Uterine tumours - Revision history

Michael: /* Uterine adenofibroma */

2022-01-10T15:26:44Z

Uterine adenofibroma

← Older revision		Revision as of 15:26, 10 January 2022
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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: /* Uterine leiomyoma */

2017-10-30T19:31:01Z

Uterine leiomyoma

← Older revision		Revision as of 19:31, 30 October 2017
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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>~~

	~~====Micro====~~
	The sections show bland spindle cells within a fascicular architecture. Hyaline change is present. No necrosis is seen. Mild proliferative activity is seen (~ 2 mitoses/10 HPFs, 1 HPF ~0.2376 mm*mm). No cytologic atypia is apparent.

	=Uncommon benign=		=Uncommon benign=

Michael: /* Myomectomy */

2017-10-30T19:26:42Z

Myomectomy

← Older revision		Revision as of 19:26, 30 October 2017
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	- SECRETORY PHASE ENDOMETRIUM.		- SECRETORY PHASE ENDOMETRIUM.
	</pre>		</pre>

			====Micro====
			The sections show bland spindle cells within a fascicular architecture. Hyaline change is present. No necrosis is seen. Mild proliferative activity is seen (~ 2 mitoses/10 HPFs, 1 HPF ~0.2376 mm*mm). No cytologic atypia is apparent.

	=Uncommon benign=		=Uncommon benign=

Michael at 13:09, 30 June 2017

2017-06-30T13:09:10Z

← Older revision		Revision as of 13:09, 30 June 2017
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	*SMA +ve.		*SMA +ve.
	*Desmin +ve.		*Desmin +ve.
	*Ki-67 -ve.		*[[Ki-67]] -ve.

	Others:		Others:

Michael: /* Uterine leiomyoma */

2017-01-03T18:42:38Z

Uterine leiomyoma

← Older revision		Revision as of 18:42, 3 January 2017
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	**Can be a cause of [[abnormal uterine bleeding]] (commonly abbreviated ''AUB'').		**Can be a cause of [[abnormal uterine bleeding]] (commonly abbreviated ''AUB'').
	*Large & multiple associated with infertility.		*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>		*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===		===Gross===

Michael: /* Uterine leiomyoma */

2017-01-03T18:34:21Z

Uterine leiomyoma

← Older revision		Revision as of 18:34, 3 January 2017
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	**Can be a cause of [[abnormal uterine bleeding]] (commonly abbreviated ''AUB'').		**Can be a cause of [[abnormal uterine bleeding]] (commonly abbreviated ''AUB'').
	*Large & multiple associated with infertility.		*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>		*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===		===Gross===

Michael: /* Sign out */ fix

2015-08-17T16:06:19Z

Sign out: fix

← Older revision		Revision as of 16:06, 17 August 2015
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	===Sign out===		===Sign out===
	<pre>		<pre>
	Uterine Cervix, Uterus, Bilateral Tubes, IUD, Total Hysterectomy and Bilateral ~~Salpingoectomy~~:		Uterine Cervix, Uterus, Bilateral Tubes and IUD, Total Hysterectomy and Bilateral Salpingectomy:
	- Uterine leiomyomas.		- Uterine leiomyomas.
	- Mild atherosclerosis.		- Mild atherosclerosis.

Michael: /* Sign out */

2015-08-17T15:56:06Z

Sign out

← Older revision		Revision as of 15:56, 17 August 2015
Line 65:		Line 65:

	===Sign out===		===Sign out===
			<pre>
			Uterine Cervix, Uterus, Bilateral Tubes, IUD, Total Hysterectomy and Bilateral Salpingoectomy:
			- 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>		<pre>
	UTERUS WITH CERVIX, UTERINE TUBES AND LEFT OVARY, TOTAL HYSTERECTOMY, BILATERAL SALPINGECTOMY		UTERUS WITH CERVIX, UTERINE TUBES AND LEFT OVARY, TOTAL HYSTERECTOMY, BILATERAL SALPINGECTOMY

Michael: /* Adenosarcoma of the uterus */

2014-11-24T02:28:25Z

Adenosarcoma of the uterus

← Older revision		Revision as of 02:28, 24 November 2014
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	==Adenosarcoma of the uterus==		==Adenosarcoma of the uterus==
	*[[AKA]] ''uterine ~~adenocarcinoma~~''.		*[[AKA]] ''uterine adenosarcoma''.
	{{Main\|Adenosarcoma of the uterus}}		{{Main\|Adenosarcoma of the uterus}}

Michael: /* Adenosarcoma of the uterus */ split out

2014-11-24T02:27:46Z

Adenosarcoma of the uterus: split out

← Older revision		Revision as of 02:27, 24 November 2014
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	==Adenosarcoma of the uterus==		==Adenosarcoma of the uterus==
	*[[AKA]] ''uterine adenocarcinoma''.		*[[AKA]] ''uterine adenocarcinoma''.
	~~===General===~~		{{Main\|Adenosarcoma of the uterus}}
	~~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.

	~~Clinical:<ref name=pmid17506376>{{Cite journal \| last1 = Abu \| first1 = J. \| last2 = Ireland \| first2 = D. \| last3 = Brown \| first3 = L. \| title =~~ Adenosarcoma of ~~an endometrial polyp in a 27-year-old nulligravida: a case report. \| journal = J Reprod Med \| volume = 52 \| issue = 4 \| pages = 326-8 \| month = Apr \| year = 2007 \| doi = \| PMID = 17506376 }}</ref>~~
	*Most common presentations of Müllerian adenosarcoma (percentages based on series of 41 individuals<ref name=pmid9625851>{{Cite journal \| last1 = Verschraegen \| first1 = CF. \| last2 = Vasuratna \| first2 = A. \| last3 = Edwards \| first3 = C. \| last4 = Freedman \| first4 = R. \| last5 = Kudelka \| first5 = AP. \| last6 = Tornos \| first6 = C. \| last7 = Kavanagh \| first7 = JJ. \| title = Clinicopathologic analysis of mullerian adenosarcoma: the ~~M.D. Anderson Cancer Center experience. \| journal = Oncol Rep \| volume = 5 \| issue = 4 \| pages = 939-44 \| month = \| year = \| doi = \| PMID = 9625851~~ }}~~</ref>):~~
	**Vaginal bleeding ~ 70%.
	**Pelvic mass ~ 40%.
	**Uterine polyp ~ 30%.
	*Prognosis (based on series of ~500 individuals<ref name=pmid20688363>{{Cite journal \| last1 = Arend \| first1 = R. \| last2 = Bagaria \| first2 = M. \| last3 = Lewin \| first3 = SN. \| last4 = Sun \| first4 = X. \| last5 = Deutsch \| first5 = I. \| last6 = Burke \| first6 = WM. \| last7 = Herzog \| first7 = TJ. \| last8 = Wright \| first8 = JD. \| title = Long-term outcome and natural history of uterine adenosarcomas. \| journal = Gynecol Oncol \| volume = 119 \| issue = 2 \| pages = 305-8 \| month = Nov \| year = 2010 \| doi = 10.1016/j.ygyno.2010.07.001 \| PMID = 20688363 }}</ref>):
	**Favourable outcome - most detected at an early stage.
	***~80% five year survival for stage I tumours.
	**Outcome better than [[uterine carcinosarcoma\|carcinosarcoma]].

	~~Treatment:~~
	*TAH-BSO.
	**Tumours are estrogen responsive.
	*Chemotherapy (platin-based).<ref name=pmid9625851/>

	~~===Microscopic===~~
	~~Features:<ref name=Ref_PBoD1089>{{Ref PBoD\|1089}}</ref><ref name=pmid20179434/>~~
	*"Malignant stroma" - '''key feature'''.
	**Stromal nuclear pleomorphism - usually low grade.
	**WHO criteria: 2+ mitoses / 10 HPF -- definition suffers from [[HPFitis]].
	***Mitotic rate criteria often ignored as mitotically inactive tumours metastasize.<ref name=pmid20179434/>
	*Benign glands with an abnormal shape.
	*"Cambium layer" = increased cellularity around the epithelial elements.<ref name=pmid20179434/><ref name=medilexicon_cambium/>

	~~Notes:~~
	*Tumour may vaguely resemble a [[phyllodes tumour]].<ref name=pmid20179434/>
	*''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>

	~~DDx:~~
	*[[Benign endometrial polyp]].
	*[[Uterine adenofibroma]].

	~~====Images====~~
	~~<gallery>~~
	~~Image:Uterine_adenosarcoma_-_low_mag.jpg \| Uterine adenosarcoma - low mag. (WC)~~
	~~Image:Uterine_adenosarcoma_-_intermed_mag.jpg \| Uterine adenosarcoma - intermed. mag. (WC)~~
	~~Image:Uterine_adenosarcoma_-_high_mag.jpg \| Uterine adenosarcoma - high mag. (WC)~~
	~~</gallery>~~

	~~===IHC===~~
	*CD10 +ve.<ref name=pmid20179434/>
	*ER +ve.
	*PR +ve.

	==Uterine leiomyosarcoma==		==Uterine leiomyosarcoma==