en dome trial cancer

8/2/2019 En Dome Trial Cancer

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Most common invasive cancer of the

female genital tract

Arise mainly in Postmenopausal WomenUncommon in women younger than 40

years of age

Peak Incidence: 55-65 year old women


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Characteristics Type I Type II

Age 55-65 yr 65-75

Clinical Setting Unopposed

estrogenObesityHypertensionDiabetes

Atrophy

Thin physique

Morphology Endometrioid SerousClear CellMixed Mullerian

Tumor


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Precursor Hyperplasia Endometrialintraepithelial

carcinomaMolecular genetics PTEN

PIK3CAKRASMSIB-cateninP53

P53AneuploidyPIK3CA


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Behavior IndolentSpreads via

lymphatics

AgrgressiveIntraperitoneal and

lymphatic spread


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Localized as polypoidtumor or diffusetumor involving

endometrial surface Spread generally by

Direct myometrial

invasion witheventual extension tothe periuterinestructures by directcontinuit


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Localized as polypoidtumor or diffusetumor involving

endometrial surface Spread generally by

Direct myometrial

invasion witheventual extension tothe periuterinestructures by directcontinuit


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Spread into broad ligaments Palpable Mass Dissemination to the regional lymph nodes May metastasize to the lungs, liver, bones and

other organs


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ENDOMETRIOID ADENOCARCINOMA

85% of Endometrial Carcinomas Gland Patterns resembling normal endometrial

epithelium


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COMPLEX ATYPICAL HYPERPLASIA- very closelypacked irregular-shaped endometrial glandseparated by hyperplastic endometrial stroma


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ENDOMETRIOID CARCINOMA


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Dilated irregular glands


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Grade I. Well Differentiated adenocarcinoma, lessthan 5% solid growth


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Grade II. Moderately differentiatedadenocarcinoma with partly (less than 50%) solidgrowth


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Grade III. Poorly differentiated adenocarcinomawith predominantly solid growth (greater than50%)


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SEROUS CARCINOMA

most common

subtype

Clear cell carcinoma and Malignant Mixed

Mullerian Tumor


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confluent glandularpattern

cribriform pattern


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Papillary pattern


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Infiltrationof glands


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Arise from small uteri Often bulky tumors

Deeply invasive into myometrium Precursor lesion: ENDOMETRIAL

INTRAEPITHELIAL CARCINOMA Invasive lesions Papillary Growth Pattern

Cells with marked atypia (high nuclear tocytoplasmic ratio, atypical figures,heterochromasia and prominent nucleoli.


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What are the important features identified onthe hysterectomy specimen in evaluating

prognosis?


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The prognosis depend heavily on the clinicalstage of the disease and its histologic grade

and type Hysterectomy specimens with endometrial

carcinoma are often submitted for frozensection to determine the depth on invasion.


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Clinicians ask for the involvement of thecervix uteri and the ovaries.

The pathologic examination of the uterus andadnexa is necessary for final staging on thepostoperative specimen


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In that process, the ff are taken: weight and the size of the uterus and adnexa appearance of the serosal surface, the myometrium,

and the uninvolved endometrium The uterine tumor should be described

location

3-dimensional size

distance from the margins and from the external oa descriptive characteristics (eg, exophytic, necroses, color)

estimated depth of infiltration into the myometrium, andits infiltration of the cervix


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What is the relationship of parity, age,exogenous estrogen administration to the

development of the endometrium?


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Clinicopathologic and epidemiologic studies

have supported the malignant of endometrialhyperplasia and the concept of a continuumof proliferative glandular lesions culminatingin some cases, in carcinoma.


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Furthermore, molecular studies haveconfirmed that endometrial hyperplasia andcarcinoma have specific molecular geneticalterations.


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Therefore, since the following factors

mentioned (parity, age, exogenous estrogenadministration ) are also closely related toendometrial hyperplasia, its safe to say thatthis factors can also contribute toendometrial carcinoma.


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Why did this patient receive internal radiumradiation


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THANKYOU!


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A malignant mixed Mllerian tumor, also known asmalignant mixed mesodermal tumor, MMMT andcarcinosarcoma, is a malignantneoplasm found in theuterus , the ovaries, the fallopian tubes and other

parts of the body that contains bothcarcinomatous(epithelial tissue) and sarcomatous (connective tissue)components. It is divided into two types, homologous(in which the sarcomatous component is made oftissues found in the uterus such as endometrial,fibrous and/or smooth muscle tissues) and aheterologous type (made upof tissues not found inthe uterus, such as cartilage, skeletal muscle and/orbone).
http://en.wikipedia.org/wiki/Carcinosarcomahttp://en.wikipedia.org/wiki/Malignancyhttp://en.wikipedia.org/wiki/Neoplasmhttp://en.wikipedia.org/wiki/Uterushttp://en.wikipedia.org/wiki/Carcinosarcomahttp://en.wikipedia.org/wiki/Malignancyhttp://en.wikipedia.org/wiki/Neoplasmhttp://en.wikipedia.org/wiki/Uterushttp://en.wikipedia.org/wiki/Carcinomahttp://en.wikipedia.org/wiki/Epitheliumhttp://en.wikipedia.org/wiki/Sarcomahttp://en.wikipedia.org/wiki/Connective_tissuehttp://en.wikipedia.org/wiki/Connective_tissuehttp://en.wikipedia.org/wiki/Connective_tissuehttp://en.wikipedia.org/wiki/Epitheliumhttp://en.wikipedia.org/wiki/Sarcomahttp://en.wikipedia.org/wiki/Connective_tissuehttp://en.wikipedia.org/wiki/Homology_(biology)http://en.wikipedia.org/wiki/Homology_(biology)http://en.wikipedia.org/wiki/Homology_(biology)http://en.wikipedia.org/wiki/Endometriumhttp://en.wikipedia.org/wiki/Fibrous_connective_tissuehttp://en.wikipedia.org/wiki/Smooth_musclehttp://en.wikipedia.org/wiki/Cartilagehttp://en.wikipedia.org/wiki/Skeletal_musclehttp://en.wikipedia.org/wiki/Bonehttp://en.wikipedia.org/wiki/Cartilagehttp://en.wikipedia.org/wiki/Skeletal_musclehttp://en.wikipedia.org/wiki/Bonehttp://en.wikipedia.org/wiki/Bonehttp://en.wikipedia.org/wiki/Skeletal_musclehttp://en.wikipedia.org/wiki/Cartilagehttp://en.wikipedia.org/wiki/Smooth_musclehttp://en.wikipedia.org/wiki/Fibrous_connective_tissuehttp://en.wikipedia.org/wiki/Endometriumhttp://en.wikipedia.org/wiki/Homology_(biology)http://en.wikipedia.org/wiki/Connective_tissuehttp://en.wikipedia.org/wiki/Sarcomahttp://en.wikipedia.org/wiki/Epitheliumhttp://en.wikipedia.org/wiki/Carcinomahttp://en.wikipedia.org/wiki/Uterushttp://en.wikipedia.org/wiki/Neoplasmhttp://en.wikipedia.org/wiki/Malignancyhttp://en.wikipedia.org/wiki/Carcinosarcoma

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