Difference between revisions of "Uterine tumours"

From Libre Pathology
Jump to navigation Jump to search
m (moved Endometrial stromal tumours to Uterine tumours: more accurate name)
(rename article)
Line 1: Line 1:
'''Endometrial stromal tumours''' is like water in the sea - very very common.  Many hysterectomies are done for 'em... the most common are leiomyomata (AKA fibroids).
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).
 
Pre-malignant endometrium and endometrial tumours are dealt with in the articles, ''[[endometrial hyperplasia]]'' and ''[[endometrial carcinoma]]''.


==Leiomyomas==
==Leiomyomas==

Revision as of 17:35, 18 May 2010

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).

Pre-malignant endometrium and endometrial tumours are dealt with in the articles, endometrial hyperplasia and endometrial carcinoma.

Leiomyomas

General

  • Often called "fibroids".
  • Extremely common... 40% of women by age 40.
  • Benign.
    • Can be a cause of AUB (abnormal uterine bleeding).
    • Large & multiple associated with infertility.

Variants

  • Lipoleiomyoma - with adipose tissue.
  • Hypercellular leiomyoma - hypercellularity assoc. with more mutations.[1]
  • Atypical leiomyoma (AKA symplastic leiomyoma) - leiomyoma with nuclear atypia.

Gross

  • Sharply circumscribed.
  • Gray-white.
  • Whorled appearance.

Look for...

  • Haemorrhage.
  • Cystic degeneration.
  • Necrosis.

Microscopy

Look for ...

  • Necrosis (low power) -- suggestive of leiomyosarcoma.
  • Hypercellularity.

IHC

Work-up of suspicious leiomyomas:[2]

  • CD10 (+ve).
  • Ki-67 (-ve).
  • SMA (+ve).
  • Desmin (+ve).

Adenomatoid tumour

General:

  • Grossly mimics leiomyoma.[3]
  • Benign tumour.

Microscopy

Features:

  • Contains small tubulocystic spaces lined by cytologically normal mesothelium.

IHC

  • CK7 +ve. (???)[4]
  • Calretin +ve.

Carcinosarcoma

  • AKA "malignant mixed muellerian tumour" (MMMT)
  • May have differentiation to:
    • Muscle,
    • Cartilage or
    • Bone.
  • Assoc. with previous radiation exposure.
  • Metstasize as adenocarcinoma.

Adenosarcoma

Features:[5]

  • Benign glands with an abnormal shape.

DDx:

  • Benign polyp.

Tx:

  • TAH + BSO.

Leiomyocarcoma

General

  • Poor prognosis.
  • Do not (generally) arise from leiomyomas.
  • Often singular, i.e. one tumour; unlike leiomyomas (which are often multiple).

Gross

  • "Fleshy" appearance.
  • Necrosis.
  • Large size.
  • Often singular, i.e. one lesion; leiomyomata are often multiple.

Microscopic

  1. Cellular atypia - common.
  2. Necrosis.
    • Should be patchy/multifocal.
    • Zonal necrosis is suggestive of vascular cause.
  3. Mitoses - key feature.
    • 10/HPF.
    • 5/HPF - if epithelioid.
    • 2/HPF - if myxoid.

IHC

  • CD10 -ve.
  • Positive for SMC markers.
    • Desmin - present in all three types of muscle.
    • Caldesmon.
    • Smooth muscle myosin.

Smooth muscle tumour of uncertain malignant potential (STUMP)

  • Like PUNLMP and ASCUS - a waffle category... when one isn't sure it is a leiomyoma vs. leiomyosarcoma.
  • Clinical behaviour: usually benign.[6]
  • Can be subclassified into four groups - as per Stanford.

Features associated with recurance:[6]

  • p16+, p53+, nuclear atypia.

Management

  • Long-term follow-up.[6]

Endometrial stromal tumours

Overview

WHO classification:[7]

  • Endometrial stromal nodule - not a tumour.
  • Endometrial stromal sarcoma (ESS), low grade.
  • Undifferentiated endometrial sarcoma

Notes:

  • Some believe in a "high grade ESS"... some don't.[8]

Low grade endometrial stromal sarcoma

Features:

  • Highly cellular Islands with a wavy irregular border.
    • Border has finger-like projections/tongue-like projections.
    • Benign uterine smooth muscle between islands of tumour cells.
  • Epithelioid cells.
  • High NC ratio.
  • Thin blood vessels within islands of cells.
    • Tumour cells pallisade around the vessels.

Notes:

  • Vaguely resembles the stroma of proliferative endometrium.

Undifferentiated endometrial sarcoma

Features:

  1. Marked nuclear atypia.
  2. Mitoses+++.
  3. Poorly differentiated - key feature
    • Looks nothing like low grade endometrial stromal sarcoma.
    • Negative for smooth muscle markers (to exclude leiomyosarcoma).

Notes:

  • Need IHC to diagnose.

DDx:

  • Leiomyosarcoma.
  • Carcinosarcoma.
  • Rhabdomyosarcoma.
  • Melanoma.

References