leiomyoma and cervix cancer

1. Leiomyoma

2. Leiomyoma or fibromyomas commonly called fibroids,are
the most common uterine tumours of smooth muscle origin
often admixed with variable amount of fibrous tissue
component.
Nearly 20% of the women above the age of 30 years carry
myomas of varying size.majority of them are benign and
cause no symptoms.
Malignant transformation occurs in less thn 0.5% of
leiomyomas.
The cause of leiomyoma is unknown but possible stimulus
to their proliferation is oestrogen.

3. Morphologic features
Morphologically they are of 3 types baesd on location.
1) Intramural or Interstitial-located within the
myometrium.
2) Subserosal- located in the serosa.
3) Submucosal- located just underneath the
endometrium.
Submucosal and subserosal myomas may develop
pedicle and protrude as pedunculated myomas.

5. Gross appearance
Irrespective of their location,leiomyomas are
often multiple,circumscribed,firm,nodular,grey
white masses of variable size.
On cut section they shows characteristic
whorled patteren.

7. Microscopic appearance
It is essentially composed of 2 tissue elements,
whorling bundles of smooth muscle cells admixed with
variable amount of connective tissue.the bundles of
smooth muscle cells resembles more or less the
architecture of myometrium,they are uniform in size
and shape with abundant cytoplasm and central oval
nuceli.
Mitotic figures are rare which differentiate it with
myosarcoma.

9. Leiomyosarcoma

10. Leiomyosarcoma is an uncommon malignant
tumour as compared to its common benign
counterpart.
The incidence of malignancy in pre existing
leiomyoma is less thn 0.5% but primary uterine
sarcoma is less common thn that which arises in
the leiomyoma.
The peak age incidence is 4th to 6th decade of life.

11. Gross appearance
Grossly the tumour may form a
diffuse,bulky,soft and fleshy mass or a
polypoidal mass projecting into lumen.

12. Microscopy
Areas showing whorled arrangement of spindle
shaped smooth muscle cells having large and
hyperchromatic nuclei.
Hallmark of diagnosis and prognosis is the
number of mitoses per high power field(HPF).

13. The essential diagnostic criteria are-
more thn 10 mitoses per 10 HPF with or without
cellular atypia or 5-10 mitoses per HPF with
cellular atypia.
More the number of mitoses per 10 HPF,worse is
the prognosis.

15. Cervical carcinoma

16. INTRODUCTION
1
6
 Cervical cancer is the most common
gynecologic cancer in women globallly 1,2
 It ranks third among all malignancies for
women
 More common in the younger population of
women
 Until recently, ca cervix was linked with many
viral infections as the cause, e.g. CMV, HSV II

17. INTRODUCTION
1
7
 Human Papilloma Virus (HPV) is now
considered a sexually transmitted disease
with particular types being highly oncogenic
as cause of ca cervix
 More than 150 types of HPV have been
described 3
 Screening for HPV is very important in the
prevention and management of ca cervix

18. AETIOLOGY
18
 The WHO in 1996 declared HPV as the major
cause of cancer of the cervix 2
 The WHO's International Agency for Research
on Cancer (IARC) has classified the HPV into
three groups 2
 carcinogenic (HPV types 16 and 18)
 probably carcinogenic (HPV types 31 and 33)
 possibly carcinogenic (other HPV types except 6
and 11)

19. AETIOLOGY
19
 The commonest strain is type 16, can be
retrieved in over 80% of ca cervix specimens
 Type 18 seen in a few cases and usually
affect the endocervical glands
 Other types involved in cervical changes
include but not limited to the following types:
 31, 33, 51, 53, 35 etc.
 In developing countries type 35 may be second to
type 16.

20. RISK FACTORS
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 Family history
 Smoking (2-3x)
 Low socioeconomic status
 Long term COCP use (up to 4 fold)
 Low immunity
 Age :30-39 and 60-69 years, mean age=
51.4yrs
 Race – more in Africans

21. PATHOGENESIS
21

22. PATHOGENESIS
22
 Like most other DNA viruses, HPV uses host
cell DNA polymerases to replicate its genome
and produce virions
 Highly virulent HPV produces two viral
oncoproteins, E6 and E7.
 The proteins inhibit p53, P21 and RB,
respectively – three potent tumor suppressors
that act to suppress the division of squamous
cells as they mature.

23. PATHOGENESIS
23

24. PATHOGENESIS
24

25. PATHOGENESIS
 Following tumorigenesis, the pattern of local
growth may be:
 Exophytic (cauliflower growth) - if a cancer arises
from the ectocervix,
 Endophytic (ulcerative growth) - if it arises from
the endocervical canal
 Tumour spread
 Direct extension
 Lymphatic
 Hematogenous (rare)
 Transceolomic 21

26. PATHOLOGY
 The main histological types of carcinoma of
the cervix are:
1. Squamous cell carcinoma (85- 90%).
 Large cell keratinising or non-keratinising
 Small cell
 Verrucous
2. Adeno-carcinoma (10- 15%)
 Typical endocervical
 Clear cell
 Endometroid
 Adenoid cystic (basaloid cylindroma)
 Adenoma malignum 22

27. PATHOLOGY
27
3. Mixed
 Adeno -squamous
 Glassy cell
4. Neuroendocrine
 Large cell neuroendocrine
 Small cell neuroendocrine
5. Other types
 lymphoma
 melanoma
 sarcoma

28. HISTOLOGY OF CERVICAL CA
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29. HISTOLOGY OF CERVICAL CA
Squamous cell carcinoma, usual type.
This tumour is characterized by infiltrative
sheets and nest of cells without overt
keratinization
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Squamous cell carcinoma. This tumour
exhibits overt keratinization either as
keratin pearls or as individual densely
keratinized cells

30. HISTOLOGY OF CERVICAL CA
Adenocarcinoma in situ of endocervical
type showing nuclear irregularity, size
variability, mitoses and apoptosis
30
Adenocarcinoma in situ. There is atypical
epithelium characterized by pseudostratifi
ed nuclei and hyperchromasia

32. Thank you