Page 525 - Concise Pathology for Exam Preparation ( PDFDrive )

510 SECTION II Diseases of Organ Systems

Gross Morphology

• May be exophytic or infiltrative
• Haemorrhage and necrosis common; may give rise to a shaggy, tan-coloured endometrium

Microscopy

Definitive diagnosis is made only when clear invasion of endometrial stroma or
myometrium is seen (differential diagnosis is atypical hyperplasia which does not
demonstrate invasion).

Criteria for Stromal Invasion

1. Irregular infiltration by glands inducing stromal fibrosis (desmoplastic response)
2. Confluent glands, merging and creating a cribriform pattern with minimal intervening
stroma
3. Extensive papillary formations
4. Replacement of stroma by masses of squamous epithelium

Histological Types

Most endometrial carcinomas are adenocarcinomas.
Based on the degree of differentiation shown by the tumour, endometrioid (Type I)
endometrial adenocarcinoma is classified into:
• Well-differentiated adenocarcinoma which has a back-to-back arrangement of
well-formed glands showing minimal atypia (less than 5% solid growth).
• Moderately differentiated adenocarcinoma which shows solid sheets of tumour
cells in addition to a glandular pattern (5–50% solid growth).
• Poorly differentiated adenocarcinoma which is composed of solid sheets of tumour
cells with marked cellular atypia and frequent mitoses; glandular pattern is difficult
to find (greater than 50% of the tumour shows a solid pattern).
Type II endometrial carcinomas are most often serous carcinomas.

Q. Describe the clinicopathological features of smooth
muscle tumours of uterus.

Ans. Smooth muscle tumours of uterus include
1. Leiomyoma uterus
(a) These are oestrogen-responsive benign tumours (also called fibroids) originating
from smooth muscle of uterus that generally present with abnormal bleeding,
infertility, bladder compression and increased urinary frequency. Increased
frequency of abortions, fetal malpresentation and postpartum haemorrhage may be
seen in pregnant women with leiomyomas.
(b) Common during active reproductive life (incidence of 30–50%); their size may
increase during pregnancy. May regress or even calcify after menopause.
Gross:
• Round, firm and grey-white tumours, variable in size with the cut surface showing
a whorled pattern.
• Sharply circumscribed and surrounded by compressed out myometrium which forms
a pseudocapsule.
• Leiomyomas may show different types of secondary changes, eg, hyaline degeneration
(due to hyaline change), red degeneration (due to venous thrombosis and congestion),
mucinous and cystic degeneration (liquefaction followed by extreme mucinous de-
generation), ischaemic necrosis, fibrosis and calcification (due to circulatory depriva-
tion and precipitation of calcium salts in the tumour).
• Based on the location, leiomyomas are classified into subserosal (beneath the serosa),
submucosal (beneath the mucosa) or intramural (embedded in the myometrium).

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