DOCSLIB.ORG

Endometrial Polyp • Polypoid Adenomyoma • Other Benign Glands + Malignant Stroma

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Endometrial Polyp • Polypoid Adenomyoma • Other Benign Glands + Malignant Stroma The Hawaii Pathology Conference: The Mighty Women of Pathology Mixed Müllerian Tumors: Does Adenofibroma Exist? Do You Grade Adenosarcoma? If So, How? Are All Carcinosarcomas Equal? Teri A Longacre, MD, Richard L Kempson Endowed Professor of Surgical Pathology, Department of Pathology, Stanford Medicine Notice of Faculty Disclosure US Pathology Biomarker Advisory Board, Merck Teri Ann Longacre, MD Introduction • Polypoid adenomyoma - Atypical polypoid adenomyoma • Adenofibroma – Adenosarcoma • Carcinosarcoma Benign Glands + Benign Stroma • Polypoid Adenomyoma (PA) • Atypical Polypoid Adenomyoma (APA) • Atypical Polypoid Adenomyoma of Low Malignant Potential (APA-LMP) • Adenofibroma • Other (benign) polyps Case 1 • 32 year old with cervical polyp Is it? • Adenofibroma • Adenosarcoma • Atypical polypoid adenomyoma • Other Polypoid Adenomyoma (PA) • Age range from 26 to 64 (median, 47 years) • Abnormal vaginal bleeding • Size 0.3 to 17 cm • Corpus, most submucosal (80%) • Cervix uncommon (10%) • Firm, cystic polypoid masses Int J Gynecol Pathol 2000;19:195-205 Polypoid Adenomyoma (PA) • Circumscribed • Fibromuscular tissue – endometrial stroma often present around glands • Simple, rounded or tubular shaped glands & cysts – no atypia! • Focal tubal metaplasia • Squamous (morules) metaplasia rare, but may be present Int J Gynecol Pathol 2000;19:195-205 Desmin CD10 Polypoid Adenomyoma (PA) • Uncommon • Probably related to adenomyosis • No clear association with infertility • No risk of recurrence Int J Gynecol Pathol 2000;19:195-205 Summary: Polypoid Adenomyoma • Uncommon • No gland architectural abnormalities • Squamous metaplasia rare • No risk of recurrence • Important to distinguish from atypical polypoid adenomyoma Case 2 • 38 year old with cervical polyp APA APA Is it? • Complex endometrial hyperplasia • Adenosarcoma • Low-grade endometrial adenocarcinoma • Polypoid adenomyoma • Other Atypical Polypoid Adenomyoma (APA) • Circumscribed • Fibromuscular tissue – endometrial stroma may be present • Crowded, architecturally complex glands with atypia • Squamous (morular) metaplasia (90%) • Stromal mitotic figures may be focally increased MICRO: Morules Atypical Polypoid Adenomyoma (APA) • Reproductive age (mean, 38 years) • Vaginal bleeding or infertility work-up • Lower uterine segment polyp – can be removed by curettage Atypical Polypoid Adenomyoma (APA) • Mimics myoinvasive endometrial carcinoma in curettings • Look for dimorphic pattern: APA + normal proliferative or secretory endometrium • Immunostains for SMA, desmin not useful! • CD10 (so-called fringe pattern) expression in myoinvasive cancer but not APA may be useful Hum Pathol 2008;39:1446-53. Atypical Polypoid Adenomyoma (APA) • Atypical polypoid adenomyoma has risk of recurrence, but can be treated by polypectomy in reproductive-age women • Rarely atypical polypoid adenomyoma develop into low grade adenocarcinoma & very rarely spread beyond uterus Am J Surg Pathol 1996;20:1-20 Atypical Polypoid Adenomyoma of Low Malignant Potential • Looks like low grade cancer, invades like low grade cancer… • So, probably is very low grade cancer • But to date, deep myometrial invasion very uncommon and very rare instances of extension beyond uterus, so clinical behavior is that of a low malignant potential tumor Atypical Polypoid Adenomyoma of Low Malignant Potential • More architecturally complex than APA Higher rate of recurrence than APA: 60% versus 33% • Higher rate of progression to carcinoma than APA: up to 20% may have superficial myoinvasion Am J Surg Pathol 1996;20:1-20 Summary: Atypical Polypoid Adenomyoma • Gland architectural abnormalities • Squamous metaplasia common • Risk of recurrence 33-60% • Can be managed conservatively • Important to distinguish from endometrioid adenocarcinoma Case 3 • 42 year old with vaginal bleeding Is it? • Complex endometrial hyperplasia • Adenosarcoma • Low-grade endometrial adenocarcinoma • Polypoid adenomyoma • Other Well Differentiated Endometrioid Adenocarcinoma • Myoinvasive adenocarcinoma in endometrial sampling is very uncommon • When present, glands are haphazardly set in myofibromatous stroma with stromal reaction • Evidence of adenocarcinoma often present elsewhere in sampling: glands typically more complex with more cytologic atypia Case 4 • 44 year old with vaginal bleeding Is it? • Complex endometrial hyperplasia • Adenosarcoma • Low-grade endometrial adenocarcinoma • Polypoid adenomyoma • Other Focal Polypoid (Nodular) Hyperplasia • Similar presentation as APA/APA-LMP • Dimorphic pattern • Can probably be managed as APA Case 5 • 44 year old with vaginal bleeding Is it? • Adenofibroma • Adenosarcoma • Benign endometrial polyp • Polypoid adenomyoma • Other Benign Glands + Malignant Stroma • Low-grade adenosarcoma Mesodermal Adenosarcoma • Uncommon • Biphasic neoplasm composed of benign glands and sarcomatous stroma • Corpus > Ovary > Cervix • Peritoneal and extra-genital sites • Rare in testis, seminal vesicle, prostate Mesodermal Adenosarcoma • Assoc. w/ endometriosis, esp extragenital sites • Unopposed estrogen, tamoxifen, radiation • Slow growing, recurrences at 5 or more years (sometimes >10 years) • Clinical behavior depends on: – site – stromal overgrowth – heterologous elements and/or high grade sarcomatous element Adenofibroma/Adenosarcoma Spectrum AdenoFib AdenoSarc Uterine Adenosarcoma • Postmenopausal, may occur in reproductive years • Polyp or polypoid lesion protruding through cervical os (1-17 cm; mean, 5 cm) • Vaginal bleeding • Often history of “recurrent polyps” Cancer 1981;48:354-366; Hum Pathol 1990;21:363-368 Cervical Adenosarcoma • Younger women, 13–67 years (mean, 38) • Vaginal bleeding • Initially interpreted as “benign cervical polyps” • Often smaller than their uterine counterparts (2–8 cm) • Arise in ecto- or endocervix, most low stage Ovarian Adenosarcoma • Reproductive & postmenopausal (50% less than 50 years) • Unilateral • Solid & cystic, 5.5-50 cm (mean, 14 cm) • +/- assoc. w/ endometriosis • Poor prognosis compared to uterine/cervix adenosarcoma Am J Surg Pathol 2002;26:1243-1258 Peritoneal Adenosarcoma • Mean age 41 years, but wide range • History of prior hysterectomy many years prior to presentation: Metastasis from unrecognized uterine primary or true de novo? • Assoc w/ endometriosis • Bladder, colorectum, omentum, recto- vaginal septum, pouch of Douglas, retroperitoneum Adenosarcoma by Location Recurrences Deaths Corpus 15-25% 10-25% (45-70%**) (54%**) Cervix 18% 12% Ovary 77% 64% Peritoneum 60% 40% ** Stromal overgrowth Do You Grade Adenosarcoma? • Actually…you do Adenosarcoma: 3 Groups • Group 1: Usual (low-grade) adenosarcoma (Exclude benign tumor) • Group 2: Adenosarcoma with high grade sarcoma (R/O other sarcoma) • Group 3: Adenosarcoma with stromal overgrowth (SO), defined as pure sarcoma comprising >25% of tumor volume – usually high-grade, often heterologous (rhabdomyosarcoma) Adenosarcoma: Usual • Uniform distribution of irregular, often cystic glands with polypoid intrusions (phyllodes-like) • Variably cellular stroma with accentuation or condensation around glands (cambium layer) • Stromal cytologic atypia (usually mild) • Stromal mitotic figures: threshold varies from 2* to 4** MF/ 10 HPF * Clement & Scully, 1990; ** Zaloudek & Norris, 1981 MMMT Adenosarcoma Endometrioid Squamous Ciliated (Eosinophilic) Mucinous Nondescript Decidualized Sex cord elements Smooth muscle Adenosarcoma with High Grade Sarcomatous Stroma • High-grade sarcoma present but no stromal overgrowth – usually with heterologous elements • Rhabdomyosarcoma • Chondrosarcoma • Osteosarcoma Adenosarcoma with Stromal Overgrowth (SO) • Defined as pure sarcoma comprising >25% of tumor volume • Usually high-grade sarcoma, often heterologous • Rarely, low-grade sarcoma (slightly improved prognosis?) Adenosarcoma: Treatment • Surgical excision is mainstay • Radiation, chemotherapy or both for metastatic disease • Hormonal therapy for low stage disease – the stromal component frequently expresses hormone receptors Adenosarcoma: Differential Diagnosis • Adenofibroma • Endometrial polyp • Polypoid endometriosis • Carcinosarcoma Summary: Adenosarcoma • Biphasic benign epithelial and malignant stromal proliferation • Low-grade delayed, local recurrence vs high-grade sarcomatous overgrowth rapid recurrence with metastatic potential • Behavior depends also on site of origin Case 6 • 54 year old with vaginal bleeding Is it? • Adenofibroma • Adenosarcoma • Benign endometrial polyp • Polypoid adenomyoma • Other Benign Glands + Benign Stroma • Adenofibroma Adenofibroma - Adenosarcoma • Paucicellular, fibromatous • Uniform distribution of or fibrotic stroma irregular, often cystic • Stroma is mitotically glands with polypoid active intrusions • Multiple epithelial • Periglandular stromal differentiated types: condensation is minimal endometrioid, squamous, or absent mucinous, etc • Polypectomy is adequate • Variably cellular stroma treatment, provided that’s with accentuation or all there is condensation around • If in doubt, imaging, re- glands (cambium layer) sampling, close f/u • Hysterectomy is treatment of choice Does Adenofibroma Exist? • Controversial • Spectrum problem • May not be single entity Adenofibroma Is Genetically Heterogeneous • MDM2 amplification 26-28% • MYBL1 (sarcomatous overgrowth) 22% • PIK3CA/AKT/PTEN pathway 72% • ATRX (sarcomatous overgrowth) 17% • Chromosomal instability in aggressive tumors J Pathol 2015;235:37-49; J Pathol 2016;238:381-8; Mod Pathol 2016; 29:1070-82 Case 7 • 54 year old with vaginal
Load more

Recommended publications
  • Cervical Polypectomy
    Cervical Polypectomy Author: Consultant Department: Gynaecology/ Colposcopy Document Number: STHK1225 Version: 4 Review date: 01/10/2022 What is a polyp? Your doctor/nurse has advised you to have a polypectomy, which is the removal of a polyp. A polyp is a flesh-like structure (often described as looking like a cherry on a stalk or a skin tag), which can develop in many places in the body, including the cervix and uterus. It may have blood vessels running through it, which can often be the cause of bleeding. If it is thought the polyp is in your uterus, you will need to have a hysteroscopy (a procedure that uses a narrow camera to look inside the cavity of the uterus). This procedure is carried out as a gynaecology outpatient appointment at the Women’s Centre, and is performed in a special clinic in the Diagnostic Suite. You will receive a further appointment for this treatment and be given a different leaflet to explain the hysteroscopy procedure. If for any reason the polyp cannot be removed or fully removed during either of these treatments, the doctor will advise you of other options. Reasons for the procedure As you know you have been referred to the Colposcopy Clinic because you have a polyp on the cervix. Sometimes the cervical polyp is broad based, where it does not have a stalk but sits on the cervix. Often they cause no symptoms and are found as a result of other examinations. Polyps are usually benign (non-cancerous). Less than 1 % (1 in 100) may have pre-cancerous or cancerous changes within them; it is therefore advisable to have them removed.
    [Show full text]
  • Imaging Description of Extragenital Müllerian Adenosarcoma: a Case Report Descrição Da Imagem Do Adenosarcoma Mülleriano Extragenital: Relato De Caso
    Published online: 2018-12-12 THIEME 124 Case Report Imaging Description of Extragenital Müllerian Adenosarcoma: A Case Report Descrição da imagem do adenosarcoma mülleriano extragenital: relato de caso Annalisa Mone1 Piergiorgio Iannone2 1 Department of Radiology, University of Verona, Verona, Italy Address for correspondence Annalisa Mone, MD, Reparto di 2 Section of Obstetrics and Gynecology, Department of Morphology, Radiologia, Policlinico G.B. Rossi, Università Degli Studi di Verona, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy Piazzale LA Scuro, 10, 37134, Verona, Italy (e-mail: [email protected]). Rev Bras Ginecol Obstet 2019;41:124–128. Abstract Müllerian adenosarcoma is a very rare gynecological disease, comprising 5% of uterine sarcomas. Extragenital localizations are even rarer. We report a very interesting case of Keywords a 27-year-old woman complaining of pelvic pain, with a subsequent diagnosis of ► extragenital müllerian extragenital Müllerian adenosarcoma. This is the first case reported in the literature adenosarcoma with a complete and wide imaging description. Even if rare, Müllerian adenosarcoma ► computed should be hypothesized in case of young female patients presenting with suspicious tomography pelvic mass. ► pelvic mass ► uterine sarcoma Resumo O adenosarcoma Mülleriano é uma doença ginecológica muito rara, compreendendo 5% dos sarcomas uterinos. Localizações extragenitais são ainda mais raras. Relatamos Palavras-chave um caso muito interessante de uma mulher de 27 anos queixando-se de dor pélvica ► adenosarcoma com diagnóstico subsequente de adenosarcoma Mülleriano extragenital. Este é o mülleriano primeiro caso relatado na literatura com uma descrição completa e ampla de imagem. extragenital Mesmo que raro, o adenosarcoma Mülleriano deve ser hipotetizado no caso de ► fi tomogra a pacientes jovens do sexo feminino com massa pélvica suspeita.
    [Show full text]
  • ICD-9-CM and ICD-10-CM Codes for Gynecology and Obstetrics
    Diagnostic Services ICD-9-CM and ICD-10-CM Codes for Gynecology and Obstetrics ICD-9 ICD-10 ICD-9 ICD-10 Diagnoses Diagnoses Code Code Code Code Menstral Abnormalities 622.12 Moderate Dysplasia Of Cervix (CIN II) N87.2 625.3 Dysmenorrhea N94.6 Menopause 625.4 Premenstrual Syndrome N94.3 627.1 Postmenopausal Bleeding N95.0 626.0 Amenorrhea N91.2 627.2 Menopausal Symptoms N95.1 626.1 Oligomenorrhea N91.5 627.3 Senile Atrophic Vaginitis N95.2 626.2 Menorrhagia N92.0 627.4 Postsurgical Menopause N95.8 626.4 Irregular Menses N92.6 627.8 Perimenopausal Bleeding N95.8 626.6 Metrorrhagia N92.1 Abnormal Pap Smear Results 626.8 Dysfunctional Uterine Bleeding N93.8 795.00 Abnormal Pap Smear Result, Cervix R87.619 Disorders Of Genital Area 795.01 ASC-US, Cervix R87.610 614.9 Pelvic Inflammatory Disease (PID) N73.9 795.02 ASC-H, Cervix R87.611 616.1 Vaginitis, Unspecified N76.0 795.03 LGSIL, Cervix R87.612 616.2 Bartholin’s Cyst N75.0 795.04 HGSIL, Cervix R87.613 Cervical High-Risk HPV DNA 616.4 Vulvar Abscess N76.4 795.05 R87.810 Test Positive 616.5 Ulcer Of Vulva N76.6 Unsatisfactory Cervical 795.08 R87.615 616.89 Vaginal Ulcer N76.5 Cytology Sample 623.1 Leukoplakia Of Vagina N89.4 795.10 Abnormal Pap Smear Result, Vagina R87.628 Vaginal High-Risk HPV DNA 623.5 Vaginal Discharge N89.8 795.15 R87.811 Test Positive 623.8 Vaginal Bleeding N93.9 Disorders Of Uterus And Ovary 623.8 Vaginal Cyst N89.8 218.9 Uterine Fibroid/Leiomyoma D25.9 Noninflammatory Disorder 623.9 N89.9 Of Vagina 256.39 Ovarian Failure E28.39 624.8 Vulvar Lesion N90.89 256.9 Ovarian
    [Show full text]
  • Having a Cervical Polypectomy
    Gynaecology information Having a cervical polypectomy Introduction This leaflet gives you advice and information about having a cervical polypectomy (removal of polyps from the neck of the womb). Please read it before you go home so that you can have your questions answered before you leave. Feel free to discuss any questions or concerns with your nurse or telephone the Colposcopy Clinic on 0118 322 7197 or Sonning Ward on: 0118 322 7181. What is a cervical polypectomy and why do I need one? A cervical polyp is a small piece of tissue, usually on a stalk, that grows on the cervix (neck of the womb). Sometimes the cervical polyp is broad-based, where it does not have a stalk but sits on the cervix. Often they cause no symptoms and are found as a result of other examinations. Polyps are usually benign (non-cancerous). Less than 1% may have pre- cancerous or cancerous changes within them; it is therefore advisable to have them removed. A polypectomy is the removal of polyps. What are the risks of a cervical polypectomy? The procedure is very low risk, but may cause an infection or heavier bleeding. Before being sent for a polypectomy your doctor will have carried out a full pelvic examination, including an examination of your cervix using a speculum and you may have had an ultrasound or scan. What happens during a cervical polypectomy? This is normally done in the outpatient clinic. You will be asked to undress from the waist down and lie down on an examination couch. A speculum (the instrument used to open up the vagina) is passed into the vagina to expose the cervix.
    [Show full text]
  • Menstrual Disorder
    Menstrual Disorder N.SmidtN.Smidt--AfekAfek MD MHPE Lake Placid January 2011 The Menstrual Cycle two phases: follicular and luteal Normal Menstruation Regular menstruation 28+/28+/--7days;7days; Flow 4 --7d. 40ml loss Menstrual Disorders Abnormal Beleding –– Menorrhagia ,Metrorrhagia, Polymenorrhagia, Oligomenorrhea, Amenorrhea -- Dysmenorrhea –– Primary Dysmenorrhea, secondary Dysmenorrhea Pre Menstrual Tension –– PMD, PMDD Abnormal Uterine Beleeding Abnormal Bleeding Patterns Menorrhagia --bleedingbleeding more than 80ml or lasting >7days Metrorrhagia --bleedingbleeding between periods Polymenorrhagia -- menses less than 21d apart Oligomenorrhea --mensesmenses greater than 35 dasy apart. (in majority is anovulatory) Amenorrhea --NoNo menses for at least 6months Dysfunctional Uterine Bleeding Clinical term referring to abnormal bleeding that is not caused by identifiable gynecological pathology "Anovulatory Uterine Bleeding“ is usually the cause Diagnosis of exclusion Anovulatory Bleeding Most common at either end of reproductive life Chronic spotting Intermittent heavy bleeding Post Coital Bleeding Cervical ectropion ( most common in pregnancy) Cervicitis Vaginal or cervical malignancy Polyp Common Causes by age Neonatal Premenarchal ––EstrogenEstrogen withdrawal ––ForeignForeign body ––Trauma,Trauma, including sexual abuse Infection ––UrethralUrethral prolapse ––Sarcoma botryoides ––Ovarian tumor ––PrecociousPrecocious puberty Common Causes by age Early postmenarche Anovulation (hypothalamic immaturity) Bleeding
    [Show full text]
  • A Giant, Deceptive Cervical Polyp
    Interventions in Gynaecology & Women’s Healthcare DOI: 10.32474/IGWHC.2020.04.000183 ISSN: 2637-4544 Case Report A Giant, Deceptive Cervical Polyp Mounia Bennani*, Hanane Baybay, Jihane Ziani, Sara Elloudi, Zakia Douhi and Fatima Zahra Mernissi Department of dermatology and venerology, Hassan II hospital university, Morocco *Corresponding author: Mounia Bennani Department of dermatology and venerology, Hassan II Hospital University, FES Received: February 29,2020 Published: March 05, 2020 Case Report This is the case of a 48-year-old patient, no Medical or pink-reddish, with a smooth surface (Figure 2), the vaginal touch pharmacological history referred in Our dermatology consultation protruding through the vagina (Figure1). The mass was firm, the tumor was in continuity with the cervix, while the vulva was for management of a lesion evolving for 6 years, increasing in intact. A dermoscopic examination was carried out objectifying size, becoming bleeding on contact, the patient did not complain the presence of a polymorphic vascularization made of vessels in of pain, but rather an unpleasant feeling of heaviness. On local points, irregular linear, and hairpins in place, associated with the examination, a multi-lobed tumor of approximately 10 cm was presence of bright white areas without structures (Figure 3). Figure 1: Image showing a 10cm Multilobed tumor protruding through the vagina. Copyright © All rights are reserved by Mounia Bennani. 384 Int Gyn & Women’s Health Volume 4 - Issue 2 Copyrights @ Mounia Bennani. Figure 2: Image showing a firm, pinkish-reddish, multiloped mass with a smooth surface. Figure 3: Dermoscopic image showing polymorphic vascularity and bright white structures.
    [Show full text]
  • Adenosarcoma of Uterus with Sarcomatous Overgrowth and Rhabdomyoblastic Differentiation - a Rare Pathological Entity
    https://www.scientificarchives.com/journal/journal-of-experimental-pathology Journal of Experimental Pathology Case Report Adenosarcoma of Uterus with Sarcomatous Overgrowth and Rhabdomyoblastic Differentiation - A Rare Pathological Entity Gaurav Sharma1, Prachi* 1Senior Consultant, Dharamshila Narayana superspeciality hospital, New Delhi- 110096 2Senior resident, Dharamshila Narayana superspeciality hospital, New Delhi- 110096 *Correspondence should be addressed to Prachi; [email protected] Received date: December 10, 2020, Accepted date: January 18, 2021 Copyright: © 2021 Sharma G, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Abstract Adenosarcoma is a rare tumor composed of benign glandular epithelium and a malignant mesenchymal component. Here we present a case of 62-year-old female, with irregular post-menopausal bleeding. On histological diagnosis, Uterine adenosarcoma with rhabdomyoblastic differentiation with sarcomatous overgrowth was made, which carries poor prognosis and reduces the survival period of a patient. Her post – operative course was uneventful. Keywords: Adenosarcoma, Rhabdomyoblastic, Sarcomatous overgrowth Introduction expression. The sarcomatous component stains for CD10 which may be lost in the cases of sarcomatous overgrowth Uterine adenosarcoma is a rare malignancy. It is defined variants. The rate of recurrence for adenosarcoma without as a biphasic tumor composed of both sarcomatous stroma sarcomatous overgrowth is between 15 & 25% and with and benign epithelial components. When the sarcomatous sarcomatous overgrowth is as high as 45-70%. Distant component occupies more than 25 % of the tumor then metastases have been described in about 5% of affected it is referred to as the sarcomatous overgrowth which patients [1].
    [Show full text]
  • Mullerian Adenosarcoma of the Endometrium in a 19-Year-Old Girl: Case Report and a Literature Review
    Open Access Austin Critical Care Case Reports Case Report Mullerian Adenosarcoma of the Endometrium in a 19-Year-Old Girl: Case Report and a Literature Review Miyoshi A1, Ueda Y1*, Sato K2 and Kimura T1 1Department of Obstetrics and Gynecology, Osaka Abstract University Graduate School of Medicine, Japan Mullerian adenosarcoma of the endometrium in adolescent girls is extremely 2Department of Pathology, Osaka University Graduate rare, with only fifteen cases under 20 years old having been reported to date. School of Medicine, Japan We describe here a new case of adolescent Mullerian adenosarcoma and *Corresponding author: Yutaka Ueda, Department of provide an updated review of the previous literature on such rare tumors. Our Obstetrics and Gynecology, Osaka University Graduate 19-year-old case presented with a six-month history of prolonged menstruation. School of Medicine, 2-2, Yamadaoka Suita, Osaka 567- She had not yet had any sexual relationship. On gross examination, a fragile 0871, Japan mass was seen in her vagina that bled easily. A 4.0×2.0 cm mass was visualized with Magnetic Resonance Imaging (MRI). The tumor seemed to Received: January 05, 2020; Accepted: February 05, slightly invade the myometrium of the uterine corpus. Transvaginal ultrasound 2021; Published: February 12, 2021 sonography confirmed the presence of a 4.0 cm mass located in the cervix and vagina. The tumor biopsy was diagnosed as a Mullerian adenosarcoma of the endometrium. We performed a Total Abdominal Hysterectomy (TAH) and Bilateral Salpingectomy (BS). The post-surgical specimen was diagnosed as a pT1aNXM0 Mullerian adenosarcoma of the endometrium. The patient did not require adjuvant chemotherapy.
    [Show full text]
  • The Woman with Postmenopausal Bleeding
    THEME Gynaecological malignancies The woman with postmenopausal bleeding Alison H Brand MD, FRCS(C), FRANZCOG, CGO, BACKGROUND is a certified gynaecological Postmenopausal bleeding is a common complaint from women seen in general practice. oncologist, Westmead Hospital, New South Wales. OBJECTIVE [email protected]. This article outlines a general approach to such patients and discusses the diagnostic possibilities and their edu.au management. DISCUSSION The most common cause of postmenopausal bleeding is atrophic vaginitis or endometritis. However, as 10% of women with postmenopausal bleeding will be found to have endometrial cancer, all patients must be properly assessed to rule out the diagnosis of malignancy. Most women with endometrial cancer will be diagnosed with early stage disease when the prognosis is excellent as postmenopausal bleeding is an early warning sign that leads women to seek medical advice. Postmenopausal bleeding (PMB) is defined as bleeding • cancer of the uterus, cervix, or vagina (Table 1). that occurs after 1 year of amenorrhea in a woman Endometrial or vaginal atrophy is the most common cause who is not receiving hormone therapy (HT). Women of PMB but more sinister causes of the bleeding such on continuous progesterone and oestrogen hormone as carcinoma must first be ruled out. Patients at risk for therapy can expect to have irregular vaginal bleeding, endometrial cancer are those who are obese, diabetic and/ especially for the first 6 months. This bleeding should or hypertensive, nulliparous, on exogenous oestrogens cease after 1 year. Women on oestrogen and cyclical (including tamoxifen) or those who experience late progesterone should have a regular withdrawal bleeding menopause1 (Table 2).
    [Show full text]
  • Pregnancy Complicated with a Giant Endocervical Polyp
    Pregnancy complicated with a giant endocervical polyp Kirbas A, Biberoglu E, Timur H, Uygur D, Danisman N Zekai Tahir Burak Women's Health Education and Research Hospital, Ankara, Turkey Objective We report the case of a giant cervical polyp in a primigravid young women that was associated cervical funneling. Methods Case report. Results A 21 year old primigravid woman admitted to our clinic with suspicion of cervical incompetence at 22 weeks of gestation. She complained of light vaginal bleeding and a vaginal mass. She did not have any pain. Her past medical history was uneventful. A detailed abdominal 2D ultrasound scan was performed to verify the presence of the pregnancy and research for associated anomalies. The US scan showed a 22 week viable fetus. Additionally, there was funneling of the cervical canal and the cervical length was 22 mm (Figure 1). On vaginal examination, there was light bleeding and a large fragile mass protruding from the vagina (Figure 2). We detected that the mass originated from the anterior lip of the cervix and it was extending into the cervical canal (Figure 3). We performed simple polypectomy. The funneling of the cervical canal disappeared after the operation and cervical canal length was 31 mm. The final histopathological findings confirmed a benign giant cervical polyp. The pregnancy is progressing well with a normal cervical length and she is currently 34 weeks of gestation. There has been no recurrence. We have planned endometrial and cervical canal evaluation after delivery. Conclusion Cervical polyps less than 2cm are quite common in the female adult population.
    [Show full text]
  • The Uterus and the Endometrium Common and Unusual Pathologies
    The uterus and the endometrium Common and unusual pathologies Dr Anne Marie Coady Consultant Radiologist Head of Obstetric and Gynaecological Ultrasound HEY WACH Lecture outline Normal • Unusual Pathologies • Definitions – Asherman’s – Flexion – Osseous metaplasia – Version – Post ablation syndrome • Normal appearances – Uterus • Not covering congenital uterine – Cervix malformations • Dimensions Pathologies • Uterine – Adenomyosis – Fibroids • Endometrial – Polyps – Hyperplasia – Cancer To be avoided at all costs • Do not describe every uterus with two endometrial cavities as a bicornuate uterus • Do not use “malignancy cannot be excluded” as a blanket term to describe a mass that you cannot categorize • Do not use “ectopic cannot be excluded” just because you cannot determine the site of the pregnancy 2 Endometrial cavities Lecture outline • Definitions • Unusual Pathologies – Flexion – Asherman’s – Version – Osseous metaplasia • Normal appearances – Post ablation syndrome – Uterus – Cervix • Not covering congenital uterine • Dimensions malformations • Pathologies • Uterine – Adenomyosis – Fibroids • Endometrial – Polyps – Hyperplasia – Cancer Anteflexed Definitions 2 terms are described to the orientation of the uterus in the pelvis Flexion Version Flexion is the bending of the uterus on itself and the angle that the uterus makes in the mid sagittal plane with the cervix i.e. the angle between the isthmus: cervix/lower segment and the fundus Anteflexed < 180 degrees Retroflexed > 180 degrees Retroflexed Definitions 2 terms are described
    [Show full text]
  • Commonly Used ICD-10 Codes in Reproductive Healthcare
    FREQUENTLY USED CODES Commonly Used ICD-10 Codes in Reproductive Healthcare Female Reproductive Healthcare Breast Conditions Infertility Uterus N60.(01/02) Solitary cyst of breast (R/L) N97.0 Infertility-anovulation C54.1 Cancer of endometrium N60.(11/12) Fibrocystic change (R/L) E23.0 Hypopituarism C54.2 Cancer of myometrium N61 Mastitis, NOS N97.1 Infertility-tubal origin C54.3 Cancer of fundus uteri N64.0 Fissure and fistula of nipple N97.2 Infertility-uterine origin C54.9 Cancer of corpus uteri, unspec. N64.3 Galactorrhea N97.8 Infertility-cervical origin D25.9 Uterine myoma N64.4 Mastodynia N97.9 Female infertility, NOS N84.0 Polyp of corpus uteri N63 Lump or mass in breast N84.8 Polyp of other parts of fem genital N64.51 Induration of breast Menopause N84.9 Polyptract of fem. genital tract, unspec. N64.53 Retraction of nipple N92.4 Perimenopausal menorrhagia N85.00 Endometrial hyperplasia N64.59 Other signs/ symptoms in breast N95.0 Postmenopausal bleeding N85.4 Malposition of uterus N64.53 Retraction of nipple N95.1 Menopausal syndrome N85.6 Asherman’s syndrome O91.23 Mastitis, postpartum, unspec. N95.2 Atrophic vaginitis N85.7 Hematometra R92.8 Abnormal mammogram N95.8 Symptoms w artificial menopause N85.9 Disorder of uterus, NOS N95.9 Menopausal disorder NOS Cervix Urinary Tract C53.0 Endocervical cancer Ovary and Adnexa N30. 10 Interstitial cystitis w/o hematuria C53.1 Exocervical cancer C56.1 Malignant neoplasm of right ovary N30.11 Interstitial cystitis w/ hematuria C53.9 Cervical cancer, NOS C56.2 Malignant neoplasm of left
    [Show full text]