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U terine corpus

U terine corpus. Uterine corpus. benign diseases : - endometritis - adenomyosis - endometrial polyps precursor lesions of endometrial carcinoma endometrial carcinoma mesenchymal tumors of the uterus. Endometritis. Pregnancy-related. Unrelated to pregnancy.

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U terine corpus

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  1. Uterine corpus

  2. Uterine corpus • benigndiseases: • - endometritis • - adenomyosis • - endometrialpolyps • precursorlesionsofendometrialcarcinoma • endometrialcarcinoma • mesenchymaltumorsofthe uterus

  3. Endometritis Pregnancy-related Unrelated to pregnancy usuallyascendinginfection IUD acute - neutrophilswithinendometrialglands - Neisseriagonorrhoeae - Chlamydiatrachomatis chronic - plasma cells - pelvicinflammatorydisease • after a vaginaldelivery 2-3% • afterCesareandelivery 13-90% • - enterococcus • - streptococcus • - chlamydia … • puerperalsepsis

  4. bacterialinfection contractedduringchildbirthor abortion usuallytreatablewithantibiotics canbefatal! between 1991 and 2001: 137 womendied up to 42 dayafterthedelivery(12,5 / 100 000 deliveries) - in the Czech Republic only 5 ofthem (4,3%) diedbecauseofinfection commoncondition – historically duringthe 18th centuryittook on epidemicproportions particularly when home deliverypracticechanged to deliverylying-in hospital - atthosetimes, therestillwas a total ignorance ofasepsis Puerperalsepsis

  5. Endometriosis • presence ofendometrialtissueoutsidethe endometrium and myometrium • pathogenesis (twotheories): • 1) metastatictheory: implantationofendometrialtissue to itsectopiclocation • 2) metaplastictheory: developmentoftheendometrialtissueattheectopicsite

  6. Endometriosis • true prevalence isunknown as many patients are asymptomatic • estimated prevalence in womenofreproductiveageis 10-15% • >80% ofpatients are in reproductiveagegroup • sitesofendometriosis: • - peritoneum • - urinarybladder • - ovaries • - uterineligaments • - largebowel, skin • -lungs, bone, stomach

  7. Adenomyosis • presence ofendometrialglands and stroma withinthemyometrium • commoncondition, detected in 15-30% ofhysterectomy specimen • clinicalfeatures: • - pre- orperimenopausalwomen • - abnormalbleeding and dysmenorrhea • - uterus isenlarged

  8. Endometrialpolyps • common • 2-23% ofpatientsundergoingendometrialbiopsybecauseofabnormaluterinebleeding • probablyrelated to hyperestrogenism • maybe single ormultiple • increasedfrequencyofpolyps in patientstaking tamoxifen

  9. Precursorlesions

  10. Endometrialhyperplasia • hyperplasiawithoutatypia (simpleorcomplex) • atypicalhyperplasia (simpleorcomplex)

  11. Natural historyofhyperplasia • hyperplasiawithoutatypia • fewerthan 2% progress to carcinoma • atypicalhyperplasia • 23% progress to carcinoma

  12. precursorlesionofinvasiveendometrialserouscarcinoma formerlyalso had beenreferred to as „carcinoma in situ“ canbeassociatedwithmetastaticdisease histologicalfeatures: - numerousmitoticfigures - high-grade nuclearatypias - enlargednuclei - prominent nucleoli - canbepapillary arrangement Endometrialintraepithelialcarcinoma

  13. Tumorsoftheuterine corpus

  14. Tumorsoftheuterine corpus Epithelial Mesenchymal Benign leiomyoma endometrialstromalnodule Malignant leiomyosarcoma endometrialstromalsarcoma • Carcinoma: • endometrioid • mucinous • serous • clear cell Mixedepithelial and mesenchymal • carcinosarcoma

  15. Endometrialcarcinomadualistic model ofcarcinogenesis

  16. low-grade carcinomas associatedwithestrogenicstimulation indolentbehaviour histologicsubtypes: - low grade endometrioid - mucinous precursorlesion: - atypicalhyperplasia Type I

  17. Type II • high-grade carcinoma • not related to estrogenicstimulation • aggresivebehaviour • histologicsubtypes: • - high-grade endometrioid • - serous • - clear cell • precursorlesion: • - endometrialintraepithelialcarcinoma

  18. Etiology (type I) Risk factors Protectivefactors increasedphysicalexercise additionof progestin to HRT smoking diet rich in vegetables parity • hormonalstimulation • - unopossed estrogen stimulation (after 2 years – 2-3fold increase in the risk of EC) • constitutionalfactors • - obesity • - diabetes mellitus • increasedtotalcaloricintake • high-fat diet • geneticalterations • - mutationof PTEN • - microstalliteinstability (HNPCC – lynch syndrome)

  19. Clinicalfeatures • initialmanifestation: • - abnormalvaginalbleeding • - rarelyasymptomatic • most womenpostmenopausal • in youngwomen – generallylow grade, minimallyinvasive, excelentprognosis

  20. Gross findings • almostuniformlyexophytic • focalordiffuse • myometrialinvasionmayresult in enlargementofthe uterus • involvementofthe cervix – approximately 20% cases

  21. Prognosis Uterinefactors Extrauterinefactors adnexalinvolvement intraperitonealmetastasis lymph node metastasis • histologic type • grade • hormone receptor status • depthofmyometrialinvasion • cervicalinvolvement • vascularinvasion

  22. Leiomyoma • the most commonuterinetumors • notedclinically in 20-30% ofwomenover 30 yearsofage • whensystematicallysearched – 75% ofwomen

  23. Gross findings • location: • - submucosal (rarepedunculated) • - intramural (most common) • - subserosal (canbepedunculated) • multipletumors in 2/3 ofwomen • spherical, firm • sharplydemarcated • cutsurface: • - white to tan • - whorledtrabecularpattern

  24. Clinicalfeatures • most asymptomatic, only a minority requirestreatment • therapyisindicatedif: • - tumors are symptomatic (metrorrhagia, abdominalpain, urinationproblems) • - interferewith fertility • - rapidlyenlarge • - pose a diagnosticproblem

  25. Leiomyosarcoma • about 1.3% ofuterinemalignancies • more than 50% ofuterinesarcomas • most intramural • averages 6-9 cm in diameter • soft, fleshy, poorlydefinedmargins • cutsurface: gray-yellowor pink, oftenwithareasofnecrosis and hemorrhage • poorprognosis: 5 yearsurvivalrate 15-25%

  26. Carcinosarcoma (malignantmixedMüllerian tumor) • composedofmalignantepithelial and mesenchymalcomponents • frequentlypolypoid • poorprognosis

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