ASF - Ovary and Fallopian Tubes (Bruner)

Question 1

What is the most common disorder of the fallopian tubes?

Answer 1

Salpingitis

Question 2

Salpingitis is usually a component of which disease of the female reproductive tract?

Answer 2

Pelvic Inflammatory Disease

Question 3

A 24-year-old female patient presents to her gynecologist to discuss recent bouts of pelvic pain and vaginal discharge. Her temperature is 99.4F. During the pelvic exam, you notice no vaginal or cervical abnormalities, but there is a thick, yellow discharge coming out of the cervix. You perform the bimanual exam and the patient experiences pain on palpation of the adnexa. What is the underlying cause of this patient’s symptoms?

Answer 3

Bacterial infection that has spread to the fallopian tubes

This patient has salpingitis, inflammation of the fallopian tubes. It is commonly associated with PID. It can be caused by a bacterial infection that travels from the vagina, through the uterus, and into the fallopian tubes.

Question 4

What is the most common cause of pelvic inflammatory disease?

Answer 4

Gonorrhea infection

Question 5

What is a puerperal infection and how does it relate to PID?

Answer 5

Puerperal infections occur after birth or after abortion. These can spread and lead to PID

Question 6

Pelvic inflammatory disease is the most common cause of what two conditions?

Answer 6

Ectopic pregnancy and infertility

Chronic inflammation causes scarring and fibrosis of the fallopian tubes and uterus. This leads to improper implantation of the embryo or failure of the egg to travel from the ovary through the fallopian tube.

Question 7

A sexually active 15-year-old female complains of lower abdominal pain and a foul-smelling vaginal discharge. She mentions that she and her boyfriend decided to have unprotected sex 3 weeks prior to her appointment. During the pelvic examination, you notice a red, inflamed cervix with a green, fishy smelling discharge. The patient complains of intense pain when you feel the cervix during the bimanual exam. If left untreated, what would this patient be at high risk of developing?

Answer 7

Infertility or ectopic pregnancy

This patient has PID caused by a bacterial infection that has spread from the vagina to the cervix and uterus.

Persistent PID causes fibrosis of the female reproductive tract, which interferes with pregnancy.

Question 8

How is pelvic inflammatory disease (PID) treated?

Answer 8

Antibiotics and pain medication

PID is caused by bacterial infection of the female reproductive tract. The only treatment is to prescribe antibiotics to get rid of the infection. Pain meds can be given to lessen symptoms until infection clears.

Question 9

What is the most common age range for PID to occur?

Answer 9

15-24

Question 10

What are the 4 primary clinical features of polycystic ovarian syndrome (PCOS)?

Answer 10

1. Persistent anovulation
2. Obesity
3. Hirsutism
4. Virilism

Question 11

What is hirsutism and how does PCOS cause it?

Answer 11

Hirsutism is unwanted male-pattern hair growth in women, typically on the face, chest, and back.

PCOS increases the number of ovarian follicles within the ovary, which increases androgen production. Excess androgens lead to hirsutism.

Question 12

How does PCOS cause oligomenorrhea/amenorrhea?

Answer 12

PCOS is characterized by an increase in sex hormones. Excess estrogen causes proliferation of the endometrium. Normally, progesterone would enter here and signal the secretory phase. However, high estrogen to progesterone ratios prevent this from happening. This causes the excess endometrial tissue to shed and bleed out of the normal cycle.

Question 13

A 22-year-old female with persistent abdominal and pelvic pain is admitted to the ICU following a bout of severe hyperglycemia. Glucose was present in her urine and her blood glucose levels were 532 mg/dL. Her glucose levels have not responded to exogenous insulin injection. Her BMI is 34. During the physical exam, what might you expect to see on her chest and abdomen?

Answer 13

Hair

This patient most likely has PCOS, a condition that can cause insulin resistance, obesity, abnormal menstruation, and hirsutism (male-pattern hair growth of face, chest, abdomen, and back).

Question 14

What are the two conditions of PCOS that are caused by an increased luteinizing hormone (LH) to follicle-stimulating hormone (FSH) ratio?

Answer 14

Hirsutism and cyst formation

Question 15

What is the most common cause of anovulatory infertility?

Answer 15

PCOS

Question 16

What are some of the risk factors for developing epithelial derived tumors of the ovary?

Answer 16

• Increasing age
• Estrogen-related: early menarche (<12), infertility, nulliparity, late onset menopause (>50)
• Obesity (BMI > 30)
• Family history: breast or ovarian cancers or familial ovarian cancer syndrome

Question 17

What is main cause of transformation of ovarian tissue to malignancy?

Answer 17

Chronic uninterrupted ovulation

Surface epithelium transforms and entraps follicles within the ovarian cortex. Metaplasia occurs, which exposes cells to DNA damage and replicative stress that leads to cancer

Question 18

What are 5 protective factors for preventing development of an ovarian epithelial tumor?

Answer 18

• Oral contraceptives
• Decreasing ovulation: Multiparity and Breast feeding
• Interruption of nutrients/migration of cancer cells: Tubal ligation and hysterectomy

Question 19

What is the 5th most lethal malignancy in women in the US, even though it can be cured if caught in early stages?

Answer 19

Epithelial-derived ovarian tumors (mucinous, endometrioid, or serous)

Question 20

What is CA-125 and which type of ovarian cancer does it correllate with in terms of progression and regression?

Answer 20

Cancer-antigen 125 is a glycoprotein that is secreted by coelomic epithelium of the ovary.

CA-125 is present in 80% of epithelial-derived cancers of the ovary

Question 21

A 32-year-old patient meets with her gynecologist to discuss the results of her recent blood test to determine her CA-125 levels. After looking at her lab work, you notice that she does have high CA-125 levels. You have a diagnosis in mind, but remember there is one test you need to perform yourself before ordering further testing. What test is this?

Answer 21

Transvaginal ultrasound of the ovary

Patients with high levels of CA-125 and abnormal morphology of the ovaries have a very high risk of getting ovarian cancer.

Question 22

What are some late symptoms of ovarian cancer?

Answer 22

• Back pain
• Urinary frequency
• Constipation
• Fatigue
• Menstrual change
• Dyspareunia

Question 23

In general, masses that are mobile, smooth, and unilateral will tend to be considered what?

Answer 23

Benign

Question 24

You are working with a fresh frozen sample of an ovarian tumor. On visualization, you notice that the tumor is lumpy and solid. When looking at the patient history, the clinician noted that the mass was firm and immobile on examination. More than likely, will this mass be considered malignant or benign?

Answer 24

Malignant

Immobile, irregular surface, and solid all tend to indicate malignant tumors.

Question 25

What is a common associated feature with benign tumors that can be seen on a transvaginal ultrasound of the ovary?

Answer 25

Calcification

Question 26

What are the 3 categories that most surface epithelial tumors can be classified as?

Answer 26

1. Benign 2. Borderline 3. Carcinoma

Question 27

Which type of surface epithelial tumor of the ovary is the most common?

Answer 27

Serous tumor

Question 28

What is the clinical term for a benign serous tumor?

Answer 28

Cystadenoma

Question 29

What is the clinical name for a malignant serous tumor of the ovary?

Answer 29

Cystadenocarcinoma

Question 30

What are two gross pathologic findings you would see if a patient with a benign serous tumor (cystadenoma) had her ovaries removed?

Answer 30

1. Smooth walls 2. Yellow-fluid filled sac surrounding ovary

Question 31

What distinguishes a borderline serous tumor from a benign and malignant one?

Answer 31

Has characteristics of both benign and malignant tumors Smooth walls, papillary architecture, some areas of cysts, some areas of solid tumor.

Question 32

What are Psammoma bodies?

Answer 32

Concentric, lamellated calcifications within papillary carcinomas Very common in malignant serous tumors of the ovary

Question 33

What are the typical gene mutations present in individuals that develop low-grade serous carcinoma?

Answer 33

KRAS or BRAF mutations Sometimes TP53, but rare

Question 34

What are the typical gene mutations leading to high-grade serous carcinoma?

Answer 34

TP53 only

Question 35

How does high-grade serous carcinoma of the ovary typically begin and progress?

Answer 35

Steps: 1. Tubal epithelium undergoes dysplasia 2. Serous Tubal Intraepithelial Carcinoma (STIC) 3. High-grade serous carcinoma

Question 36

How does low-grade serous carcinoma typically begin and progress?

Answer 36

Steps: 1. Inclusions within ovarian epithelium 2. Benign serous cystadenoma 3. Borderline serous tumor 4. Low-grade serous carcinoma

Question 37

In patients with serous tubal intraepithelial carcinoma (STIC), where are cancerous cells located and how do cancerous cells typically spread?

Answer 37

Originate in the fallopian tubes (mainly in parts with fimbriae) Chunks of neoplastic cells fall off of the fallopian tube epithelium. These cells fall onto the ovary and induce tumor growth. They can also spread to the abdomen in this way.

Question 38

True or False: Primary ovarian mucinous carcinomas are common.

Answer 38

False Most of the time, mucinous carcinomas will originate elsewhere and spread to the ovaries. This is especially true if the tumors are bilateral.

Question 39

What does a gross specimen of an ovary with a mucinous tumor appear like on the outside and on the inside?

Answer 39

Outside - smooth wall, enlarged Inside - large, multiloculated cystic lesions

Question 40

How could you differentiate between histological sections of benign and malignant mucinous tumors?

Answer 40

* Benign - single layer of columnar epithelial cells with lots of apical mucin * Malignant - solid growth with atypical cells, no mucin, loss of glandular architecture, and necrosis

Question 41

What type of tissue do endometrioid tumors closely resemble on histologic section?

Answer 41

Endometrium Tall, pseudostratified columnar epithelium and many tubular glands

Question 42

True or False: Benign and borderline endometrioid tumors are uncommon.

Answer 42

True Most endometrioid carcinomas will be malignant.

Question 43

What risk factor causes some women to get endometrioid tumors of the ovary 10 years earlier than the typical age of onset?

Answer 43

Endometriosis

Question 44

A 32-year-old patient visits an oncologist complaining of abdominal pain and an altered menstrual cycle. It is found that she has an endometrioid carcinoma of the ovary. Radiologists have staged this cancer as a Stage III. What does this mean and what is her % 5-year-survival rate

Answer 44

Stage 3 means that the cancer has spread throughout the abdomen. 5-year-survival rate is 20-50%

Question 45

What is a stage 2 endometrioid carcinoma?

Answer 45

Tumor that is confined to the pelvis 70-80% 5-year-survival rate

Question 46

What is stage 4 endometrioid carcinoma and what is this patient's 5-year-survival rate?

Answer 46

Cancer that has spread to the abdomen and outside of the abdomen 1-5% 5-year-survival rate

Question 47

On your oncology rotation, your attending mentions that the next patient you will be visiting has stage 1 endometrioid carcinoma of the ovary. What makes this tumor a stage 1, and what is her 5-year-survival rate?

Answer 47

Stage 1 means the tumor is confined to the ovary and has not spread. 90-95% 5-year-survival rate

Question 48

Which BRCA gene tends to confer a higher risk of getting breast and ovarian cancers than the other?

Answer 48

BRCA1 BRCA2 is actually more common in familial breast cancer that afflicts men.

Question 49

What is Lynch Syndrome and what cancers is it associated with?

Answer 49

Hereditary non-polyposis colorectal cancer (HNPCC) Associated with high rates of breast, ovarian, colon, and endometrial cancers

Question 50

Which age group predominantly gets germ cell tumors of the ovary?

Answer 50

Children and young adults

Question 51

Most germ cell tumors are considered to be of what type?

Answer 51

Teratoma

Question 52

What are the 3 types of teratomas?

Answer 52

Mature (benign), monodermal (specialized), and immature (malignant)

Question 53

Which cell type do teratomas usually arise from?

Answer 53

Ovum that has gone through its 1st meiotic division

Question 54

What is the typical appearance of a teratoma?

Answer 54

Cystic with a wall composed of squamous epithelium, hair shafts, and sebaceous glands

Question 55

What is a Rokitansky Protuberance and which type of ovarian cancer is it typically found in?

Answer 55

Calcifications and tooth structures within the cyst wall of a teratoma

Question 56

Of the 1% of teratomas that undergo malignant transformation, which type of cancer do they tend to become?

Answer 56

Squamous cell carcinoma

Question 57

What is Struma ovarii and what type of paraneoplastic syndrome does it cause?

Answer 57

Mature thyroid tissue within the ovary Can cause hyperthyroidism

Question 58

What is the name of the teratoma that is associated with intestinal epithelium?

Answer 58

Carcinoid