|
|
(99 intermediate revisions by the same user not shown) |
Line 1: |
Line 1: |
| This article deals with '''uterine tumours''', excluding tumours that arise from the endometrium. | | This article deals with '''[[uterus|uterine]] tumours''', with the exception of the 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 them. 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= | | =Common benign= |
| ==Leiomyomas== | | ==Uterine leiomyoma== |
| {{Main|Leiomyoma}} | | *Often called ''fibroids''. |
| | {{Main|Uterine leiomyoma}} |
|
| |
|
| | =Uncommon benign= |
| | ==Uterine adenofibroma== |
| | *[[AKA]] ''[[adenofibroma]] of the uterus''. |
| ===General=== | | ===General=== |
| *Often called "fibroids". | | *Uncommmon. |
| *Extremely common... 40% of women by age 40. | | *Benign looking lesions can reoccur.<ref name=pmid2351327>{{Cite journal | last1 = Seltzer | first1 = VL. | last2 = Levine | first2 = A. | last3 = Spiegel | first3 = G. | last4 = Rosenfeld | first4 = D. | last5 = Coffey | first5 = EL. | title = Adenofibroma of the uterus: multiple recurrences following wide local excision. | journal = Gynecol Oncol | volume = 37 | issue = 3 | pages = 427-31 | month = Jun | year = 1990 | doi = | PMID = 2351327 }}</ref> |
| *Benign.
| | **It has been proposed that these lesions are in fact well-differentiated ''adenosarcomas''.<ref name=pmid18941402>{{Cite journal | last1 = Gallardo | first1 = A. | last2 = Prat | first2 = J. | title = Mullerian adenosarcoma: a clinicopathologic and immunohistochemical study of 55 cases challenging the existence of adenofibroma. | journal = Am J Surg Pathol | volume = 33 | issue = 2 | pages = 278-88 | month = Feb | year = 2009 | doi = 10.1097/PAS.0b013e318181a80d | PMID = 18941402 }}</ref> |
| **Can be a cause of abnormal uterine bleeding (commonly abbreviated ''AUB'').
| |
| **Large & multiple associated with infertility.
| |
| | |
| ===Gross=== | |
| * Sharply circumscribed. | |
| * Gray-white. | |
| * Whorled appearance.
| |
| | |
| Factor that raise concern for leiomyosarcoma:
| |
| * Haemorrhage.
| |
| * Cystic degeneration.
| |
| * [[Necrosis]].
| |
|
| |
|
| ===Microscopic=== | | ===Microscopic=== |
| Features: | | Features: |
| * Spindle cells arranged in fascicles. | | *Moderately demarcated lesion with: |
| ** Fascicular appearance: adjacent groups of cells have their long axis perpendicular to one another; looks somewhat like a braided hair that was cut. | | **Pale stroma and epithelioid/spindle cells. |
| * Whorled arrangement of cells. | | **Simple cuboidal (or columnar) epithelium with eosinophilic cytoplasm. |
| | *Low mitotic rate. |
| | *Nuclear atypia minimal. |
| | |
| | Note: |
| | *Appearance similar to ''[[fibroadenoma]]''. |
|
| |
|
| Negatives:
| | DDx: |
| * Necrosis (low power) - suggestive of leiomyosarcoma. | | *Adenosarcoma. |
| * Hypercellularity.
| |
| * Nuclear atypia seen at low power.
| |
| * Few mitoses.
| |
|
| |
|
| Images: | | Images: |
| *[http://commons.wikimedia.org/w/index.php?title=File:Cutaneous_leiomyosarcoma_-_a_-_intermed_mag.jpg Fascicular pattern - leiomyosarcoma (WC)]. | | *[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5496288/figure/F2/ Adenofibroma (nlm.nih.gov)].<ref>{{cite journal |authors=Chawla L, Vatsa R, Roy KK, Kumar S |title=Uterine Adenofibroma: An Unsual Cause of Nonpuerperal Uterine Inversion in Postmenopausal Female |journal=J Midlife Health |volume=8 |issue=2 |pages=95–97 |date=2017 |pmid=28706412 |pmc=5496288 |doi=10.4103/jmh.JMH_27_17 |url=}}</ref> |
| | |
| ====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)].
| |
| *Benign metastasizing leiomyoma.<ref>{{Cite journal | last1 = Patton | first1 = KT. | last2 = Cheng | first2 = L. | last3 = Papavero | first3 = V. | last4 = Blum | first4 = MG. | last5 = Yeldandi | first5 = AV. | last6 = Adley | first6 = BP. | last7 = Luan | first7 = C. | last8 = Diaz | first8 = LK. | last9 = Hui | first9 = P. | title = Benign metastasizing leiomyoma: clonality, telomere length and clinicopathologic analysis. | journal = Mod Pathol | volume = 19 | issue = 1 | pages = 130-40 | month = Jan | year = 2006 | doi = 10.1038/modpathol.3800504 | PMID = 16357844 |url=http://www.nature.com/modpathol/journal/v19/n1/full/3800504a.html}}</ref>
| |
| **This is just what it sounds like. Some believe these are low grade [[leiomyosarcoma]]s.
| |
| | |
| ===IHC===
| |
| Work-up of suspicious leiomyomas:<ref>STC. 25 February 2009.</ref>
| |
| *CD10 (+ve).
| |
| *Ki-67 (-ve).
| |
| *SMA (+ve).
| |
| *Desmin (+ve).
| |
|
| |
|
| =Uncommon benign=
| |
| ==Adenomatoid tumour== | | ==Adenomatoid tumour== |
| :Should '''not''' be confused with ''[[Adamantinoma]]'' - a bone tumour. | | :Should '''not''' be confused with the [[bone tumour]] ''[[adamantinoma]]''. |
| ===General===
| | {{Main|Adenomatoid tumour}} |
| *Grossly mimics leiomyoma.<ref name=pmid8543111>{{Cite journal | last1 = Huang | first1 = CC. | last2 = Chang | first2 = DY. | last3 = Chen | first3 = CK. | last4 = Chou | first4 = YY. | last5 = Huang | first5 = SC. | title = Adenomatoid tumor of the female genital tract. | journal = Int J Gynaecol Obstet | volume = 50 | issue = 3 | pages = 275-80 | month = Sep | year = 1995 | doi = | PMID = 8543111 }}
| |
| </ref>
| |
| *Benign tumour - derived from mesothelium.
| |
| *May be seen paratesticular.<ref name=pmid20223139>{{Cite journal | last1 = González Resina | first1 = R. | last2 = Carranza Carranza | first2 = A. | last3 = Congregado Córdoba | first3 = J. | last4 = Conde Sánchez | first4 = JM. | last5 = Congregado Ruiz | first5 = CB. | last6 = Medina López | first6 = R. | title = [Paratesticular adenomatoid tumor: a report of nine cases]. | journal = Actas Urol Esp | volume = 34 | issue = 1 | pages = 95-100 | month = Jan | year = 2010 | doi = | PMID = 20223139 }}
| |
| </ref>
| |
| | |
| ===Microscopic===
| |
| Features:<ref>{{Ref GP|346}}</ref>
| |
| *Well-circumscribed lesion; however, ''not'' encapsulated.
| |
| *Small tubulocystic spaces lined by cytologically normal mesothelium.
| |
| **These pseudotubular spaces are crossed by "thread-like bridging strands" - '''key feature'''.<ref name=pmid19543245>{{Cite journal | last1 = Sangoi | first1 = AR. | last2 = McKenney | first2 = JK. | last3 = Schwartz | first3 = EJ. | last4 = Rouse | first4 = RV. | last5 = Longacre | first5 = TA. | title = Adenomatoid tumors of the female and male genital tracts: a clinicopathological and immunohistochemical study of 44 cases. | journal = Mod Pathol | volume = 22 | issue = 9 | pages = 1228-35 | month = Sep | year = 2009 | doi = 10.1038/modpathol.2009.90 | PMID = 19543245 }}</ref><ref name=pmid14571427>{{Cite journal | last1 = Hes | first1 = O. | last2 = Perez-Montiel | first2 = DM. | last3 = Alvarado Cabrero | first3 = I. | last4 = Zamecnik | first4 = M. | last5 = Podhola | first5 = M. | last6 = Sulc | first6 = M. | last7 = Hora | first7 = M. | last8 = Mukensnabl | first8 = P. | last9 = Zalud | first9 = R. | title = Thread-like bridging strands: a morphologic feature present in all adenomatoid tumors. | journal = Ann Diagn Pathol | volume = 7 | issue = 5 | pages = 273-7 | month = Oct | year = 2003 | doi = | PMID = 14571427 }}</ref>
| |
| | |
| Images:
| |
| *[http://commons.wikimedia.org/wiki/File:Adenomatoid_tumour_-_low_mag.jpg Adenomatoid tumour - low mag. (WC)].
| |
| *[http://commons.wikimedia.org/wiki/File:Adenomatoid_tumour_-_intermed_mag.jpg Adenomatoid tumour - intermed. mag. (WC)].
| |
| *[http://commons.wikimedia.org/wiki/File:Adenomatoid_tumour_-b-_very_high_mag.jpg Adenomatoid tumour - very high mag. (WC)].
| |
| | |
| DDx:
| |
| *Lymphangioma.
| |
| *Leiomyoma.
| |
| | |
| ===IHC===
| |
| Features:<ref name=pmid16548294>{{Cite journal | last1 = Canedo-Patzi | first1 = AM. | last2 = León-Bojorge | first2 = B. | last3 = de Ortíz-Hidalgo | first3 = C. | title = [Adenomatoid tumor of the genital tract. Clinical, pathological and immunohistochemical study in 9 cases] | journal = Gac Med Mex | volume = 142 | issue = 1 | pages = 59-66 | month = | year = | doi = | PMID = 16548294 }}
| |
| </ref>
| |
| *Calretin +ve.
| |
| *AE1/AE3 +ve.
| |
| *CD31 -ve.
| |
| *CK7 +ve.<ref>LAE. 9 December 2009.</ref>
| |
|
| |
|
| =Uncertain malignant potential= | | =Uncertain malignant potential= |
| ==Smooth muscle tumour of uncertain malignant potential (STUMP)== | | ==Smooth muscle tumour of uncertain malignant potential== |
| ===General===
| | *Abbreviated ''STUMP''. |
| *Like ''[[ASAP]]'' and ''[[ASCUS]]'' - a [[waffle diagnosis|waffle category]]... when one isn't sure it is a ''leiomyoma'' vs. ''leiomyosarcoma''. | | {{Main|Smooth muscle tumour of uncertain malignant potential}} |
| *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= | | =Malignant= |
| ==Uterine carcinosarcoma== | | ==Uterine carcinosarcoma== |
| * [[AKA]] ''malignant mixed muellerian tumour'', abbreviated ''MMMT''. | | * [[AKA]] ''malignant mixed muellerian tumour'', abbreviated ''MMMT''. |
| | {{Main|Uterine carcinosarcoma}} |
|
| |
|
| ===General=== | | ==Adenosarcoma of the uterus== |
| * Associated with previous radiation exposure.
| | *[[AKA]] ''uterine adenosarcoma''. |
| * Metstasize as adenocarcinoma.
| | {{Main|Adenosarcoma of the uterus}} |
| * 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.
| |
| | |
| Images:
| |
| *[http://commons.wikimedia.org/wiki/File:Carcinosarcoma_-_low_mag.jpg MMMT - low mag. (WC)].
| |
| *[http://commons.wikimedia.org/wiki/File:Carcinosarcoma_-_high_mag.jpg MMMT - high mag. (WC)].
| |
| *[http://commons.wikimedia.org/wiki/File:MalignantMixedMullerianTumor.JPG MMMT - crappy (WC)].
| |
| | |
| ==Adenosarcoma==
| |
| ===General===
| |
| Features:<ref name=pmid20179434>{{Cite journal | last1 = McCluggage | first1 = WG. | title = Mullerian adenosarcoma of the female genital tract. | journal = Adv Anat Pathol | volume = 17 | issue = 2 | pages = 122-9 | month = Mar | year = 2010 | doi = 10.1097/PAP.0b013e3181cfe732 | PMID = 20179434 }}</ref>
| |
| *Uncommon.
| |
| *May prolapse through cervical os and thus present as [[cervical polyp]].
| |
| *Most commonly uterine corpus, occasionally cervix and ovary, rarely in the vagina, fallopian tube, peritoneal surfaces, intestine.
| |
| *Typically 30-40 years old.
| |
| | |
| Treatment:
| |
| *TAH-BSO.
| |
| **Tumours are estrogen responsive.
| |
| ===Microscopic===
| |
| Features:<ref name=Ref_PBoD1089>{{Ref PBoD|1089}}</ref><ref name=pmid20179434/>
| |
| *"Malignant stroma" - '''key feature'''.
| |
| **Stromal nuclear pleomorphism - usu. low grade.
| |
| **WHO criteria: 2+ mitoses / 10 HPF -- definition suffers from [[HPFitis]].
| |
| *Benign glands with an abnormal shape.
| |
| *"Cambium layer" = increased cellularity around the epithelial elements.<ref name=pmid20179434/><ref name=medilexicon_cambium/>
| |
| | |
| DDx:
| |
| *Benign polyp.
| |
| | |
| Notes:
| |
| *''Cambium layer'' - seen in: adenosarcoma, botryoid [[RMS]].<ref name=medilexicon_cambium>URL: [http://www.medilexicon.com/medicaldictionary.php?t=48297 http://www.medilexicon.com/medicaldictionary.php?t=48297]. Accessed on: 9 August 2011.</ref>
| |
|
| |
|
| ==Uterine leiomyocarcoma== | | ==Uterine leiomyosarcoma== |
| {{Main|Leiomyosarcoma}} | | {{Main|Leiomyosarcoma}} |
| ===General=== | | ===General=== |
Line 176: |
Line 69: |
| ===Microscopic=== | | ===Microscopic=== |
| Features: | | Features: |
| #Cellular atypia - common.
| | *Smooth muscle differentiation - '''essential'''. |
| #Necrosis. | | **Fascicular architecture. |
| #*Should be patchy/multifocal. | | ***Whorled look at low power. |
| #*Zonal necrosis is suggestive of vascular cause. | | ***Groups of spindle cells cut peripendicular to their long axis adjacent to groups of spindle cells cut in the plane of their long axis. |
| #Mitoses - '''key feature'''. | | **May rely on [[IHC]] - if poorly differentiated. |
| #*10 mitoses/HPF. | | *Malignant histomorphologic features - two of three required - '''key features''':<ref name=pmid21865091>{{Cite journal | last1 = Ip | first1 = PP. | last2 = Cheung | first2 = AN. | title = Pathology of uterine leiomyosarcomas and smooth muscle tumours of uncertain malignant potential. | journal = Best Pract Res Clin Obstet Gynaecol | volume = 25 | issue = 6 | pages = 691-704 | month = Dec | year = 2011 | doi = 10.1016/j.bpobgyn.2011.07.003 | PMID = 21865091 }}</ref> |
| #*5 mitoses/HPF - if epithelioid. | | *#[[Nuclear pleomorphism]]. |
| #*2 mitoses/HPF - if myxoid. | | *#Coagulative tumour cell [[necrosis]] |
| | *#*Should be patchy/multifocal. |
| | *#*Zonal necrosis is suggestive of vascular cause and may be a degenerative change. |
| | *#**Zonal necrosis may be seen in (benign) leiomyomas. |
| | *#Mitoses. |
| | *#*10 mitoses/10 HPF. |
| | *#*5 mitoses/10 HPF - if epithelioid. |
| | *#*2 mitoses/10 HPF - if [[myxoid]]. |
| | |
| | Note: |
| | *The mitotic rate seems to be a relatively weak predictor; a modest rate may be malignant and a high rate benign.<ref name=pmid9388868>{{Cite journal | last1 = Guo | first1 = L. | last2 = Liu | first2 = T. | last3 = Huang | first3 = H. | title = [Reappraisal of the pathological criteria for uterine leiomyosarcoma]. | journal = Zhonghua Bing Li Xue Za Zhi | volume = 25 | issue = 5 | pages = 266-9 | month = Oct | year = 1996 | doi = | PMID = 9388868 }}</ref> |
| | |
| | DDx: |
| | *[[Endometrial stromal sarcoma]]. |
| | *[[Uterine carcinosarcoma]]. |
| | *[[Undifferentiated endometrial sarcoma]]. |
| | *[[Smooth muscle tumour of uncertain malignant potential]]. |
| | *[[Uterine leiomyoma]]. |
|
| |
|
| ===IHC=== | | ===IHC=== |
Line 191: |
Line 101: |
| **Caldesmon. | | **Caldesmon. |
| **Smooth muscle myosin. | | **Smooth muscle myosin. |
| | *p16 +ve.<ref name=pmid18156978>{{Cite journal | last1 = Gannon | first1 = BR. | last2 = Manduch | first2 = M. | last3 = Childs | first3 = TJ. | title = Differential Immunoreactivity of p16 in leiomyosarcomas and leiomyoma variants. | journal = Int J Gynecol Pathol | volume = 27 | issue = 1 | pages = 68-73 | month = Jan | year = 2008 | doi = 10.1097/pgp.0b013e3180ca954f | PMID = 18156978 }}</ref> |
| | **Useful for differentiation from leiomyoma. |
|
| |
|
| =Endometrial stromal tumours= | | =Endometrial stromal tumours= |
Line 208: |
Line 120: |
|
| |
|
| ===General=== | | ===General=== |
| *Benign. (???) | | *Benign. |
|
| |
|
| ===Microscopic=== | | ===Microscopic=== |
| Features: | | Features: |
| *Well-circumscribed - '''key feature'''. | | *Well-circumscribed - '''key feature'''. |
| **The interface of lesion may not have more than three finger-like irregularities/projections into the surround myometrium that are >= 3 mm.<ref name=pmid17347285>{{Cite journal | last1 = Baker | first1 = P. | last2 = Oliva | first2 = E. | title = Endometrial stromal tumours of the uterus: a practical approach using conventional morphology and ancillary techniques. | journal = J Clin Pathol | volume = 60 | issue = 3 | pages = 235-43 | month = Mar | year = 2007 | doi = 10.1136/jcp.2005.031203 | PMID = 17347285 | url = http://jcp.bmj.com/content/60/3/235.full }}</ref> | | **The interface of the lesion may not have more than three finger-like irregularities/projections into the surround myometrium that are >= 3 mm.<ref name=pmid17347285>{{Cite journal | last1 = Baker | first1 = P. | last2 = Oliva | first2 = E. | title = Endometrial stromal tumours of the uterus: a practical approach using conventional morphology and ancillary techniques. | journal = J Clin Pathol | volume = 60 | issue = 3 | pages = 235-43 | month = Mar | year = 2007 | doi = 10.1136/jcp.2005.031203 | PMID = 17347285 | url = http://jcp.bmj.com/content/60/3/235.full }}</ref> |
| *No vascular invasion. | | ***If it does... it is an [[ESS]]. |
| | *No [[vascular invasion]]. |
|
| |
|
| Notes:
| | DDx: |
| *Myometrial invasion or vascular invasion = ESS or UES. | | *[[Endometrial stromal sarcoma]] (ESS), [[UES]] - myometrial invasion or [[vascular invasion]]. |
|
| |
|
| Images: | | Images: |
| *[http://en.wikipedia.org/wiki/File:EndometrialStromalNodule.JPG ESN (WC)]. | | *[http://commons.wikimedia.org/wiki/File:EndometrialStromalNodule.JPG ESN (WC)]. |
|
| |
|
| ==Endometrial stromal sarcoma== | | ==Endometrial stromal sarcoma== |
| *Abbreviated ESS. | | *Abbreviated ESS. |
| *[[AKA]] low grade endometrial stromal sarcoma. | | *Previously known as ''low-grade endometrial stromal sarcoma''. |
| | {{Main|Endometrial stromal sarcoma}} |
| | |
| | ==Undifferentiated endometrial sarcoma== |
| | *Abbreviated as ''UES''. |
| | *Previously known as ''high-grade endometrial stromal sarcoma''.<ref name=pmid24146786>{{Cite journal | last1 = Feng | first1 = W. | last2 = Malpica | first2 = A. | last3 = Skaland | first3 = I. | last4 = Gudlaugsson | first4 = E. | last5 = Robboy | first5 = SJ. | last6 = Dalen | first6 = I. | last7 = Hua | first7 = K. | last8 = Zhou | first8 = X. | last9 = Baak | first9 = JP. | title = Can proliferation biomarkers reliably predict recurrence in world health organization 2003 defined endometrial stromal sarcoma, low grade? | journal = PLoS One | volume = 8 | issue = 10 | pages = e75899 | month = | year = 2013 | doi = 10.1371/journal.pone.0075899 | PMID = 24146786 }}</ref> |
| ===General=== | | ===General=== |
| *Rare.<ref name=pmid20179433> {{Cite journal | last1 = Chew | first1 = I. | last2 = Oliva | first2 = E. | title = Endometrial stromal sarcomas: a review of potential prognostic factors. | journal = Adv Anat Pathol | volume = 17 | issue = 2 | pages = 113-21 | month = Mar | year = 2010 | doi = 10.1097/PAP.0b013e3181cfb7c2 | PMID = 20179433 }}</ref> | | *Malignant. |
| | *Rare. |
| | *This can be thought of as ''[[pleomorphic undifferentiated sarcoma]]'' in the [[uterus]]. |
|
| |
|
| ===Microscopic=== | | ===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.
| |
|
| |
| Notes:
| |
| *Vaguely resembles the stroma of proliferative endometrium.
| |
|
| |
| DDx:
| |
| *[[Leiomyoma]].
| |
| *Endometrial stromal nodule.
| |
|
| |
| Images:
| |
| *[http://commons.wikimedia.org/wiki/File:EndometrialStromalSarcoma.JPG ESS (WC)].
| |
| *[http://commons.wikimedia.org/wiki/File:EndometrialStromalSarcomaLowGrade.JPG Endometrial stromal sarcoma - low grade (WC)].
| |
| *[http://jcp.bmj.com/content/60/3/235/F5.large.jpg ESS in an article with many crappy images].<ref name=pmid17347285>{{Cite journal | last1 = Baker | first1 = P. | last2 = Oliva | first2 = E. | title = Endometrial stromal tumours of the uterus: a practical approach using conventional morphology and ancillary techniques. | journal = J Clin Pathol | volume = 60 | issue = 3 | pages = 235-43 | month = Mar | year = 2007 | doi = 10.1136/jcp.2005.031203 | PMID = 17347285 | url = http://jcp.bmj.com/content/60/3/235.full }}</ref>
| |
|
| |
| ===IHC===
| |
| Features:<ref name=pmid14751141>{{Cite journal | last1 = Zhu | first1 = XQ. | last2 = Shi | first2 = YF. | last3 = Cheng | first3 = XD. | last4 = Zhao | first4 = CL. | last5 = Wu | first5 = YZ. | title = Immunohistochemical markers in differential diagnosis of endometrial stromal sarcoma and cellular leiomyoma. | journal = Gynecol Oncol | volume = 92 | issue = 1 | pages = 71-9 | month = Jan | year = 2004 | doi = | PMID = 14751141 }}</ref>
| |
| *CD10 +ve.
| |
| *h-caldesmin -ve.
| |
| **[[Leiomyoma]]s +ve.
| |
| *PR +/-ve.
| |
| *ER +/-ve.
| |
|
| |
| ===Molecular===
| |
| May be associated a recurrent [[translocation]]:<ref name=pmid12648605>{{Cite journal | last1 = Amant | first1 = F. | last2 = Moerman | first2 = P. | last3 = Cadron | first3 = I. | last4 = Hagemeijer | first4 = A. | last5 = Vergote | first5 = I. | last6 = Debiec-Rychter | first6 = M. | title = Endometrial stromal sarcoma with a sole t(X;17) chromosome change: report of a case and review of the literature. | journal = Gynecol Oncol | volume = 88 | issue = 3 | pages = 459-62 | month = Mar | year = 2003 | doi = | PMID = 12648605 | URL = http://www.sciencedirect.com/science/article/pii/S0090825802000963 }}</ref>
| |
| *t(7;17)(p15;q21).
| |
| **JAZF1 - chromosome 7.<ref name=omim606246>{{OMIM|606246}}</ref>
| |
| **SUZ12 - chromosome 17.<ref name=omim606245>{{OMIM|606245}}</ref>
| |
|
| |
| ==Undifferentiated endometrial sarcoma==
| |
| Features: | | Features: |
| #Marked nuclear atypia. | | #Marked nuclear atypia. |
Line 277: |
Line 161: |
| DDx: | | DDx: |
| *[[Leiomyosarcoma]]. | | *[[Leiomyosarcoma]]. |
| *Carcinosarcoma. | | *[[Uterine carcinosarcoma|Carcinosarcoma]]. |
| *[[Rhabdomyosarcoma]]. | | *[[Rhabdomyosarcoma]]. |
| *[[Melanoma]]. | | *[[Melanoma]]. |
| | |
| | ===IHC=== |
| | Features:<ref name=pmid21464730>{{Cite journal | last1 = Abeler | first1 = VM. | last2 = Nenodovic | first2 = M. | title = Diagnostic immunohistochemistry in uterine sarcomas: a study of 397 cases. | journal = Int J Gynecol Pathol | volume = 30 | issue = 3 | pages = 236-43 | month = May | year = 2011 | doi = 10.1097/PGP.0b013e318200caff | PMID = 21464730 }}</ref> |
| | *SMA ~50% +ve. |
| | |
| | Typically negative:<ref name=pmid21464730/> |
| | *Smooth muscle markers: desmin, h-caldesmon. |
| | *Skeletal muscle markers: Myf4, actin. |
| | *Melanoma: S100, HMB-45. |
| | *GIST: CD117. |
|
| |
|
| =Weird stuff= | | =Weird stuff= |
Line 287: |
Line 181: |
| *[[Placental site trophoblastic tumour]]. | | *[[Placental site trophoblastic tumour]]. |
|
| |
|
| ==Uterine tumors resembling ovarian sex cord tumours== | | ==Uterine tumour resembling an ovarian sex cord stromal tumour== |
| *Abbreviated ''UTROSCT''. | | *Abbreviated ''UTROSCT''. |
| | {{Main|Uterine tumour resembling an ovarian sex cord stromal tumour}} |
|
| |
|
| ===General=== | | ==Atypical polypoid adenomyoma of the uterus== |
| *Super rare. | | *Abbreviated ''APA''. |
| | | *[[AKA]] ''atypical polypoid adenomyoma''. |
| ===Microscopic===
| | {{Main|Atypical polypoid adenomyoma of the uterus}} |
| Features:
| |
| *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.
| |
|
| |
|
| =See also= | | =See also= |