The document discusses endometrial hyperplasia and various types of uterine cancers. It defines endometrium as the inner lining of the uterine wall that grows and sheds during menstruation. It describes endometrial hyperplasia as an increased proliferation of endometrial glands relative to the stroma. Endometrial hyperplasia is classified as simple, complex, or atypical depending on the presence of cell changes. The document also discusses endometrial carcinoma, the most common type of which is adenocarcinoma arising from the endometrium. Less common types include sarcomas arising from the uterine stroma or myometrium. Risk factors, diagnosis, staging, treatment, and
India is the highest TB burden country accounting for more than one-fourth of the global incidence .Genital TB is found in 5-10% of women with infertility problems, with low rates in Australia (1%) and high rates of up to 19% in India (ICMR,2011)
Endometrial hyperplasia - irregular proliferation of the endometrial glands with an increase in the gland to stroma ratio when compared with proliferative endometrium
Endometrial Ca - most common gynaecological maglinancy in the western country, endometrial hyperplasia as the precursor
Incidence of endometrial hyperplasia 3 folds higher than endometrial Ca
Fourth most common cancer in women in Peninsular Malaysia
India is the highest TB burden country accounting for more than one-fourth of the global incidence .Genital TB is found in 5-10% of women with infertility problems, with low rates in Australia (1%) and high rates of up to 19% in India (ICMR,2011)
Endometrial hyperplasia - irregular proliferation of the endometrial glands with an increase in the gland to stroma ratio when compared with proliferative endometrium
Endometrial Ca - most common gynaecological maglinancy in the western country, endometrial hyperplasia as the precursor
Incidence of endometrial hyperplasia 3 folds higher than endometrial Ca
Fourth most common cancer in women in Peninsular Malaysia
A lecture on endometrial hyperplasia and carcinoma, exploring the etiology, clinical features, types, investigations, management and treatment options and prognosis.
This was presented to undergraduate medical students at Livingstone Central Teaching Hospital, Livingstone, Zambia, department of Obstetrics and Gynecology by Nghitukuhamba T.E Kalipi (final year student) Cavendish University Zambia, School of Medicine.
breast cancer, diagnosis of breast cancer , aetiology of breast cancer, pathophysiologyy of breast cancers, drugs for the treatment of breast cancers, counselling points for breast cancers and education , surgical inyerventions in breast cancer, types of surgical intervention , chemotherapy in breast cancers,
Seminar presentation by 5th-year medical students under the supervision of in house lecturer. He was previously working as a consultant surgeon in Syria. Reference as mentioned in the slides.
Seminar presentation by 5th year Medical Student under the supervision of a pediatric surgery specialist from HRPZ II. Reference as mentioned in the slide.
Seminar presentation by group C 5th year medical student under supervision Dato Imi, endocrine specialist in HRPZ II.
Reference as mentioned at the end of the slide presentation
4th year medical student's seminar presentation under supervision of orthopedic lecturer. Reference is from Dr. Sameh Doss Textbook of upper and lower limb, and also other multiple websites.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
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MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
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
Title: Sense of Taste
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 structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
8. Increased proliferation of the endometrial glands relative
to the stroma, resulting in an increased gland-to-stroma
ratio when compared with normal proliferative
endometrium.
DEFINITION
9. Inactivation of the PTEN tumor suppressor
gene. When PTEN is inactive, AKT
phosphorylation and it stimulates protein
synthesis and cell proliferation and inhibits
apoptosis. Loss of PTEN function may also
activate pathways normally activated by
estrogen.
PATHOPHYSIOLOGY
10. Endometrial hyperplasia is classified as simple and
complex. It also is classified by whether certain cell
changes are present or absent. If abnormal changes are
present, it is called atypical. The terms are combined to
describe the exact kind of hyperplasia.
TYPES
1. Simple hyperplasia
2. Complex hyperplasia
3. Simple atypical hyperplasia
4. Complex atypical hyperplasia
11. Incidence without atypia and with atypia peaks in the early
postmenopausal years and in the early 60s, respectively.
Simple : 142 in100,000 woman in early 50s
Complex : 213 in 100,000 women in early 50s 1995 - 2014
Atypical : 56 in 100,000 women in early 60s.
INCIDENCE
12. Most common sign of hyperplasia is abnormal uterine
bleeding.
SIGNS AND
SYMPTOMS
1. Heavy bleeding during menstrual period
2. Period lasts longer than usual
3. Menstrual cycle shorter than 21 days
4. Any bleeding after menopause
13. RISK FACTORS
ENDOGENOUS
OESTROGEN
EXOENOUS OESTROGEN
OTHERS
① Nulliparity
② Infertility / PCOS
③ Early menarche or late
menopause
④ Obesity
⑤ Functioning ovarian tumor
① Hormone replacement
therapy
② Use of Tamoxifen
Diabetes | Hypertension | Hypothyroidism
Hereditary Non-polyposis Colorectal Syndrome
14. AETIOLOGY
Failure of ovulation
Prolonged administration of estrogenic
steroids
Polycystic ovaries
Cortical stromal hyperplasia
Granulosa-theca cell tumors of the ovary.
15. TYPES OF ENDOMETRIAL
HYPERPLASIASIMPLE HYPERPLASIA WITHOUT ATYPIA
COMPLEX HYPERPLASIA WITHOUT ATYPIA
COMPLEX HYPERPLASIA WITH ATYPIA
Cystic Hyperplasia or Mild hyperplasia
Cystic dilated glands, non-neoplastic, due to
anovulatory cycles.
Adenomatous Hyperplasia
Overcrowded, closely opposed glands where some
are neoplastic with PTEN mutation
Complex / Adenomatous Hyperplasia with Atypia
Overcrowded glands with cytological atypid. Most
are neoplastic andcontain PTEN mutation.
16. MANAGEMENT
MEDICAL
SURGICAL
Simple endometrial hyperplasia without atypia responds to high-dose
progestogens, with repeat histology after three months.
This can be effectively delivered by the levonorgestrel intrauterine system
(IUS)
It is also given orally, higher regression rates and reduced need for
hysterectomy, even for atypical hyperplasia.
Relapse occurs relatively frequently (approximately 14% with the IUS and
30% with oral treatment) after regression, especially in complex hyperplasia,
so long-term follow-up is advised.
Transcervical resection of the endometrium (TCRE)
Hysterectomy - usually advised for atypical endometrial hyperplasia
20. ENDOMETRIAL
CARCINOMA
The most common type of CA affecting the
uterus is Adenocarcinoma which arises from the
lining of uterus (endometrium)
Endometrial cancer is now the most common
gynaecological malignancy worldwide and the
fourth most common female cancer after breast,
colon and lung.
22. 30% of all gynaecological malignancies
The lifetime risk of developing the cancer is 1.1%
The lifetime of death probability is 0.4%
Good prognosis with early diagnosis
The mean age of diagnosis is 54, can also be diagnosed at their
reproductive age
Rises sharply in the mid 40s
INCIDENCE
23. RISK FACTORS
1. Post menopause
2. Atypical hyperplasia of endometrium
3. Nulliparity
4. Early puberty
5. Late menopause
6. Treatment with unopposed oestrogen
7. Treatment with tamoxifen
8. Family history of endometrium cancer
9. Obesity
10. Hypertension
11. Diabetes
12. Associated medical conditions (breast, colon, ovarian CA)
24. AETIOLOGY
Idiopathic, however it is associated with high circulating levels of oestrogen
Post-menopause women: conversion of androgens to oestrogens occurs in
adipose tissue
– Selective oestrogen receptor modulator (SERM)
– Increase risk of endometrial CA, most likely d/t weak oestrogenic effect on
endometrium
– Most common genetic link is with hereditary non-polyposis colorectal cancer
syndrome (HNPCC), an autosomal dominant inheritance resulting in mismatch
repair genes MLH1, MSH2 and MSH6.
TAMOXIFEN
GENETIC CAUSES
25. ENDOMETRIOID ADENOCARCINOMA
(TYPE 1)
Account for 90% of endometrial adenocarcinomas
Oestrogen dependant (obesity, polycystic ovarian
syndrome / Stein-Leventhal syndrome, exogenous
estrogen use, tamoxifen use)
Occur in younger women
Good prognosis
Includes endometrioid and mucinous carcinoma
PTEN, KRAS and PAX2 gene alterations are common
Endometrial intraepithelial neoplasia (EIN) / atypical
hyperplasia is regarded as the precursor lesion
26. SEROUS PAPILLARY CARCINOMA
(TYPE 2)
High grade carcinomas
Non-oestrogen dependant
Elderly women
Poorer prognosis than Type 1
Includes serous, clear cell, undifferentiated carcinoma
and carcinosarcoma
Characterized by early alterations in TP53
Serous intraepithelial carcinoma, referred to as
‘endometrial intraepithelial Carcinoma’ (EIC) has been
proposed as the preinvasive precursor lesion.
27. CLINICAL FEATURES
PRE-MENOPAUSAL MENOPAUSAL
Abnormal bleeding
Intermenstrual bleeding
Blood stained vaginal
discharge
Heavy menstrual bleeding
Lower abdominal pain
Dyspareunia.
Abnormal bleeding
Post-menopausal bleeding
(10% most likely to have
malignancy
38. FIGO CLASSIFICATION
2009
In general, a two tier system can be also applied, with Grade 1 and 2 being
considered low grade, and FIGO 3 being considered high grade
Other carcinoma types; serous, clear cell, carcinosarcoma, undifferentiated,
mixed) are by definition HIGH GRADE
Grade 1: predominant glandular growth and < 5% non-squamous solid
component; glandular architecture is identified by the presence of
patent lumina within the gland, relatively preserved polarity of the
epithelium and absent to mild epithelial stratification
Grade 2: 6-50% non-squamous solid component
Grade 3: more than 50% non-squamous solid component
Architectural grading described above is upgraded by one if there is severe
nuclear atypia (pleomorphism, enlargement, prominent nucleoli)
HISTOLOGICAL GRADING
40. CONSERVATIVE
MANAGEMENT
Progestogens are used, particularly administered by
intrauterine system (IUS) or orally, as a conservative
management of disease.
Complications in young women with severe endometrial
atypia or low-grade endometrial cancer who wish to
preserve their fertility.
However, it is risky to use in obese patients with
endometrial cancer, thus, it may not necessarily apply to
obese patients with endometrial cancer.
41. SURGICAL
INTERVENTION Primary treatment, including hysterectomy, bilateral salpingo-
oophorectomy, abdominopelvic washings, lymph node
evaluation
Most common with Stage 1
The extent of surgery depends on grade, MRI stage, patient’s
comorbidities
Standard surgery = total hysterectomy and bilateral
salpingectomy
Patient low grade or MRI staging (< Stage 1B) surgery
If MRI staging suggest cervical involvement radical
hysterectomy + pelvic node dissection.
Tumour high grade (grade 3) / papillary serous pelvic and
para-aortic node dissection.
• 30% risk of nodal disease
43. ADJUVANT
THERAPYPOST-OPERATIVE
RADIOTHERAPY
CHEMOTHERAPY
Reduce local recurrence rate
No effects on survival
1. Local radiotherapy to vaginal vault
High dose radiotherapy (HDR)
Short period of time
2. External beam radiotherapy + HDR
For locally advanced disease
(stage 3)
Combat risk of distant spread of
cancer
44. PROGNOSIS
Five year survival rate : 80 %
Stage 1- 88%
1A: 99%
1B: 66%
Stage 2 - 75%
Stage 3 - 55%
Stage 4 - 16%
Adverse prognostic feature for
survival:
>70 years
High BMI
Grade 3 tumour
Papillary serous / clear cell
histology
Lymphovascular space
involvement
Metastases (nodal / distant)
46. SARCOMAS
Rare tumors (5%) arising from stroma or myometrium.
Classification depends on histological specimen
1. Pure sarcomas (ESS & Leiomyosarcomas)
2. Mixed epithelial sarcomas (Carcinosarcomas)
3. Heterologous sarcomas (Rhabdomyosarcoma)
Most common: Leiomyosarcomas and
Carcinosarcomas
47. PURE SARCOMAS
ENDOMETRIAL STROMAL SARCOMAS (ESS)
LEIOMYOSARCOMA
Perimenopausal women (45 – 50 years old)
Clinical features: Irregular bleeding with soft and enlarged uterus
Majority low grade
Main treatment: Surgery
Rare tumor of uterine smooth muscle (myometrium)
0.75% associated with benign fibroids
Clinial features: Rapidly growing pelvic mass with pain, enlarged and soft uterus
Pre-op diagnosis: MRI (delineate areas of necrosis within the fibroid)
Main treatment: surgery
Adjuvant treatment if mitotic count is high (>10 mitoses per high powered field)
Metastatic spread usually vascular to distant sites such as lungs and brain
48. MIXED EPITHELIAL
SARCOMAS Formerly known as mixed mesenchymal tumors
Containing both carcinoma and sarcoma
Carcinomatous element: glandular
Sarcomatous element: endometrial, stromal, (rare) bone / cartilage / muscle
Majority: post-menopause
Occasionally: previous history of pelvic radiation
Clinical Features:
History of PMB
Fleshy mass protruding from cervix along with enlarged soft uterus
Treatment: surgery followed by post-op radiotherapy
Prognosis:
73% 5 years survival if confined to uterus
25% 5 years survival if spread outside uterus
49. HETEROLOGOUS
SARCOMAS
Rare group of tumors
Consists of sarcomatous tissue not usually found in
the uterus (striated muscle, bone, cartilage)
Most common: Rhabdomyosarcoma
– In children
– Grape-like mass protruding from cervix with a watery
discharge
– Histologically primitive rhabdomyoblasts
– Recurrence rate is high with distant metastases
50. Endometrial stromal
sarcoma (ESS) Leiomyosarcomas Carcinosarcoma Rhabdomyosarcoma
Definition
Tumors of uterine smooth
muscle (myometrium)
Mixed tumors consisting
carcinomatous element
& sarcomatous element
Tumor consists of
sarcomatous tissue not
usually found in uterus
Affecting
Peri-menopausal
Post-menopausal or
previous history of
pelvic radiation
Children
Presentation Irregular
bleeding
Soft and
enlarged uterus
Associated with benign
fibroids
Rapidly growing pelvic
mass
Pain
History of PMB
Fleshy mass
protruding from
cervix
Soft and enlarged
uterus
Grape-like mass
protruding from cervix
with watery discharge
Histologically:
primitive
rhabdomyoblast
Diagnosis History
Abdominal palpation
MRI
Abdominal palpation
Treatment Surgery Surgery
Adjuvant treatment if high
mitotic count
Surgery with post-
operative radiotherapy
Prognosis Low grade Metastatic spread is
vascular to distant sites
5 years survival rate
(75% confined to
uterus, 25% spread out
of uterus)
Recurrence occur with
distant metastases
51. REFERENCES
1. GYNAECOLOGY by Ten Teachers, 19th edition, edited by
Ash Monga and Stephen Dobbs
2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1002466
/
HNPCC - Autosomal dominant genetic condition that has a high risk of colon cancer as well as other cancers including endometrial cancer, ovary, stomach, small intestines, hepatobiliary tract, upper urinary tract, brain and skin.
The preoperative use of pelvic MRI scan showing (A) deep myoinvasion with (B) extension to the uterine serosa and cervix, and (C) a complex ovarian cyst. Metastatic disease was identified in the pelvic lymph nodes following staging surgery (stage IIIC).