Medical Archive

Epidemiology and risk factors

• The m/c risk factor is obesity.
• Protective factors
  • Oral contraceptives (E+P)
  • Tobacco use
    • Stimulating estrogen metabolism in the liver and decreasing serum estrogen levels.

## Endometrial biopsy indications

• Age ?45
  • Abnormal uterine bleeding
  • Postmenopausal bleeding
• Age <45
  • Abnormal uterine bleeding PLUS:
    • Unopposed estrogen (obesity, anovulation)
    • Failed medical management
    • Lynch syndrome (HNPCC)
• Atypical glandular cells on Pap.
  • Age <35: common, benign especially during the menstrual cycle
  • Age ?35: need colposcopy + ECC + biopsy

Endometrial hyperplasia

Risk factor

??, ??, ???, Estrogen ?? ??, PCOS, granulosa-theca cell tumor, POF, nullipara, OCS(single), tamoxifen, raloxifen

Diagnosis

???: ?? ??, ????, ????
???: ? ?? (??? 5-10%)

US: ??? 14mm, ?? ? 4mm
Aspiration Bx, Hysteroscopy, D&C
C14 Benign Diseases of the Female Reproductive Tract

• 

• 

Treatment

Progestin Tx? 2-3???. ?? 1?? ? Bx ????.

NO atypia: Cyclic low P ? if fail, Cont. low P
With atypia: Continuous high P + 3month ? f/u Bx/TVUSG. ?? or ??? TAH+BSO

Endometrial cancer

Similar risk factors with hyperplasia. + HNPCC – POF

Type	Type I (75%)	Type II (25%)
Cause	E dependent	E independent, p53 mutation is common.
Arises from…	Endometrial hyperplasia	Atrophic hyperplasia
Histology	Endometrioid	Papillary structures with psammoma body
Age	Younger	Older
Prognosis	Favorable	Poor

Clinical presentation

???? ? ?? (90%), ?? ?? ??? DDx: ?? ?? ?? – m/c

Diagnosis

Physical exam: Pelvic exam, US;?? ??? 4mm??? ??
Screening test: ??. ???… Pap, cytology, USG(???? ??? ??? ?), CA125
US: ??? 14mm, ?? ? 4mm
Aspiration Bx
Hysteroscopy
D&C

Staging process

Surgical Flow
Peritoneal fluid cytology ? abdomen/pelvis explore ? TAH&BSO ? uterine specimen eval. ? suspicious LN sampling

Staging
Surgically, after TAH+BSO.

Histology
Bad: nonsquamous or nonmorular solid growth pattern
G1: ~5% / G2: 5~50% / G3: 50%~

Treatment

Pelvic, para-aortic LND Indication

• Histology
  • Non-endometrioid (serous, clear, squamous)
  • Grade 2-3 endometrioid
• ???? 1/2 ?? ?? (stage IB ??)
• ?? ?? >2cm
  • ??? 2cm ??? ?? pelvic,
  • Pelvic?? ??? para-aortic??.
• Isthmus-cervix extension
  • ?? ? ?? ??

Recurrence risk

• Risk factors
  • 60? ??
  • LVSI (+)
  • Size >2cm
  • Uterine ?? ??
• Risk factor ?? ?? RTx or CTx ??? ??.
• RTx
  • Stage IA G2~: vaginal brachytherapy (local)
  • Stage IA G3~: pelvic RTx (external)
  • + Extended field RTx, whole abdomen RTx, Etc.
• CTx

surgical staging ?
RTx
IB G3 RF+ ??? ??? RTx ?? ??.
Vaginal vault < External pelvic < Extended field < Whole abdomen
CTx
IB G3 RF+, II G3 ??? CTx ?? ? ??. III?? ??? ????.

???
1/4??, ??? 2? ??. Vagina>pelvis>lung>LN
??? ? ???. Palliative, RTx ?????? ??????

??? ? ???? ?? ??? E ??? controversial
??? ????? – IB?? ??? RTx. ?? ?? ????? ????.

Uterine sarcoma

Risk factors

Pelvic radiation, tamoxifen use, postmenopausal patients

Presentation

Abnormal/postmenopausal bleeding
Pelvic paian or pressure
Uteraine mass

Diagnosis

Ultrasound +/- additional imaging
Endometrial biopsy
Histopathology of surgical specimen

Leiomyosarcoma

Malignant proliferation of smooth muscle arising from the myometrium(usually seen in postmenopausal women).
Arises de novo; leiomyosarcomas do not arise from leiomyomas.
Gross exam often shows a single lesion with areas of necrosis and hemorrhage; histological features include necrosis, mitotic activity, and cellular atypia.