This document discusses endometrial hyperplasia and carcinoma. It defines endometrial hyperplasia as an abnormal increase in the endometrium that can progress to carcinoma. Causes include prolonged estrogen stimulation without progesterone. Hyperplasia is classified as simple or complex depending on morphological features and risk of progression. Endometrial carcinoma is more common in postmenopausal women and often presents with abnormal bleeding. Risk factors include obesity, diabetes, and infertility. The document also discusses leiomyoma and leiomyosarcoma of the uterus, defining them, describing their morphology and microscopic features, and distinguishing between them.
Presentation about the the second most common type of ovarian tumors which have a very unique property of being similar to the testicular germ cell tumors.
Ca ovary staging(AJCC 8th Edition& FIGO 2014) and classificationDr.Bhavin Vadodariya
Pathological classification of ovary in details.
Principles of Staging in Ca Ovary.
Staging according to AJCC 8th edition & Figo 2014.
Summary of changes in 8th Edition AJCC
Benign ovarian masses include functional cysts and tumors; most are asymptomatic.Most functional cysts and benign tumors are asymptomatic. Sometimes they cause menstrual abnormalities. Hemorrhagic corpus luteum cysts may cause pain or signs of peritonitis, particularly when they rupture. Occasionally, severe abdominal pain results from adnexal torsion of a cyst or mass, usually > 4 cm. Treatment varies depending on the patient's reproductive status.
Presentation about the the second most common type of ovarian tumors which have a very unique property of being similar to the testicular germ cell tumors.
Ca ovary staging(AJCC 8th Edition& FIGO 2014) and classificationDr.Bhavin Vadodariya
Pathological classification of ovary in details.
Principles of Staging in Ca Ovary.
Staging according to AJCC 8th edition & Figo 2014.
Summary of changes in 8th Edition AJCC
Benign ovarian masses include functional cysts and tumors; most are asymptomatic.Most functional cysts and benign tumors are asymptomatic. Sometimes they cause menstrual abnormalities. Hemorrhagic corpus luteum cysts may cause pain or signs of peritonitis, particularly when they rupture. Occasionally, severe abdominal pain results from adnexal torsion of a cyst or mass, usually > 4 cm. Treatment varies depending on the patient's reproductive status.
Various types of benign conditions of the ovaries. The pathology, histopathology, clinical features, investigation plan and findings and management plan are mentioned.
Lecture class on pathology of breast for 3rd & 4th year MBBS students based on "Robbins & Cotran: Pathologic Basis of Disease'. Images are collected from internet.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
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Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
2. EM - Hyperplasia
• Increase glands to stromal ratio
• Abnormalities of epithelial growth
• May progress to EM carcinoma
3. • Pathogenesis: abnormal prolonged estrogen
stimulation / anovulation.
1-Anovulation
2-Menopause
3-PCOD
4-Granulosa cell tumor
5-Adrenal cortical hyperplasia
6-prolonged administration of estrogens
7-inactivation of PTEN
EM - Hyperplasia
4. Morphology of EM hyperplasia:
1-Low grade (simple)
2-High grade (atypical)
Low grade includesLow grade includes: anovulatory epithelium
and subtle EIN
High grade includesHigh grade includes: Complex hyperplasia and
PTEN mutation of EIN.
EM - Hyperplasia
5. Simple non-atypical hyperplasias:
1-glands of varying sizes
2-glands resemble proliferative endometrium
They rarely progress to carcinoma
They frequently evolve to atrophy of both
glands and stroma
EM - Hyperplasia
6. The endometrial cavity is opened to reveal lush fronds of hyperplastic endometrium. Endometrial
hyperplasia usually results with conditions of prolonged estrogen excess and can lead to
metrorrhagia (uterine bleeding at irregular intervals), menorrhagia (excessive bleeding with
menstrual periods), or menometrorrhagia
7. This uterus is not enlarged, but there is an irregular mass in the upper fundus that
proved to be endometrial adenocarcinoma on biopsy. Such carcinomas are more likely
to occur in postmenopausal women. Thus, any postmenopausal bleeding should make
you suspect that this lesion may be present
8. This is endometrial hyperplasia in which the amount of endometrium is abnormally increased
and not cycling as it should. The glands are enlarged and irregular with columnar cells that have
some atypia. Simple endometrial hyperplasias can cause bleeding, but are not thought to be
premalignant. However, adenomatous hyperplasia is premalignant.
9. This is endometrial hyperplasia in which there is pronounced cystic change to the
glands, with very little stroma. There is a slight proliferation of glands--a
postmenopausal "cystic" atrophy of the endometrium has similar enlarged glands. This
condition is not premalignant, like an adenomatous hyperplasia.
10. Complex hyperplasia:
1-increase in number and size of the EM
glands (crowding)
2-epithelial stratification
3-nuclear enlargement
4-tufting of epithelium
5-mitotic figures are common
23% may progress to adenocarcinoma
EM - Hyperplasia
11. With progesterone Tx:
--50% persisted
--25% recurred
--25% progressed to carcinoma
Treatment:
Hysterectomy
In young a trial of progesterones & follow up
Because of low rate of regression with progesterone Tx
ultimately patients has to undergo hysterectomy.
EM - Hyperplasia
14. • Occurs mainly in post menopausal women
(55-65yrs) (uncommon <40yrs)
• Presents as post menopausal bleeding
It’s more commonly associated with:
1-Obesity
2-DM
3-Hypertension
4-Infertility
5-EM ca and Breast Ca develop in the same
person
Endometrial carcinoma
15. • In terms of pathogenesis there are two
subgroups of EMca have been identified:
1-EM ca developing in the background of
prolonged estrogen stimulation and EM-
hyperplasia
2-without hyperplasia / hyperestrinism
Endometrial carcinoma
16. Endometrial carcinoma
Support comes from the following evidences:
1-both hyperplasia and cancer are linked to abdominal
obesity anovulatory cycles
2-females with ovarian estrogen secreting tumors develop
carcinoma of EM
3-EM ca is rare in women with ovarian dysgenesis
4-HRT is associated with increased risk of EM Ca.
5-Prolonged administration of DES to lab animals produced
EM polyps and hyperpalsias and carcinomas
6-PTEN mutation is common in EM hyperplasia and
carcinoma
17. • Second subtype – without hyperplasia:
1-old age
2-carcinomas are more poorly differentiated
(tumors may resemble serous carcinoma
of the ovary)
3-overall these tumors have poor prognosis
than estrogen related tumors
Endometrial carcinoma
18. Morphology:
Two types:
1-polypoidal
2-diffuse (involving whole EM surface)
Spread occurs to:
-myometrium
-periuterine structures
-LN mets
-metastasis to lung, liver, bone
-serous type of carcinomas may involve
peritoneal cavity due to different way of spread
i.e. tubal or lymphatic transmission
Histology: 85% are adenocarcinomas
Endometrial carcinoma
19.
20. This adenocarcinoma of the endometrium is more obvious. Irregular
masses of white tumor are seen over the surface of this uterus that has
been opened anteriorly. The cervix is at the bottom of the picture. This
enlarged uterus was no doubt palpable on physical examination. Such
a neoplasm often present with abnormal bleeding.
21. The endometrial adenocarcinoma is present on the
lumenal surface of this cross section of uterus. Note that
the neoplasm is superficially invasive. The cervix is at
the right.
22. The endometrial adenocarcinoma in the polyp at the left is
moderately differentiated, as a glandular structure can still be
discerned. Note the hyperchromatism and pleomorphism of the
cells, compared to the underlying endometrium with cystic
atrophy at the right.
23. This is endometrial adenocarcinoma which can be seen invading
into the smooth muscle bundles of the myometrial wall of the
uterus. This neoplasm has a higher stage than a neoplasm that
is just confined to the endometrium or is superficially invasive.
32. Leiomyoma
• Most common tumor of humans
• Commonly called as ‘FIBROIDS’
• More than one genetic abnormality can
lead to leiomyomatous growth – t(12,
14); 7q del; Trisomy 12.
33. Morphology:
• Well circumscribed
• Discrete, round, firm
• Grayish white
• Variable sizes (a few mm to very large
tumors)
• Types (Subserosal, Intramural, Submucosal)
• c/s whorled pattern
• Red degeneration in large tumors
• Other degenerative changes
Leiomyoma
34.
35.
36.
37.
38. In the upper fundus of the
uterus protruding into the
endometrial cavity is a nodule
that proved to be a
leiomyoma. Thus, this is a
submucosal leiomyoma. Such
benign smooth muscle tumors
of the myometrium are very
common--perhaps at least 1 in
5 women has one. They may
be the cause of irregular
bleeding if present in a
submucosal location, as seen
here. Larger leiomyomas may
also produce bleeding or
pelvic discomfort
39. Smooth muscle tumors of the uterus are often multiple. Seen here are submucosal,
intramural, and subserosal leiomyomata of the uterus.
40. Here is a very large
leiomyoma of the uterus that
has undergone degenerative
change and is red (so-called
"red degeneration"). Such an
appearance might make you
think that it could be
malignant. Remember that
malignant tumors do not
generally arise from benign
tumors, which is a good thing,
because leiomyomas are so
common (at least 20% of
women will have one).
Postmenopausally,
leiomyomas tend to regress in
size and become fibrotic.
41. Here is a bifid (septate) uterus. Sometimes even the cervix and/or vagina may be double as well.
This is of no major consequence except that in pregnancy a bifid uterus may not enlarge
normally and lead to fetal loss, or a normal vaginal delivery may not be possible with a double
cervix or vagina. Note that there is also a small intramural leiomyoma on the septum at the left.
43. This large squamous
carcinoma (yellow
square) has
obliterated the cervix
and invaded the lower
uterine segment. The
uterus also has a
round leiomyoma up
higher (Red arrow).
44. Microscopy:
1-Whorled bundles of smooth muscle cells
2-Spindle cells with ‘CIGAR’ shaped nucleus
3-Long slender cytoplasmic extensions
4-Cytolpalsm is eosinophilic
5-Necrosis, hemorrhages, calcification,
ossification, cartilage, hyalinization et.c.
Leiomyoma
45.
46. Here is the microscopic appearance of a benign leiomyoma. Normal myometrium is at
the left, and the neoplasm is well-differentiated so that the leiomyoma at the right
hardly appears different. Bundles of smooth muscle are interlacing in the tumor mass
47.
48.
49. • Most of the leiomyosarcomas arise in the uterus
• Peak incidence at 40-60yrs of age
• Two distinct growth patterns
1-Buky fleshy masses that invade the uterine wall &
2-Polypoidal masses that project into the lumen
• Soft fleshy tumors with a whitish cut surface
• Areas of hemorrhage and necrosis
• Periphery of the tumor is not sharply defined
Leiomyosarcoma
50.
51. This is a leiomyosarcoma protruding from myometrium into the endometrial cavity of this uterus
that has been opened laterally so that the halves of the cervix appear at right and left. Fallopian
tubes and ovaries project from top and bottom. The irregular nature of this mass suggests that is
not just an ordinary leiomyoma.
52. Microscopy:
• Apperances vary from resemblence of
leiomyoma to anaplastic tumors
• All smooth muscle tumors with mitotic figures
fewer than 2 / 10hpf are considered benign
(Hendrikson and Kempson)
• Note: Leiomyomas in young and pregnant females may show mitotic
activity and may be mistaken for leiomyosarcoma
• There may be areas of myxoid change
• Extensive necrosis is also an ominous sign
Leiomyosarcoma
53. Here is the microscopic appearance of a leiomyosarcoma. It is much more cellular and
the cells have much more pleomorphism and hyperchromatism than the benign
leiomyoma. An irregular mitosis is seen in the center.
54. As with sarcomas in general, leiomyosarcomas have spindle cells.
Several mitoses are seen here, just in this one high power field.
55. Sarcomas, including leiomyosarcomas, often have very large bizarre giant cells along
with the spindle cells. A couple of mitotic figures appear at the left and lower left
56.
57.
58. Metastasis thru blood stream to lung,
bone and brain
Dissemination also occur thru
abdominal cavity
5yr survival for patients with uterine
leiomyosarcomas is < 40%
Leiomyosarcoma
PTEN. Phosphatase and tensin homologue, deleted on chromosome 10 (PTEN) gene, mapped on chromosome 10q23, is frequently deleted in many human cancers but at particularly high frequency in endometrial carcinomas and glioblastomas.[90] PTEN activity causes cell-cycle arrest and apoptosis as well as inhibition of cell motility. It has been proposed that PTEN blocks the cell cycle by increasing the transcription of the p27 Cip/Kip cell-cycle inhibitor and stabilizing the protein.[90][91] With loss of PTEN, therefore, cells are released into the cell cycle.Ref: Robbin’s pathology 7th Ed, 2004.
PTEN. Phosphatase and tensin homologue, deleted on chromosome 10 (PTEN) gene, mapped on chromosome 10q23, is frequently deleted in many human cancers but at particularly high frequency in endometrial carcinomas and glioblastomas.[90] PTEN activity causes cell-cycle arrest and apoptosis as well as inhibition of cell motility. It has been proposed that PTEN blocks the cell cycle by increasing the transcription of the p27 Cip/Kip cell-cycle inhibitor and stabilizing the protein.[90][91] With loss of PTEN, therefore, cells are released into the cell cycle.Ref: Robbin’s pathology 7th Ed, 2004.
Fig. 19.129 Various types of endometrial hyperplasia: C, complex.
PTEN. Phosphatase and tensin homologue, deleted on chromosome 10 (PTEN) gene, mapped on chromosome 10q23, is frequently deleted in many human cancers but at particularly high frequency in endometrial carcinomas and glioblastomas.[90] PTEN activity causes cell-cycle arrest and apoptosis as well as inhibition of cell motility. It has been proposed that PTEN blocks the cell cycle by increasing the transcription of the p27 Cip/Kip cell-cycle inhibitor and stabilizing the protein.[90][91] With loss of PTEN, therefore, cells are released into the cell cycle.Ref: Robbin’s pathology 7th Ed, 2004.
Fig. 19.136 A and B, Gross appearances of endometrioid adenocarcinoma. The tumor shown in A is polypoid, whereas that depicted in B is highly infiltrating.
This adenocarcinoma of the endometrium is more obvious. Irregular masses of white tumor are seen over the surface of this uterus that has been opened anteriorly. The cervix is at the bottom of the picture. This enlarged uterus was no doubt palpable on physical examination. Such a neoplasm often present with abnormal bleeding.
The endometrial adenocarcinoma is present on the lumenal surface of this cross section of uterus. Note that the neoplasm is superficially invasive. The cervix is at the right.
This is endometrial adenocarcinoma which can be seen invading into the smooth muscle bundles of the myometrial wall of the uterus. This neoplasm has a higher stage than a neoplasm that is just confined to the endometrium or is superficially invasive.
Fig. 19.138 Well-differentiated endometrioid adenocarcinoma with squamous metaplasia (so-called “adenoacanthoma”).
Fig. 19.139 A and B, Endometrial adenocarcinoma of endometrioid type with squamous metaplasia. In contrast to the case shown in Fig. 19.138, the squamous component has markedly atypical cytologic features.
Fig. 19.140 Secretory carcinoma of endometrium. This well-differentiated lesion is a variant of endometrioid adenocarcinoma and is composed of cells with abundant clear to finely granular cytoplasm. It should be distinguished from clear cell carcinoma.
Fig. 19.167 Multiple uterine leiomyomas.
Fig. 19.168 Large uterine leiomyoma with intramural and subserous involvement.
Fig. 19.170 This uterine leiomyoma has undergone massive red degeneration.
Fig. 19.171 Leiomyoma with edematous (hydropic) changes leading to the formation of cystic cavities.
This large squamous carcinoma (bottom of picture) has obliterated the cervix and invaded the lower uterine segment. The uterus also has a round leiomyoma up higher.
Fig. 19.169 Elongated spindle cells with fibrillary acidophilic cytoplasm in the usual type of uterine leiomyoma.
Fig. 19.172 So-called “perinodular hydropic degeneration” in uterine leiomyoma.
Fig. 19.174 A and B, Two views of bizarre leiomyoma. The size of some of the tumor cell nuclei makes them almost visible to the naked eye.
Fig. 19.181 Leiomyosarcoma resulting in a large intramural and submucous mass. There are foci of hemorrhage and necrosis.
Fig. 19.183 Uterine myxoid leiomyosarcoma (slide courtesy of Dr. Robert E Scully, Boston).
Fig. 19.184 Malignant giant cell tumor of uterus. This is regarded as a variant of leiomyosarcoma with osteoclast-like giant cells.