PATHOLOGY OF UTERINE CORPUS SUMALEE SIRIAUNGKUL, M.D. DEPARTMENT OF PATHOLOGY
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1 PATHOLOGY OF UTERINE CORPUS SUMALEE SIRIAUNGKUL, M.D. DEPARTMENT OF PATHOLOGY
2 PATHOLOGY OF THE UTERINE CORPUS Anatomy and physiology Benign diseases : Infections : Functional disorders Dysfunctional Uterine Bleeding- DUB : Polyp / Leiomyoma Endometrial Hyperplasia and Carcinoma Sarcoma and Carcinosarcoma Tumor-like Lesions ( Adenomyosis )
3 Endometrium Myometrium
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8 Endometrium Proliferative phase (before ovulation) Follicular phase Estrogen effect Mitosis Pseudostratification
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11 Endometrium Secretory phase Luteal phase Estrogen + progesterone Exhausted glandular epithelium Predecidual change
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16 Menstruation Menstruation ; Latin = mensa = month Interval days Duration 3-5 days Blood loss ml Endometrium (functional layer) WBC, RBC, enzyme
17 COMMON CAUSES OF AUB Adolescence : DUB / Complication of pregnancy Reproductive ages : Complication of pregnancy / DUB : Benign tumors (leiomyoma,polyp ). Perimenopause : DUB / Endometrial hyperplasia : Polyp. Menopause : Atrophy / Endometrial hyperplasia : Endometrial carcinoma / Polyp
18 DYSFUNCTIONAL UTERINE BLEEDING : DUB Abnormal bleeding without lesions in the uterus Reproductive age Most common cause is anovulatory cycle ( no ovulation )
19 Endometrial Hyperplasia Definition : Epithelial and stromal cell proliferation : Abnormal glandular architectures : Nuclear atypia Clinical significance : Concurrent carcinoma : Risk of progression to carcinoma Presentation : Abnormal bleeding
20 Risk Factors for Endometrial Hyperplasia : Obesity (3-10x) : Nulliparity (2x) / Late menopause : Hypertension (1.5x) / DM (2.8) : Unopposed estrogen (9.5x) : Atypical hyperplasia (29x)
21 Endometrial Hyperplasia Diagnosis : Histologic material is preferable Classification : Simple hyperplasia : Complex hyperplasia : Atypical hyperplasia ( Simple or Complex )
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27 Endometrial Carcinoma Most common gyn cancer in western world In Thailand ; Cervix, Ovary, Endometriual CA Incidence 2.9:100,000 Type I, II Any factor associated with increased exposure to estrogen over time, especially if unopposed by the anti-proliferative effects of progesterone, leads to anincreased risk of endometrial cancer.
28 Type I ( tumor (estrogen-dependent Younger women Peri-menopause A history of exposure to unopposed estrogen Tumors begin as hyperplastic endometrial and progress to carcinoma.
29 Type II ( tumor (estrogen-independent Older women Post-menopause Thin Associated with a poor prognosis
30 Endometrial Carcinoma Perimenopausal / Postmenopausal abnormal bleeding / leukorrhea abnormal vaginal discharge Gross : Body > lower segment : Single / multiple / diffuse infiltration : Shaggy ulcerative friable surface : Myometrial invasion
31 Diagnosis The standard method of assessing uterine bleeding and diagnosing endometrial carcinoma is Fractional D&C (dilatation ( curettage and Outpatient procedures : endometrial biopsy or aspiration (if fail to provide sufficient information, the fractional D&C is mandatory)
32 Prognostic factors for Endometrial Carcinoma : Tumor grade ( 1-3 ) : Histologic type ( typeii:serous, clear cell ) : Depth of myometrial invasion : Lymphvascular invasion : Others ( Hyperplasia, Hormone receptor )
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37 HISTOLOGIC CLASSIFICATION OF TUMORS OF UTERINE CORPUS Endometrial Carcinoma Nonepithelial Tumors : Smooth muscle tumors Leiomyoma / Leimyosarcoma : Endometrial stromal tumors Endometrial stromal sarcoma Mixed Epithelial-Nonepithelial Tumors : Adenosarcoma : Carcinosarcoma
38 Leiomyoma Most common tumors of the corpus Gross : Well circumscribed mass, pushing margin : Whorl trabecular pattern on cut surface : Firm consistency Micro : Anastomosing fascicles of spindle cell : Cigar-shaped nuclei / No atypia Malignancy : Necrosis / Atypia / Mitotic figures Hormone-dependent tumor (reproductive life)
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43 Leiomyosarcoma Cancer of smooth muscle cells originated in muscular layer (myometrium). Gross : Well-defined or infiltrative border : Soft fleshy tissue (fish-like) Micro : Necrosis / Nuclear Atypia / Mitotic figures
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45 Photo Album by host1
46 Carcinosarcoma Malignant mixed mullerian tumor (MMMT) Mailgnant epithelial (adenocarcinoma) and nonepithelial (sarcoma) components Sarcoma - heterologous : Rhabdomyosarcoma - homologous : Leiomyosarcoma
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48 Adenomyosis Tumor-like lesion Endometrial glands and stroma in the myometrium Abnormal bleeding / dysmenorrhea Gross : Enlarged uterus : Thickened uterine wall : Hemorrhagic foci on cut surface
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53 ส อประกอบการเร ยน 1. พยาธ ว ทยาพ นฐานของโรคท พบบ อย โดย ผศ.อน พงศ น ต เร องจร ส 1.1. Premalignant and malignant lesion of cervix (หน า ) 3 H&E slides (negative/lsil/hsil) 1.2. Invasive squamous cell carcinoma of cervix (หน า สไลด 50) 1.3. Endometrial carcinoma of endometrium (หน า สไลด 51) 1.4. Adenomyosis of uterus (หน า สไลด 52) 1.5. Leiomyoma of uterus (หน า สไลด 91) 1.6. Leiomyosarcoma of uterus (หน า สไลด 92) 2. มะเร งว ทยานร เวช (จต พล ศร สมบ รณ บรรณาธ การ) 3. Robbins and Cotran Pathologic Basis of Disease 4. Gross specimens พร อมร ปภาพ
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