uterus






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  • Normal

    • endometrium
      • stages
      • stroma
      • hormone effects
        • gestational
        • hormones
        • IUD
      • artifacts
        • intravascular menstrual endometrium
        • cervical mucus
          • lots of PMNs
        • telescoping
        • thermal artifact
          • vacuolation
        • glandular molding
          • mimicks crowding but with tearing of surrounding stroma
        • pseudopapillary endometrium
          • lots of strips of endometrium
        • histiocytes
          • can have vacuoles and look like signet ring cells
      • other
      • stains
        • glands
          • positive: ER/PR, Bcl-2 (during proliferative), CK7, p63 (some basal/reserve cells)
          • negative: CK20
        • stroma
          • positive: CD10, Bcl-2
          • negative: CD34
    • myometrium
  • Non-neoplastic

  • WHO neoplasms

  • Patterns

  • Stains

    • p53
    • PTEN
      • mutated in: endometrioid (frequent)
    • ER/PR
      • positive
      • negative
        • endocervical adenoma
          • may be limited/focal
        • serous
    • p16
      • diffuse and strong in endocervical adenocarcinoma
      • patchy in endometrioid adenocarcinoma
    • PAS positive
    • Ki-67
      • high in serous
      • low in endometrioid
    • WT1
      • common diffuse nuclear expression in ovarian, tubal, primary peritoneal serous
      • infrequent in endometrial serous
    • CD10, Bcl2, CD34
      • endometrial stroma: CD10+, Bcl2+, CD34-
      • cervical stroma: CD10- (may have some around glands), Bcl2-, CD34+
  • TNM (useful for grossing)

    • non-trophoblastic
      • T1: confined to uterine corpus
        • T1a: endometrium confined
        • T1b: invades < 1/2 myometrium
        • T1c: invades > 1/2 myometrium
      • T2: invades cervix
        • T2a: endocervical glandular involvement only
        • T2b: cervical stromal invasion
      • T3: regional spread
        • T3a: involves serosa, adnexa or peritoneal fluid
        • T3b: vaginal involvement
      • T4: invades bladder or bowel mucosa
      • Regional nodes
        • pelvic
          • hypogastric (obturator, internal iliac)
          • common and external iliac
          • parametrial
          • sacral
        • para-aortic
    • trophoblastic
      • T1: confined to uterus
      • T2: extension to vagina, ovary, broad ligament, fallopian tube
      • M1a: lung metastasis
      • M1b: other distant metastasis
  • Staging

    • non-trophoblastic
      • IA: T1a
      • IB: T1b
      • IC: T1c
      • IIA: T2a
      • IIB: T2b
      • IIIA: T3a
      • IIIB: T3b
      • IIIC: N1
      • IVA: T4
      • IVB: M1
    • trophoblastic
      • I: T1
      • II: T2
      • III: M1a
      • IV: M1b
      • each stage can be further divided into A and B based on a prognostic score
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    • endometrial biopsy
      • disordered proliferative endometrium with glandular and stromal breakdown
      • No hyperplasia, atypia, carcinoma, endometrial polyp, or endometritis identified
    • benign hysterectomy
      • Cervix: Benign ectocervix and endocervix
      • Endometrium: inactive endometrium, no carcinoma seen
      • Myometrium: Small intramural leiomyomata, no malignancy identified
      • left/right ovary: benign ovary
      • left/right fallopian tube: benign fallopian tube