Leiomyomas, also known as fibroids, are benign smooth muscle tumors of the uterus, most commonly occurring in women aged 30 to 50. Their etiology is not fully understood, but risk factors include earlier menarche, nulliparity, obesity, and exposure to environmental estrogens. Endometrial carcinoma, the most common malignancy in the female genital tract, is categorized into type I (low-grade) and type II (high-grade), with stage being a critical factor in prognosis.

1. LEIOMYOMA
Dr OM JHA
MBBS, MD (PATHOLOGY)

2. INTRODUCTION
• Benign tumors of smooth muscle of uterus.
• Most common tumors in females.
• Commonly referred to as Fibroids.
• Can occur in any age group but more common in 30
to 50 years.
• Incidence decreases after menopause.

3. ETIOLOGY
• Exact etiology is not known.
• Age of menarche and parity are important risk factors.
• Earlier age of menarche and nulliparous women have higher risk.
• Other risk factors: Obesity, lack of exercise.
• Most important risk factor: Exposure to environmental estrogens before
puberty.
• This will result in hyper responsivenesness to normal levels of estrogen in
adults.

4. CYTOGENETIC ABNORMALITIES
• 40 to 50% show karyotypic abnormalities.
• Most common abnormalities:
• Translocations on chromosome 12.
• Deletion on chromosomes 3q and 7q.
• Genes involved: HGMA2, ESR2, RAD5 & MED12.

5. CLINICAL FEATURES
• Most often asymptomatic.
• Can manifest with abnormal uterine bleeding (AUB).
• More common in submucosal leiomyomas.
• Can also interfere in fertility.
• Larger tumors result in various pressure symptoms.

6. GROSS
• Usually multiple.
• Sizes ranging from microscopic foci to large bulky tumors.
• Cut surfaces: well circumscribed, with greywhite and whorled
cut surface.
• If the tumor is very large, the degenerative changes can be seen.
• Highly cellular variant and lipoleiomyomas will be yellowish in
color.

7. Cont'd...
• Based on the location of the
tumor they are categorized as:
• Submucosal: Can manifest with
menorrhagia.
• Intramural: Usually asymptomatic.
• Subserosal: Can cause pressure
symptoms.
• Pedunculated: Submucosal and
subserosal tumors can be
pedunculated with the presence
of narrow pedicle.

8. MICROSCOPY
• Pattern: Interlacing fascicles or whorling of smooth
muscle cells.
• Individual smooth muscle cells:
• Uniform in size and shape.
• Nucleus: oval to elongated with blunt ends (CIGAR shaped).
• Cytoplasm: abundant and eosinophilic with elongated
bipolar processes.

9. Cont'd...

10. Cont'd...
• Many microscopic variants.
• Cellular leiomyoma
• Leiomyoma with bizzare nuclei
• Mitotically active leiomyoma
• Epithelioid leiomyoma
• Other: Lipomatous, myxoid, dissecting leiomyomas etc.

11. DEGENERATION
• Red Degeneration:
• Due to hemorrhagic infaction of a leiomyoma.
• Usually occurs in pregnancy.
• Common cause: obstruction of venous drainage at the
periphery of the lesion.
• Other: Hyaline Degeneration, etc

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13. ENDOMETRIAL
CARCINOMA
Dr OM JHA
MBBS, MD (PATHOLOGY)

14. ENDOMETRIAL CARCINOMA

21. Lesions:
Can be localized polypoidal lesion to diffusely
infiltrative.
May extend into and outside the pelvis.

33. SUMMARY: ENDOMETRIAL CA
• Endometrial carcinoma is the most common malignancy of the female genital tract.
• There are two major types of endometrial carcinoma: type I and type II.
 Type I tumors are low-grade and usually indolent.
 Type II tumors are high-grade aggressive tumors and have a poor prognosis.
• Four molecular subtypes of endometrioid and serous carcinoma are currently recognized.
• Endometrioid (type I) carcinoma is often preceded by atypical hyperplasia and commonly has mutations that
upregulate PI3K/AKT signaling.
• Serous (type II) carcinoma is associated with serous endometrial intraepithelial carcinoma, and the most common
mutations are in TP53.
TP53 mutations are also found in precursor lesions.
• Stage remains the most important factor in outcome; serous tumors are much more likely to present at advanced
stage and have a decidedly worse prognosis.
• Carcinosarcomas are aggressive tumors that resemble endometrial carcinoma genetically and have poor outcomes
with current therapies.

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