Difference between revisions of "Uterine tumours"
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==Carcinosarcoma== | ==Carcinosarcoma== | ||
* AKA | * AKA ''malignant mixed muellerian tumour'', abbreviated ''MMMT''. | ||
===General=== | |||
* Associated with previous radiation exposure. | |||
* | |||
* Metstasize as adenocarcinoma. | * Metstasize as adenocarcinoma. | ||
* Aggressive/poor prognosis;<ref name=pmid15688674>{{Cite journal | last1 = Ivy | first1 = JJ. | last2 = Unger | first2 = JB. | title = Malignant mixed mullerian sarcomas of the uterus--the LSUHSC Shreveport experience. | journal = J La State Med Soc | volume = 156 | issue = 6 | pages = 324-6 | month = | year = | doi = | PMID = 15688674 }}</ref> in one series 5 year survival ~= 30-35%.<ref name=pmid14967435>{{Cite journal | last1 = Callister | first1 = M. | last2 = Ramondetta | first2 = LM. | last3 = Jhingran | first3 = A. | last4 = Burke | first4 = TW. | last5 = Eifel | first5 = PJ. | title = Malignant mixed Müllerian tumors of the uterus: analysis of patterns of failure, prognostic factors, and treatment outcome. | journal = Int J Radiat Oncol Biol Phys | volume = 58 | issue = 3 | pages = 786-96 | month = Mar | year = 2004 | doi = 10.1016/S0360-3016(03)01561-X | PMID = 14967435 }}</ref> | |||
*Considered to be a poorly differentiated endometrial carcinoma with metaplastic changes.<ref name=pmid19853898>{{Cite journal | last1 = D'Angelo | first1 = E. | last2 = Prat | first2 = J. | title = Uterine sarcomas: a review. | journal = Gynecol Oncol | volume = 116 | issue = 1 | pages = 131-9 | month = Jan | year = 2010 | doi = 10.1016/j.ygyno.2009.09.023 | PMID = 19853898 }}</ref> | |||
*Case reports of MMMT in [[ovary]] and [[fallopian tube]]. | |||
===Microscopic=== | |||
Features:<ref name=Ref_WMSP428>{{Ref WMSP|428}}</ref> | |||
*Biphasic tumour: | |||
*#Malignant glandular component (adenocarcinoma). | |||
*#Malignant stromal component (one of the following): | |||
*#*Skeletal muscle. | |||
*#*Smooth muscle. | |||
*#*Cartilage. | |||
*#*Bone. | |||
*#*Undifferentiated sarcoma. | |||
Image: | |||
[http://commons.wikimedia.org/wiki/File:MalignantMixedMullerianTumor.JPG MMMT (WC)]. | |||
==Adenosarcoma== | ==Adenosarcoma== | ||
Revision as of 16:36, 30 May 2011
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.
- Image: Lipoleiomyoma - low mag. (WC).
- Hypercellular leiomyoma - hypercellularity assoc. with more mutations.[1]
- Atypical leiomyoma (AKA symplastic leiomyoma) - leiomyoma with nuclear atypia.
- Image: Atypical leiomyoma (WC).
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 - derived from mesothelium.
Notes:
- Should not be confused with Adamantinoma - a bone tumour.
Microscopy
Features:[4]
- Well-circumscribed lesion; however, not encapsulated.
- Small tubulocystic spaces lined by cytologically normal mesothelium.
Images:
- Adenomatoid tumour - low mag. (WC).
- Adenomatoid tumour - intermed. mag. (WC).
- Adenomatoid tumour - very high mag. (WC).
DDx:
- Lymphangioma.
- Leiomyoma.
IHC
Features:[5]
- Calretin +ve.
- AE1/AE3 +ve.
- CD31 -ve.
- CK7 +ve.[6]
Carcinosarcoma
- AKA malignant mixed muellerian tumour, abbreviated MMMT.
General
- Associated with previous radiation exposure.
- Metstasize as adenocarcinoma.
- Aggressive/poor prognosis;[7] in one series 5 year survival ~= 30-35%.[8]
- Considered to be a poorly differentiated endometrial carcinoma with metaplastic changes.[9]
- Case reports of MMMT in ovary and fallopian tube.
Microscopic
Features:[10]
- Biphasic tumour:
- Malignant glandular component (adenocarcinoma).
- Malignant stromal component (one of the following):
- Skeletal muscle.
- Smooth muscle.
- Cartilage.
- Bone.
- Undifferentiated sarcoma.
Image: MMMT (WC).
Adenosarcoma
Features:[11]
- Benign glands with an abnormal shape.
DDx:
- Benign polyp.
Tx:
- TAH + BSO.
Leiomyocarcoma
Main article: Leiomyosarcoma
General
- Poor prognosis.
- Do not (generally) arise from leiomyomas.
- Often singular, i.e. one tumour; unlike leiomyomas (which are often multiple).
Gross
Features:
- "Fleshy" appearance.
- Necrosis.
- Large size.
- Often singular, i.e. one lesion; leiomyomata are often multiple.
Microscopic
Features:
- Cellular atypia - common.
- Necrosis.
- Should be patchy/multifocal.
- Zonal necrosis is suggestive of vascular cause.
- Mitoses - key feature.
- 10 mitoses/HPF.
- 5 mitoses/HPF - if epithelioid.
- 2 mitoses/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)
General
- Like ASAP and ASCUS - a waffle category... when one isn't sure it is a leiomyoma vs. leiomyosarcoma.
- Clinical behaviour: usually benign.[12]
- Can be subclassified into four groups - as per Stanford.
Management:
- Long-term follow-up.[12]
Microscopic
Features associated with recurrence:[12]
- Nuclear atypia.
IHC
Features associated with recurrence:[12]
- p16 +ve.
- p53 +ve.
Endometrial stromal tumours
Overview
WHO classification:[13]
- 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.[14]
Low grade endometrial stromal sarcoma
Microscopic
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.
Image(s):
Notes:
- Vaguely resembles the stroma of proliferative endometrium.
Undifferentiated endometrial sarcoma
Features:
- Marked nuclear atypia.
- Mitoses+++.
- 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.
Weird stuff
Uterine tumors resembling ovarian sex cord tumours (UTROSCT)
- Look like sex cord tumour:[15]
- May have: anastomosing cords, trabeculae, small nests and/or tubules.
See also
References
- ↑ http://www3.interscience.wiley.com/journal/119360394/abstract
- ↑ STC. 25 February 2009.
- ↑ Huang, CC.; Chang, DY.; Chen, CK.; Chou, YY.; Huang, SC. (Sep 1995). "Adenomatoid tumor of the female genital tract.". Int J Gynaecol Obstet 50 (3): 275-80. PMID 8543111.
- ↑ Nucci, Marisa R.; Oliva, Esther (2009). Gynecologic Pathology: A Volume in Foundations in Diagnostic Pathology Series (1st ed.). Churchill Livingstone. pp. 346. ISBN 978-0443069208.
- ↑ Canedo-Patzi, AM.; León-Bojorge, B.; de Ortíz-Hidalgo, C.. "[Adenomatoid tumor of the genital tract. Clinical, pathological and immunohistochemical study in 9 cases]". Gac Med Mex 142 (1): 59-66. PMID 16548294.
- ↑ LAE. 9 December 2009.
- ↑ Ivy, JJ.; Unger, JB.. "Malignant mixed mullerian sarcomas of the uterus--the LSUHSC Shreveport experience.". J La State Med Soc 156 (6): 324-6. PMID 15688674.
- ↑ Callister, M.; Ramondetta, LM.; Jhingran, A.; Burke, TW.; Eifel, PJ. (Mar 2004). "Malignant mixed Müllerian tumors of the uterus: analysis of patterns of failure, prognostic factors, and treatment outcome.". Int J Radiat Oncol Biol Phys 58 (3): 786-96. doi:10.1016/S0360-3016(03)01561-X. PMID 14967435.
- ↑ D'Angelo, E.; Prat, J. (Jan 2010). "Uterine sarcomas: a review.". Gynecol Oncol 116 (1): 131-9. doi:10.1016/j.ygyno.2009.09.023. PMID 19853898.
- ↑ Humphrey, Peter A; Dehner, Louis P; Pfeifer, John D (2008). The Washington Manual of Surgical Pathology (1st ed.). Lippincott Williams & Wilkins. pp. 428. ISBN 978-0781765275.
- ↑ Cotran, Ramzi S.; Kumar, Vinay; Fausto, Nelson; Nelso Fausto; Robbins, Stanley L.; Abbas, Abul K. (2005). Robbins and Cotran pathologic basis of disease (7th ed.). St. Louis, Mo: Elsevier Saunders. pp. 1089. ISBN 0-7216-0187-1.
- ↑ 12.0 12.1 12.2 12.3 Ip PP, Cheung AN, Clement PB (July 2009). "Uterine smooth muscle tumors of uncertain malignant potential (STUMP): a clinicopathologic analysis of 16 cases". Am. J. Surg. Pathol. 33 (7): 992–1005. doi:10.1097/PAS.0b013e3181a02d1c. PMID 19417585.
- ↑ Humphrey, Peter A; Dehner, Louis P; Pfeifer, John D (2008). The Washington Manual of Surgical Pathology (1st ed.). Lippincott Williams & Wilkins. pp. 426. ISBN 978-0781765275.
- ↑ Amant F, Vergote I, Moerman P (November 2004). "The classification of a uterine sarcoma as 'high-grade endometrial stromal sarcoma' should be abandoned". Gynecol. Oncol. 95 (2): 412–3; author reply 413. doi:10.1016/j.ygyno.2004.07.021. PMID 15491769. http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6WG6-4DF46J8-3&_user=1166899&_coverDate=11%2F01%2F2004&_rdoc=1&_fmt=high&_orig=search&_sort=d&_docanchor=&view=c&_searchStrId=1204975755&_rerunOrigin=google&_acct=C000051839&_version=1&_urlVersion=0&_userid=1166899&md5=d6ec1eee2941460a085d1dac6615b5a5.
- ↑ URL: http://www.nature.com/modpathol/journal/v19/n1/full/3800475a.html. Accessed on: 5 August 2010.