Uterine tumours
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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.
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
- 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)
- 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
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.
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.
- ↑ LAE. 9 December 2009.
- ↑ 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.
- ↑ 6.0 6.1 6.2 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.