TUMORS OF THE

BODY OF UTERUS
AMMAD JAVED
203
MALIGNANT TUMORS OF
ENDOMETRIUM
 CARCINOMA OF ENDOMETRIUM
 TUMORS OF ENDOMETRIUM WITH STROMAL
DIFFERENTIATION
1. CARCINOSARCOMAS
2. ADENOSARCOMAS
3. STROMAL TUMORS
CARCINOMA OF ENDOMETRIUM
 Endometrial cancer refers to several types of
malignancy which arise from the
endometrium , or lining of the uterus.
 Most common invasive cancer of female
genital tract.
 Occur mainly in postmenopausal women
causing abnormal postmenopausal bleeding.

Incidence
 Peak incidence — 55 to 65 year old women
 Uncommon in women younger than 40 years of
age
vRisk factors
1.Obesity
2.Diabetes
3.Hypertension
4.Infertility
5.Birth control pills (estrogen only)
6.Radiation exposure



Pathogenesis
 Two general groups can be identified:
1.Type I: These cancers occur most commonly
in pre- and peri-menopausal women, often
with a history of unopposed estrogen
exposure and/or endometrial hyperplasia.
They are often minimally invasive into the
underlying uterine wall, are of the low-
grade endometrioid type, and carry a good
prognosis.



 Relationship between hyperplasia and
carcinoma of endometrium:
Ø Both are linked with obesity and anovulatory
cycles.
Ø Women with ovarian-estrogen secreting
tumors are at high risk.
Ø Carcinoma is rare in women with ovarian
agenesis.
Ø Estrogen replacement therapy increases risk.
Ø Greater synthesis of estrogen in
postmenopausal women in body fat.
Ø Inactivation of PTEN gene is common in both
 Type II: These cancers occur in older, post-
menopausal women , are not associated
with increased exposure to estrogen, and
carry a poorer prognosis. They include:
 the high-grade endometrioid cancer,
 the uterine papillary serous carcinoma,
 the uterine clear cell carcinoma.

Morphology
 Gross
 Either localized polypoid or diffuse
 Spread by direct myometrial invasion
 Metastasizes to lungs, liver , bones etc
 Certain types, mostly serous spread by tubal or
lymphatic transmission
Histology
 85 % are adenocarcinomas (endometroid- tumors).
Ø Most adenocarcinomas are well differentiated
Ø Show mucinous,squamous,andtubal
differentiation.


 Upto 20 % are non-endometroid carcinomas

Ø Papillary serous and clear cell carcinomas
Ø Highly aggressive type
Ø Managed as grade 3 carcinomas



Staging and grading of
adenocarcinoma.
qStaging


§ Stage 1

carcinoma confined to corpus uteri
§ Stage 2

carcinoma has involved corpus and
cervix.
§ Stage 3

carcinoma has extended outside uterus
but not outside true pelvis.
§ Stage 4

carcinoma has extended outside true
pelvis.

 Grading

§ Grade 1

well differentiated.
§ Grade 2
 differentiated with partially solid
areas.
§ Grade 3

predominantly solid or entirely
undifferentiated.
Clinical features
 Irregular vaginal bleeding with leukorrhea.
 Difficult or painful urination.
 Pain in the pelvic area.
 With progression of tumor uterus may be
enlarged or become fixed to surrounding
structures.
diagnosis
 History
 General examination
 Blood and urine tests.
 Pelvic examination.
 Paps test.
 Transvaginal ultrasound.
 Biopsy.
Prognosis and treatment
 Prognosis depends on clinical stage of disease
and its histologic grade and type.
 Treatment options:
 Surgery—hysterectomy with bilateral salpingo-
oophorectomy.
 Radiation therapy.
 Hormonal therapy.
 Combination therapy.

Tumors of the endometrium with
stromal differentiation
 Carcinosarcomas
 Adenosarcomas
 Stromal tumors
carcinosarcomas
 Adenosarcomas with malignant stromal
differentiation.
 Stroma differentiates into muscle,cartilage or
bone etc.
 Occur in postmenopausal women with
postmenopausal bleeding.
 Grossly more fleshy,bulky and polypoid,and
may protrude through cervicla os.
 Highly malignant.
 Prognosis depends upon grade and type of
tumor.
adenosarcomas
 Large broad based endometrial polypoid
growths, may prolapse through cervical os.
 Diagnosis is based upon malignant appearing
stroma.
 Incidence is between 40-50 years of age.
 Generally of low grade malignancy.
 Differentiation from large benign polyps is
important.
 Oophorectomy is performed since they are
estrogen sensitive.
Stromal tumors
 Resemble normal stromal cells.
 Divided into two categories
Ø Benign stromal nodules:

Well circumscribed non-invasive
aggregates in the myometrium.
Ø Endometrial stromal sarcomas:

neoplastic endometrial stroma lying
between muscle bundles of myometrium
with diffuse infiltration and penetration of
lymphatics.

Tumors of myometrium
 LEIOMYOMAS:

 Leiomyomas are benign soft tissue neoplasms

that arise from smooth muscle.
 fibroids are the most common type of
abnormal pelvic growth in women.

Types and Symptoms
 Fibroids develop from cells in the wall of the uterus.
 Fibroids can also grow beneath the uterine lining. As they expand,
they can stretch the endometrium, causing heavy menstrual
bleeding and severe pain as the uterus tries to expel the mass.
 Some fibroids grow beneath the outside covering of the uterus, or
appear to be attached by a stemlike structure to the uterus. All
these tumors can grow much larger than the uterus itself.
 Large uterine fibroids can cause pain, constipation, frequency of
urination and increased menstrual pain and irregularity.
 These tumors also can obstruct the fallopian tubes or block
implantation of the fertilized egg. If conception does take
place, the tumors can cause a miscarriage or premature labor..
 The cause of uterine fibroids is unknown, but evidence suggests
that their growth is tied to estrogen.
 When a woman is pregnant or takes certain birth control pills, both
of which increase estrogen levels, the normally slow growth rate
of the fibroid often accelerates.

 leiomyosarcoma
 Leiomyosarcomas arising from myometrial
muscle, with a peak incidence occurring at
age 50, and accounting for 30% of all uterine
sarcomas.
 Most cases arise de novo and not from pre-
exisiting leiomyomas.
 In its advanced stages uterine leiomyosarcoma
is highly lethal, and effective treatment is
directly linked to early discovery and
prompt curative action.