醫學五 楊世慧 詹舜文 屠冠翔. 2007/11/26 Breast Partial mastectomy Invasive ductal...

醫學五楊世慧詹舜文屠冠翔

2007/11/26 Breast Partial mastectomy

Invasive ductal carcinoma, Grade 3 , pT1bN1MxHER-2/Neu: 1+, negative

ER: 70% strongly positive

PR: 50% strongly postive

2010-7-20 Endometrium curettage

CD10

Uterus, endometrium, curettage

-----malignant Tumor, favor adenosarcoma with sarcomatous overgrowth

AdenosarcomaMicroscopic findings

Benign epithelial component: Resembles inactive or proliferative

endometrial epithelium

Malignant mesenchymal component: Low-grade sarcoma Resembles ESS, fibrosarcoma Periglandular cuffs: hypercellularity May contain heterologous elements

Immunohistochemistry

Epithelial component Keratin (+), ER (+), PR (+)

Mesenchymal component Cytoplasmic CD 10 (+) Nuclear ER (+), PR (+), WT-1 (+) Smooth muscle actin sometimes (+), desmin (+)

Differential Diagnosis Adenofibromas

Benign epithelial and stromal components paucicellular stroma , no periglandular cuffing, no stromal

atypia

Benign endometrial polyp Benign epithelial and stromal components inactive glands, No periglandular cuffing , no stromal mitoses

Atypical polypoid adenomyoma Atypical epithelial component and benign stromal component cellular smooth muscle ,glandular component with squamous

morules

Malignant mixed mullerian tumor (MMMTs) Malignant epithelial and stromal components carcinomatous glandular component

Endometrial stromal sarcomas Malignant stromal component only no glandular component

Sarcomatous overgrowth Uncommon variant

a benign glandular component sarcomatous portion constituting more than 25%

of the tumor

Higher grade and higher mitotic rate

High recurrence and mortality, comparable to carcinosarcoma

2010/08/06

Uterus, Endometrium, total Hysterectomy Bilateral salpingooophorectomy Pelvic lymph node dissection Partial omentectomy

Gross Features

Endometrial polypoid tumor occupying the endometrial cavity and measuring 7.5 x 5 x 4.2 cm. Foci of necrosis and hemorrhage present.

No definite myometrial invasion grossly Ovaries: no tumor Omentum: 4.1 x 2.8 x 0.4 cm, no tumor

Sarcomatous overgrowth

Diagnosis

Uterine adenosarcoma with sarcomatous overgrowth

Myometrial invasion less than 25% of myometrial wall thickness

All else negative

2011 / 02/ 18 Intra-abdomen tumor resection with right hemicolectomy

Omentectomy

Gross: Multiple nodules measuring up to 1.5 x 1.5 x 1.0 cm

Reference

[1] Piura B, Rabinovich A, Meirrovitz M, Yanai I. Müllerian adenosarcoma of the uterus: case report and review of literature. Eur J Gynecol Oncol. 2000;21:387–390.

[2] American Cancer Society, Inc [3] Atlas of Gynecologic Surgical Pathology [4] Blaustein’s pathology of the female genital tract ,

fourth edition