronic endometritis, Actinomyces often present
Granulomatous Endometritis
Cause: Fungi, pinworm, schistosomiasis, foreign bodies, sarcoid, TB
Posted in Uterus
Tagged Actinomyces, Acute Endometritis, Chronic Endometritis, Endometrial inflammation, Endometritis, Granulomatous Endometritis, Intrauterine device, IUD, Schistosomiasis, Xanthogranulomatous Endometritis
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Arias-Stella Reaction
Arias-Stella Reaction
Cause: pregnancy-related change
Histology: glands enlarged, abundant clear or eosinophilic cytoplasm, marked nuclear changes, rare mitoses; decidualized stroma
Differential Diagnosis: clear cell carcinoma (post-menopausal, numerous mitoses, no decidual reaction)
Posted in Uterus
Tagged Arias-Stella, Arias-Stella Reaction, Arias-Stella Reaction Endometrium
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Disordered Proliferative Endometrium
Disordered Proliferative Endometrium
Cause: unopposed estrogen stimulation
Histology: glands: proliferative glands, cystically dilated, various sizes (no uniform development), stroma: proliferative with mitoses and may have stromal breakdown
Posted in Uterus
Tagged Disordered endometrium, Disordered Proliferative Endometrium, Proliferative endometriun, Proliferative phase
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