Difference between revisions of "Uterine tumours"

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Uterine tumours (view source)

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=Common benign=
=Common benign=
==Uterine leiomyoma==
==Uterine leiomyoma==
{{Main|Leiomyoma}}
*Often called ''fibroids''.
*Often called ''fibroids''.
*''Fibroid uterus'' redirects here.
{{Main|Uterine leiomyoma}}
===General===
*Extremely common... 40% of women by age 40.
*Benign.
**Can be a cause of [[abnormal uterine bleeding]] (commonly abbreviated ''AUB'').
*Large & multiple associated with infertility.
*May be treated medically with a selective progesterone receptor modulator, e.g. ''ulipristal'' (''Fibristal'').<ref name=pmid24712276>{{Cite journal  | last1 = Delev | first1 = DP. | title = Ulipristal acetate--a review of the new therapeutic indications and future prospects. | journal = Folia Med (Plovdiv) | volume = 55 | issue = 3-4 | pages = 5-10 | month =  | year =  | doi =  | PMID = 24712276 }}</ref>
 
===Gross===
Feature:
* Sharply circumscribed.
* Gray-white.
* Whorled appearance.
 
Factor that raise concern for leiomyosarcoma:
* Haemorrhage.
* Cystic degeneration.
* [[Necrosis]].
 
===Microscopic===
Features:
* 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.
* Nuclear atypia seen at low power.
* Few mitoses.
 
Images:
*[http://commons.wikimedia.org/w/index.php?title=File:Cutaneous_leiomyosarcoma_-_a_-_intermed_mag.jpg Fascicular pattern - leiomyosarcoma (WC)].
 
====Variants====
*Lipoleiomyoma - with adipose tissue.
**Image: [http://commons.wikimedia.org/wiki/File:Lipoleiomyoma1.jpg Lipoleiomyoma - low mag. (WC)].
*Hypercellular leiomyoma - hypercellularity associated with more mutations.<ref name=pmid_none>{{Cite journal  | last1 = Pandis | first1 = N. | last2 = Heim | first2 = S. | last3 = Willén | first3 = H. | last4 = Bardi | first4 = G. | last5 = Flodérus | first5 = U-M. | last6 = Mandahl | first6 = N. | last7 = Mitelman | first7 = F. | title = Histologic—cytogenetic correlations in uterine leiomyomas. | journal = International Journal of Gynecological Cancer | volume = 1 | issue = 4 | pages = 163-68 | month = Jan | year = 1991 | doi = | PMID =  |url=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 name=pmid16357844>{{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.<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>
*SMA +ve.
*Desmin +ve.
*Ki-67 -ve.
 
Others:
*p16 usually -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>
**Often +ve in leiomyosarcoma.
*H-caldesmon +ve.<ref name=pmid14751141/>
 
===Sign out===
<pre>
Uterine Cervix, Uterus, Bilateral Tubes and IUD, Total Hysterectomy and Bilateral Salpingectomy:
- Uterine leiomyomas.
- Mild atherosclerosis.
- Inactive endometrium.
- Intrauterine device (IUD) - gross only.
- Uterine cervix within normal limits.
- Left uterine tube with small paratubal cyst, negative for
  significant pathology.
- Right uterine tube with paratubal cyst, negative for significant pathology.
- NEGATIVE for malignancy.
</pre>
 
=====Block letters=====
<pre>
UTERUS WITH CERVIX, UTERINE TUBES AND LEFT OVARY, TOTAL HYSTERECTOMY, BILATERAL SALPINGECTOMY
AND LEFT OOPHRECTOMY:
- LEIOMYOMATA WITH FOCAL CALCIFICATION AND HYALINE CHANGE.
- SECRETORY PHASE ENDOMETRIUM.
- LEFT OVARY WITHIN NORMAL LIMITS.
- UTERINE TUBES WITHIN NORMAL LIMITS.
- UTERINE CERVIX WITHIN NORMAL LIMITS.
</pre>
 
====Myomectomy====
<pre>
UTERINE MASSES ("FIBROIDS"), MYOMECTOMY:
- LEIOMYOMATA.
</pre>
 
<pre>
UTERINE MASS, HYSTEROSCOPIC MYOMECTOMY:
- BENIGN SMOOTH MUSCLE FRAGMENTS COMPATIBLE WITH LEIOMYOMA.
- SECRETORY PHASE ENDOMETRIUM.
</pre>


=Uncommon benign=
=Uncommon benign=
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Images:
Images:
*[http://www.webpathology.com/image.asp?n=6&Case=572 Adenofibroma of the uterus - low mag. (webpathology.com)].
*[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>
*[http://www.webpathology.com/image.asp?n=7&Case=572 Adenofibroma of the uterus - high mag. (webpathology.com)].


==Adenomatoid tumour==
==Adenomatoid tumour==
Michael
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