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This article deals with '''uterine tumours''', | This article deals with '''[[uterus|uterine]] tumours''', with the exception of the tumours that arise from the [[endometrium]]. | ||
Pre-malignant endometrium and endometrial tumours are dealt with in the articles, ''[[endometrial hyperplasia]]'' and ''[[endometrial carcinoma]]''. | 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]]''. | |||
=Common benign= | =Common benign= | ||
== | ==Uterine leiomyoma== | ||
{{Main| | *Often called ''fibroids''. | ||
{{Main|Uterine leiomyoma}} | |||
=Uncommon benign= | |||
==Uterine adenofibroma== | |||
*[[AKA]] ''[[adenofibroma]] of the uterus''. | |||
===General=== | ===General=== | ||
* | *Uncommmon. | ||
* | *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> | ||
**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> | |||
=== | |||
* | |||
* | |||
===Microscopic=== | ===Microscopic=== | ||
Features: | Features: | ||
* | *Moderately demarcated lesion with: | ||
** | **Pale stroma and epithelioid/spindle cells. | ||
* | **Simple cuboidal (or columnar) epithelium with eosinophilic cytoplasm. | ||
*Low mitotic rate. | |||
*Nuclear atypia minimal. | |||
Note: | |||
* | *Appearance similar to ''[[fibroadenoma]]''. | ||
DDx: | |||
* | *Adenosarcoma. | ||
Images: | Images: | ||
*[ | *[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> | ||
==Adenomatoid tumour== | ==Adenomatoid tumour== | ||
:Should '''not''' be confused with | :Should '''not''' be confused with the [[bone tumour]] ''[[adamantinoma]]''. | ||
{{Main|Adenomatoid tumour}} | |||
=Uncertain malignant potential= | =Uncertain malignant potential= | ||
==Smooth muscle tumour of uncertain malignant potential | ==Smooth muscle tumour of uncertain malignant potential== | ||
*Abbreviated ''STUMP''. | |||
* | {{Main|Smooth muscle tumour of uncertain malignant potential}} | ||
=Malignant= | =Malignant= | ||
== | ==Uterine carcinosarcoma== | ||
* AKA ''malignant mixed muellerian tumour'', abbreviated ''MMMT''. | * [[AKA]] ''malignant mixed muellerian tumour'', abbreviated ''MMMT''. | ||
{{Main|Uterine carcinosarcoma}} | |||
== | ==Adenosarcoma of the uterus== | ||
* | *[[AKA]] ''uterine adenosarcoma''. | ||
{{Main|Adenosarcoma of the uterus}} | |||
== | ==Uterine leiomyosarcoma== | ||
{{Main|Leiomyosarcoma}} | {{Main|Leiomyosarcoma}} | ||
===General=== | ===General=== | ||
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===Microscopic=== | ===Microscopic=== | ||
Features: | Features: | ||
*Smooth muscle differentiation - '''essential'''. | |||
# | **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 | **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=== | ||
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**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= | ||
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===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]]. | |||
DDx: | |||
* | *[[Endometrial stromal sarcoma]] (ESS), [[UES]] - myometrial invasion or [[vascular invasion]]. | ||
Images: | Images: | ||
*[http:// | *[http://commons.wikimedia.org/wiki/File:EndometrialStromalNodule.JPG ESN (WC)]. | ||
==Endometrial stromal sarcoma== | ==Endometrial stromal sarcoma== | ||
*Abbreviated ESS. | *Abbreviated ESS. | ||
* | *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. | *Malignant. | ||
*Rare. | |||
*This can be thought of as ''[[pleomorphic undifferentiated sarcoma]]'' in the [[uterus]]. | |||
===Microscopic=== | ===Microscopic=== | ||
Features: | Features: | ||
#Marked nuclear atypia. | #Marked nuclear atypia. | ||
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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= | ||
==Trophoblastic | ==Trophoblastic tumours== | ||
*[[Choriocarcinoma]]. | *[[Choriocarcinoma]]. | ||
*[[Epithelioid trophoblastic tumour]]. | *[[Epithelioid trophoblastic tumour]]. | ||
*[[Placental site trophoblastic tumour]]. | *[[Placental site trophoblastic tumour]]. | ||
==Uterine | ==Uterine tumour resembling an ovarian sex cord stromal tumour== | ||
* | *Abbreviated ''UTROSCT''. | ||
* | {{Main|Uterine tumour resembling an ovarian sex cord stromal tumour}} | ||
==Atypical polypoid adenomyoma of the uterus== | |||
*Abbreviated ''APA''. | |||
*[[AKA]] ''atypical polypoid adenomyoma''. | |||
{{Main|Atypical polypoid adenomyoma of the uterus}} | |||
=See also= | =See also= | ||
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*[[Endometrial carcinoma]]. | *[[Endometrial carcinoma]]. | ||
*[[Endometrial hyperplasia]]. | *[[Endometrial hyperplasia]]. | ||
*[[Endometrial polyp]]. | |||
=References= | =References= |
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