2. Endometrial hyperplasia, endometrial carcinoma, leiomyoma.pptx

FGT

1. Female genital tract- II Topics to be covered: Endometrial lesions- hyperplasia, carcinoma Leiomyoma

2. Case 1

3. Clinical details A 35 year old obese female patient presented to her gynecologist with history of abnormal uterine bleeding, abdominal pain and vaginal discharge Patient is a known case of diabetes and hypertension Examination findings: Per speculum examination- Vagina and cervix appeared normal Transvaginal ultrasonography - Endometrial thickness was increased and measuring 15 mm

4. Gross- Cut surface Myometrium Cervix Endometrial cavity There is increased endometrial thickness which is spongy with cystic spaces

5. Gross features The endometrium can be uniformly thickened or can be polypoid , spongy with cystic spaces

6. Microscopy- Endometrium histology PROLIFERATIVE PHASE SECRETORY PHASE

7. Microscopy of endometrial hyperplasia There is increased gland : stromal ratio ( >3 : 1) with glands in proliferative phase and some cystically dilated glands – SWISS CHEESE APPEARANCE

8. Microscopy HYPERPLASIA WITHOUT ATYPIA- dilated and crowded glands without cellular atypia HYPERPLASIA WITH ATYPIA - crowded glands with cellular atypia

9. Microscopy features Hyperplasia without atypia: Increased gland : stromal ratio , with variation in size and shape of glands with cystically dilated glands Hyperplasia with atypia: There is complex pattern of proliferation of glands displaying nuclear atypia

10. IMPRESSION: ENDOMETRIAL HYPERPLASIA

11. Classification of endometrial hyperplasia

12. Predisposing factors Prolonged estrogenic stimulation of endometrium leads to hyperplasia

13. Case 2

14. Clinical details A 55 year old postmenopausal woman with a BMI of 35.3, history of hypertension and diabetes for the past 15 years presented with vaginal spotting Examination findings Transvaginal ultrasound - Thickened endometrium with a growth Patient underwent hysterectomy

15. Gross Cut open specimen of uterus The endometrial cavity is filled with a grey tan, proliferative growth arising from the endometrium and infiltrating the myometrium

16. Gross Bisected specimen of uterus Diffuse infiltrating growth in the endometrium

17. Gross features The endometrial cavity shows a grey tan, proliferative growth The tumour can be polypoidal or diffusely infiltrating the endometrium

18. Microscopy Neoplastic glands are arranged back to back with crowding , complex gland formation along with stromal invasion

19. Microscopy

20. Histology features Endometrioid adenocarcinomas demonstrate glandular growth patterns resembling normal endometrial epithelium HISTOLOGIC GRADES: Well-differentiated : composed of entirely well formed glands Moderately differentiated : composed of well formed glands admixed with solid sheets of cells (<50%) Poorly differentiated : >50% solid growth pattern

21. IMPRESSION: ENDOMETRIAL CARCINOMA

22. Characteristics Type I Type II Age 55-65 yr 65-75 yr Clinical setting Unopposed estrogen Obesity Hypertension Diabetes Endometrial atrophy Thin physique Morphology Endometrioid Serous Clear cell Mixed mullerian tumour Precursor Hyperplasia Serous endometrial intraepithelial carcinoma Mutated genes PTEN, KRAS, PIK3CA TP53, aneuploidy Behaviour Indolent Aggressive CHARACTERISTICS OF TYPE I AND TYPE II ENDOMETRIAL CARCINOMA

23. Case 3

24. Clinical details A 42 year old female presented with complaints of irregular and heavy menstrual bleeding PV examination – uterus is slightly enlarged in size On ultrasonography - Multiple, well-circumscribed nodules were noted in the intramural location

25. Gross- Cut surface Endometrial cavity Sharply circumscribed intramural fibroid , cut surface of which is solid, homogeneous, grey white with whorling Cervix

26. Gross- Cut surface Single intramural fibroid

27. Gross features Sharply circumscribed , discrete, round, firm (on palpation), grey-white nodules Cut surface is solid, homogeneous with whorling

28. Microscopy Section shows bundles of smooth muscle cells arranged in fascicles and whorls

29. Microscopy The individual cells are uniform in size and shape with oval, elongated cigar shaped nucleus and have long slender bipolar cytoplasmic processes

30. Histology features The tumour is composed of interlacing fascicles of smooth muscle cells The individual cells are uniform in size and shape with oval, elongated cigar shaped nucleus and have long slender bipolar cytoplasmic processes Mitotic figures are scarce

31. IMPRESSION: LEIOMYOMATA

32. Secondary changes in leiomyoma : Areas of degeneration – hyaline, mucoid change Red degeneration Calcification Cystic change Fatty metamorphosis Benign metastasizing leiomyoma : Uterine leiomyoma which extends into vessels and spreads hematogenously