Benign and Malignant Conditions of the Uterus, Cervix, Fallopian Tubes, and Ovaries (Moulton) PART 2 Flashcards
What term includes the ovaries, fallopian tubes, upper portion of the broad ligament, and mesosalpinx?
Adnexa
What syndrome is associated with abnormal gonad development, small rudimentary streaked ovaries, and development of secondary sexual characteristics but enters menopause shortly after?
What is the karyotyping?
1) Turner syndrome
2) 45XO
What is characterized by a lack of androgen receptors, phenotypically female, and gonads (functioning testes) that needs to be removed after puberty because of malignant potential?
What is the karyotyping?
1) Complete Androgen Insensitivity Syndrome/Testicular feminization
2) 46XY
What does DES (diethylstilbestrol) lead to with fallopian tubes?
Shortened, distorted, clubbed Fallopian Tubes
What are the functional cysts?
Follicular
Luteal
Hemorrhagic
Polycystic Ovaries
Follicular Cysts are lined by one or more layers of __1__ cells.
When do they develop?
1) Granulosa
2) Ovarian follicle fails to rupture
(basically egg should rupture out of ovarian follicle. If it doesn’t, it forms a cyst)
Corpus Luteum Cysts may develop if what occurs?
1) Corpus Luteum becomes Cystic
2) >3cm
3) fails to regress after 14 days
1) Hemorrhagic cysts are more likely to cause symptoms
and are caused by hemorrhage where?
2) When?
1) Hemorrhage in Corpus luteum cyst
2) 2-3 days post ovulation
Theca-lutein cysts
1) Bilateral or Unilateral
2) Size?
3) May develop in patients with what?
4) What causes that?
1) Bilateral
2) Large
3) High levels of hCG
4) Pregnancy, Choriocarcinoma, hydatidiform molar pregnancy
What are Luteoma of pregnancy caused by?
What color nodules do they appear as?
1) Hyperplastic reaction of ovarian theca cells (secondary to prolonged hCG stimulation during pregnancy)
2) Reddish-brown
What is Polycystic ovarian cysts associated with?
Chronic Anovulation (no ovulation)
Hyperandrogenism*
Insulin Resistance
(This is because PCOS cause Increased LH->Stimulate Thecal Cells->Increased Androgen*->Increased estrogen-| FSH-> NO OVULATION)
Polycystic ovarian cysts causes increased __1__ levels that promote __2__ secretion from the ovarian theca cells, leading to elevated levels of __3__ and __3__.
Then the peripheral conversion of __2__ to
estrogen results in elevated estrogen levels that then suppress __4__ from the pituitary gland
1) LH
2) Androgen
3) Androstenedione and testosterone
4) FSH
Functional ovarian cysts Management
1) IF patient is asymptomatic and premenopausal, what do you give?
2) Why?
3) If the patient is symptomatic and premenopausal, MUST rule out
1) OCP’s
2) To suppress gonadotropins and prevent development of other cysts
3) Ectopic Pregnancy, Torsion, Tubo-ovarian abscess
What are the three types of Benign Neoplastic Ovarian Tumors?
1) Epithelial
2) Sex Cord Stroma
3) Germ Cell tumors
As a group which benign neoplastic ovarian tumors are the most common?
What are the tumors that make up this group?
1) Epithelial ovarian neoplasms
2) Serous cystadenoma, mucinous cystadenoma, and Brenner tumors
Epithelial tumors are thought to derive from the __1__ cells lining the peritoneal cavity and also the
lining from the surface of the ovary.
2) Mucinous ovarian tumors cytologically resemble what?
3) Endometrioid ovarian tumors resemble what?
4) Serous ovarian tumors resemble what?
1) Mesothelial
2) Endocervical epithelium
3) Endometrium
4) Fallopian tube Lining
What are the most common epithelial ovarian tumors (75%)?
2) What can be seen histologically
3) Where is that seen more often in?
1) Serous cystadenoma
2) Psammoma bodies
3) Psammoma bodies seen more in Malignant serous cystadenocarcinoma
Mucinous cystadenoma
1) Size?
2) Associated with?
3) Can lead to what?
1) Huge size (fills pelvis/abdomen)
2) mucocele of Appendix
3) Pseudomyxoma peritonei
Brenner Tumor
1) What are they?
2) Benign or Malignant?
3) What do they contain?
4) What does it encase that resembles what?
5) What are they associated with?
1) Epithelial Ovarian neoplasm
2) Benign
3) Large fibrotic component
4) Encases epithelioid cells resembling transitional cells of bladder
4) Associated with mucinous epithelial elements
What are the sex-cord stromal benign neoplastic cysts?
1) Fibromas
2) Granulosa-theca cell
3) Sertoli-Leydig
If the ultimate differentiation of cell types occurring in the tumor is feminine then the tumor is feminine and becomes a __1__ cell tumor.
If the cells take on a masculine differentiation then the tumor becomes a __2__ tumor.
1) Granulosa-theca
2) Sertoli leydig
Which sex cord-stromal ovarian tumor can cause
- Precocious menarche (Early menses)
- Premenarchal uterine bleeding
- Menorrhagia (heavy Bleed)
- Breast tenderness?
What is it also associated with?
Granulosa-theca cell tumors
Endometrial cancer
Which sex cord-stromal ovarian tumor can cause hirsutism, temporal baldness, deepening of the voice, and clitormegaly?
Sertoli leydig tumors
Ovarian Fibroma
1) What kind of tumor?
2) What are they are made up of?
3) What does it not secrete?
4) What syndrome can ovarian fibromas cause?
5) What is this syndrome characterized by?
1) Sex Cord-stromal ovarian tumor
2) Interlacing bundles of Fibrocytes
3) Sex steroids
4) Meigs syndrome
5) Ascites and right pleural effusion (hydrothorax)
A
null
1) What is the Mature cystic teratoma also called?
2) What is it?
3) Benign or malignant?
4) Which embryonic germ layers is it differentiated from? germ cell benign neoplastic cyst?
5) Which are they composed primarily of which causes the presence of skin, sweat, sebaceous glands, and hair follicles?
1) Dermoid Cyst
2) Germ Cell Tumor
3) Benign
4) All three: ectoderm, mesoderm, and endoderm
5) Ectoderm
What can rupture of a cystic teratoma or mucinous tumor can result in?
Peritonitis
What finding related to calcification can be diagnostic of a dermoid cyst when using ultrasonography?
Seeing a tooth
What tumor serum marker is used to monitor ovarian tumors
Especially in who?
1) CA-125
2) Post-menopausal women
1) Epithelial benign ovarian tumors are usually managed with what?
2) But if mucinous cystadenoma tumor is diagnosed, then do what?
3) Why?
1) Unilateral Salpingo-oophorectomy (Remove ovary and Fallopian Tube)
2) Appendectomy
3) Removal of Mucocele in appendix
What is the treatment for stromal cell tumors?
When what is considered?
Unilateral salpingo-oophorectomy
Future Pregnancy
__1__ is characterized by fluid filled fallopian tubes from previous infection.
__2__ is characterized by purulent filled fallopian tube from active infection.
1) Hydrosalpinx
2) Pyosalpinx
What refers to the complete or partial rotation of the ovary on its ligamentous supports, which often results in impedance of its blood supply?
Ovarian torsion
Adnexal torsion is when the ____ and ____ both twists.
Ovary and fallopian tube
What is the classic presentation for ovarian torsion?
What is first line imaging study to identify mass causing torsion?
1) Acute onset of unilateral pain
2) Nausea and possibly vomiting
Ultrasound
