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Difference between revisions of "Uterine tumours"
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This article deals with '''uterine tumours''', excluding tumours that arise from the endometrium. | This article deals with '''uterine tumours''', excluding tumours that arise from the endometrium. | ||
Uterine tumours are like water in the sea - very very common. Many hysterectomies are done for 'em... the most common are leiomyomata ([[AKA]] fibroids). | Uterine tumours are like water in the sea - very very common. Many hysterectomies are done for 'em... the most common are leiomyomata ([[AKA]] fibroids). | ||
Pre-malignant endometrium and endometrial tumours are dealt with in the articles, ''[[endometrial hyperplasia]]'' and ''[[endometrial carcinoma]]''. | Pre-malignant endometrium and endometrial tumours are dealt with in the articles, ''[[endometrial hyperplasia]]'' and ''[[endometrial carcinoma]]''. | ||
=Common benign= | |||
==Leiomyomas== | ==Leiomyomas== | ||
{{Main|Leiomyoma}} | |||
===General=== | ===General=== | ||
*Often called "fibroids". | *Often called "fibroids". | ||
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**Can be a cause of [[AUB]] (abnormal uterine bleeding). | **Can be a cause of [[AUB]] (abnormal uterine bleeding). | ||
**Large & multiple associated with infertility. | **Large & multiple associated with infertility. | ||
===Gross=== | ===Gross=== | ||
| Line 24: | Line 20: | ||
* Whorled appearance. | * Whorled appearance. | ||
Factor that raise concern for leiomyosarcoma: | |||
* Haemorrhage. | * Haemorrhage. | ||
* Cystic degeneration. | * Cystic degeneration. | ||
* [[Necrosis]]. | * [[Necrosis]]. | ||
=== | ===Microscopic=== | ||
Features: | |||
* Necrosis (low power) | * Spindle cells arranged in fascicles. | ||
** Fascicular appearance: adjacent groups of cells have their long axis perpendicular to one another; looks somewhat like a braided hair that was cut. | |||
* Whorled arrangement of cells. | |||
Negatives: | |||
* Necrosis (low power) - suggestive of leiomyosarcoma. | |||
* Hypercellularity. | * Hypercellularity. | ||
* Nuclear atypia seen at low power. | |||
* Few mitoses. | |||
====Variants==== | |||
*Lipoleiomyoma - with adipose tissue. | |||
**Image: [http://commons.wikimedia.org/wiki/File:Lipoleiomyoma1.jpg Lipoleiomyoma - low mag. (WC)]. | |||
*Hypercellular leiomyoma - hypercellularity assoc. with more mutations.<ref>[http://www3.interscience.wiley.com/journal/119360394/abstract http://www3.interscience.wiley.com/journal/119360394/abstract]</ref> | |||
*Atypical leiomyoma (AKA ''symplastic leiomyoma'') - leiomyoma with nuclear atypia. | |||
**Image: [http://commons.wikimedia.org/wiki/File:Atypical_leiomyoma_intermed_mag.jpg Atypical leiomyoma (WC)]. | |||
===IHC=== | ===IHC=== | ||
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*Desmin (+ve). | *Desmin (+ve). | ||
=Uncommon benign= | |||
==Adenomatoid tumour== | ==Adenomatoid tumour== | ||
===General=== | ===General=== | ||
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*CK7 +ve.<ref>LAE. 9 December 2009.</ref> | *CK7 +ve.<ref>LAE. 9 December 2009.</ref> | ||
=Uncertain malignant potential= | |||
==Smooth muscle tumour of uncertain malignant potential (STUMP)== | |||
===General=== | |||
*Like ''[[ASAP]]'' and ''[[ASCUS]]'' - a [[waffle diagnosis|waffle category]]... when one isn't sure it is a ''leiomyoma'' vs. ''leiomyosarcoma''. | |||
*Clinical behaviour: usually benign.<ref name=pmid19417585>{{cite journal |author=Ip PP, Cheung AN, Clement PB |title=Uterine smooth muscle tumors of uncertain malignant potential (STUMP): a clinicopathologic analysis of 16 cases |journal=Am. J. Surg. Pathol. |volume=33 |issue=7 |pages=992–1005 |year=2009 |month=July |pmid=19417585 |doi=10.1097/PAS.0b013e3181a02d1c |url=}}</ref> | |||
*Can be subclassified into four groups - as per Stanford. | |||
Management: | |||
*Long-term follow-up.<ref name=pmid19417585/> | |||
===Microscopic=== | |||
Features associated with recurrence:<ref name=pmid19417585/> | |||
*Nuclear atypia. | |||
===IHC=== | |||
Features associated with recurrence:<ref name=pmid19417585/> | |||
*p16 +ve. | |||
*p53 +ve. | |||
=Malignant= | |||
==Carcinosarcoma== | ==Carcinosarcoma== | ||
* AKA ''malignant mixed muellerian tumour'', abbreviated ''MMMT''. | * AKA ''malignant mixed muellerian tumour'', abbreviated ''MMMT''. | ||
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==Adenosarcoma== | ==Adenosarcoma== | ||
===General=== | |||
*Uncommon. | |||
Tx: | |||
*TAH + BSO. | |||
===Microscopic=== | |||
Features:<ref name=Ref_PBoD1089>{{Ref PBoD|1089}}</ref> | Features:<ref name=Ref_PBoD1089>{{Ref PBoD|1089}}</ref> | ||
*Benign glands with an abnormal shape. | *Benign glands with an abnormal shape. | ||
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DDx: | DDx: | ||
*Benign polyp. | *Benign polyp. | ||
==Leiomyocarcoma== | ==Leiomyocarcoma== | ||
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**Smooth muscle myosin. | **Smooth muscle myosin. | ||
=Endometrial stromal tumours= | |||
==Overview== | |||
WHO classification:<ref name=Ref_WMSP426>{{Ref WMSP|426}}</ref> | WHO classification:<ref name=Ref_WMSP426>{{Ref WMSP|426}}</ref> | ||
*Endometrial stromal nodule - not a tumour. | *Endometrial stromal nodule - not a tumour. | ||
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*[[Melanoma]]. | *[[Melanoma]]. | ||
=Weird stuff= | |||
==Uterine tumors resembling ovarian sex cord tumours (UTROSCT)== | |||
*Look like sex cord tumour:<ref>URL: [http://www.nature.com/modpathol/journal/v19/n1/full/3800475a.html http://www.nature.com/modpathol/journal/v19/n1/full/3800475a.html]. Accessed on: 5 August 2010.</ref> | *Look like sex cord tumour:<ref>URL: [http://www.nature.com/modpathol/journal/v19/n1/full/3800475a.html http://www.nature.com/modpathol/journal/v19/n1/full/3800475a.html]. Accessed on: 5 August 2010.</ref> | ||
**May have: anastomosing cords, [[trabeculae]], small nests and/or tubules. | **May have: anastomosing cords, [[trabeculae]], small nests and/or tubules. | ||
=See also= | |||
*[[Gynecologic pathology]]. | *[[Gynecologic pathology]]. | ||
*[[Endometrial carcinoma]]. | *[[Endometrial carcinoma]]. | ||
*[[Endometrial hyperplasia]]. | *[[Endometrial hyperplasia]]. | ||
=References= | |||
{{reflist|2}} | {{reflist|2}} | ||
[[Category:Gynecologic pathology]] | [[Category:Gynecologic pathology]] | ||