Reproduction L18 Uterine Malignancies

Front 1

What are the two types of endometrial carcinoma? (classic vs. alternate)

What is their relationship to hormones?

What is the prototypical carcinoma? (hint: endometroid vs. serous)

Back 1

Type I: Classic pathway: (young women), Estrogen related, Prototype: endometroid carcinoma…

Type II: alternate pathway: non-hormone related, serous related

Front 2

What two tissues are involved in endometrial/uterine cancer?

Back 2

What two tissues are involved in endometrial/uterine cancer? Epithelial and stromal

Front 3

Is this a characteristic/association of Type I or type II uterine cancer? 5x increased risk to develop WDEmCa, superficially invasive, arising in background of CHA?????????????

Back 3

Type I: 5x increased risk to develop WDEmCa, superficially invasive, arising in background of CHA

Front 4

Is this a characteristic/association of Type I or type II uterine cancer? Multiparous

Back 4

Type II: multiparous

Front 5

Is this a characteristic/association of Type I or type II uterine cancer? Nuliparous

Back 5

Type I: Nuliparous

Front 6

Is this a characteristic/association of Type I or type II uterine cancer?

Front 7

Which hyperplasia is more likely to lead to carcinoma? Simple, complex, or complex with atypia?

Back 7

Which hyperplasia is more likely to lead to carcinoma? complex with atypia

Front 8

Which ovarian tumor can produce excess amounts of Estrogen?

Back 8

Which ovarian tumor can produce excess amounts of Estrogen? Ovarian granulosa cells

Front 9

Why is Tamoxifen used for breast cancer, worrisome for a person with hyperplasia?

Back 9

Why is Tamoxifen used for breast cancer, contraindicated for a person with hyperplasia? While in the breast Tamoxifen block E-® (antagonist), it is an agonist in the endometrium --> endometrium cancer… HOWEVER, the benefit of Tamoxifen in breast cancer outweighs the risk of endometrial cancer

Front 10

T/F endometrial polyps are a risk factor for endometrial cancer.

Back 10

T/F endometrial polyps are a risk factor for endometrial cancer. FALSE… merely surveilance for more polyps

Front 11

When is uterine bleeding associated with malignancy?

Back 11

Uterine Malignancy: when bleeding is associated with: post menopause, perimenopause (intermittent or heavy), premenopausal (abnormal or assoc w/anovulatory PCOD

Front 12

What are some other causes of uterine bleeding?

Back 12

What are some other causes of uterine bleeding? Polyps, hyperplasia, leomyomas

Front 13

Is this a characteristic/association of Type I or type II uterine cancer?

Front 14

What do you include in the evaluation of uterine bleeding?

Back 14

What do you include in the evaluation of uterine bleeding? Biopsy and Endometrial curettage

Front 15

REVIEW ENDOMETRIAL CANCER SLIDES FROM CONFERENCE AND COURSE IMAGES

Back 15

REVIEW ENDOMETRIAL CANCER SLIDES FROM CONFERENCE AND COURSE IMAGES

Front 16

CONFIRM FIRST SLIDE ON PAGE 281 OF SYLLABUS

Back 16

CONFIRM FIRST SLIDE ON PAGE 281 OF SYLLABUS

Front 17

Is this a characteristic/association of Type I or type II uterine cancer? Microsatellite instability

Back 17

Microsatellite instability = type I

Front 18

Is this a characteristic/association of Type I or type II uterine cancer? p53 mutation

Back 18

p53 mutation = type II

Front 19

Is this a characteristic/association of Type I or type II uterine cancer? Increased ER/PR, especially in low grade

Back 19

Increased ER/PR, especially in low grade = Type I

Front 20

Is this a characteristic/association of Type I or type II uterine cancer? PTEN mutation

Back 20

PTEN mutation = type I

Front 21

Is this a characteristic/association of Type I or type II uterine cancer? Ras mutation

Back 21

Ras mutation (apoptosis)= type I

Front 22

Is this a characteristic/association of Type I or type II uterine cancer? Non neoplastic tissue appears atrophic

Back 22

Non neoplastic tissue appears atrophic = Type II

Front 23

Is this a characteristic/association of Type I or type II uterine cancer? High proportion of Ki-67 cells

Back 23

High proportion of Ki-67 cells (related to p53) = type II

Front 24

Is this a characteristic/association of Type I or type II uterine cancer? Endometrial intraepithelial neoplasm (precursor)

Back 24

EIC in situ replacement of benign endometrail gladular epithelium with malignant cells resembing high grade serous carcinoma = Type II

Front 25

T/F all endometrial carcinomas are associated with hyperplasia

Back 25

all endometrial carcinomas are associated with hyperplasia: FALSE, some are not

Front 26

Is this a characteristic/association of Type I or type II uterine cancer? ER/PR associated

Back 26

ER/PR associated = probably just type I, CHECK!!!!!!!!!!

Front 27

Is this a characteristic/association of Type I or type II uterine cancer? Due to unopposed Estrogen

Back 27

Due to unopposed Estrogen = type I

Front 28

Is this a characteristic/association of Type I or type II uterine cancer? Related to hyperplasia

Back 28

Related to hyperplasia = type 1

Front 29

Is this a characteristic/association of Type I or type II uterine cancer? Low grade, high grade

Back 29

Low grade = type I… high grade = type II

Front 30

Is this a characteristic/association of Type I or type II uterine cancer? Myometrial invasion.. Deep or minimal

Back 30

minimal = type I… deep = type II

Front 31

Is this a characteristic/association of Type I or type II uterine cancer? Seous cells

Back 31

Serous = type II

Front 32

Is this a characteristic/association of Type I or type II uterine cancer? Endometrioid cells

Back 32

Endometrioid cells = type I

Front 33

Is this a characteristic/association of Type I or type II uterine cancer? Clear cell

Back 33

Clear cell = type II

Front 34

Is this a characteristic/association of Type I or type II uterine cancer? Behavior: stable vs progressive

Back 34

Behavior: stable = I… Progressive = II

Front 35

T/F In endometrial cancer, a tumor that less solid and more glandular is more poorly differentiated.

Back 35

FALSE: In endometrial cancer, a tumor that MORE solid and LESS glandular is more poorly differentiated….

Front 36

Which two histologic subtypes of endometrial carcinoma are more aggressive?

Back 36

Which two histologic subtypes of endometrial carcinoma are more aggressive? Papillary serious, and clear cell

Front 37

identify the image and describe it.

Back 37

[insert endometrial serous carcinoma- micro] complex branching, psammmoma bodies, (identical to ovarian serous carcinoma), widespread lymphvascular permation

Front 38

identify the image and describe it.

Back 38

[clear cell carcinoma from image collection]

Front 39

What are the 3 tumors of the endometrium with stromal differentiation?

Back 39

What are the 3 tumors of the endometrium with stromal differentiation? Carcinocarcinoma, adenosarcoma,. Stromal tumors

Front 40

Review page 285 with computer

Back 40

Review page 285 with computer

Front 41

T/F in adenosarcomas, glands are bening, and the stroma is malignant

Back 41

TRUE in adenosarcomas, glands are bening, and the stroma is malignant

Front 42

T/F In Leiomyosarcomas, smooth muscle is malignant

Back 42

TRUE: In Leiomyosarcomas, smooth muscle is malignant

Front 43

T/F: in mixed tumors of the uterus, mixed tumors have a malignant epithelium and stroma.

Back 43

TRUE: in mixed tumors of the uterus, mixed tumors have a malignant epithelium and malignant stroma.

Front 44

T/F: in mixed mesodermal tumors/carcinosarcomas, both the glands and smooth muscle are malignant

Back 44

FALSE: in mixed mesodermal tumors/carcinosarcomas, GLANDS and STROMA ARE MALIGNANT… NOT smooth muscle

Front 45

Which of the following is TRUE of "mixed mesodermal tumors": post-menopause, hard atrophied uterus, polyoid fungating tumor with necrosis and hemorrhage, metastasis are seen in brain, and kidneys.

Back 45

Of "Mixed mesodermal tumors": TRUE: post-menopause, polyoid fungating tumor with necrosis and hemorrhage, FALSE: SOFT-ENLARGED UTERUS, NOT hard atrophied uterus, metastasis are seen in the LUNGS, ABDOMEN AND RP

Front 46

T/F: In homogenous MMT, the differentiation is the same as uterous, where heterologenous has mesenchymal tissue from other parts of the body.

Back 46

TRUE: In homogenous MMT, the differentiation is the same as uterous, where heterologenous has mesenchymal tissue from other parts of the body.

Front 47

Are MMTs benign? And what value does the appearance of stroma in play in predicting outcome?

Back 47

Are MMTs benign? NO, the are aggressive… What value does the appearance of stroma in play in predicting outcome? It's not predictive

Front 48

What is needed to make a dx of leiomyosarcomas?

Back 48

What is needed to make a dx of leiomyosarcomas? Mtotic activity, cytologic/nuclear atypia, coagulative tumor cell necrosis (unusual karyotype)… peak is 53 y/o, many symptoms similar to leiomyomas: bleeding, uterine enlargement, pain, constipation, urinary frequency, incidental dx = presumed leiomyomas,