Benign and Malignant Conditions of the Uterus, Cervix, Fallopian Tubes, and Ovaries (Moulton) PART 2

Question 1

What term includes the ovaries, fallopian tubes, upper portion of the broad ligament, and mesosalpinx?

Answer 1

Adnexa

Question 2

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?

Answer 2

1) Turner syndrome

2) 45XO

Question 3

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?

Answer 3

1) Complete Androgen Insensitivity Syndrome/Testicular feminization
2) 46XY

Question 4

What does DES (diethylstilbestrol) lead to with fallopian tubes?

Answer 4

Shortened, distorted, clubbed Fallopian Tubes

Question 5

What are the functional cysts?

Answer 5

Follicular
Luteal
Hemorrhagic
Polycystic Ovaries

Question 6

Follicular Cysts are lined by one or more layers of __1__ cells.

When do they develop?

Answer 6

1) Granulosa
2) Ovarian follicle fails to rupture

(basically egg should rupture out of ovarian follicle. If it doesn’t, it forms a cyst)

Question 7

Corpus Luteum Cysts may develop if what occurs?

Answer 7

1) Corpus Luteum becomes Cystic
2) >3cm
3) fails to regress after 14 days

Question 8

1) Hemorrhagic cysts are more likely to cause symptoms
and are caused by hemorrhage where?

2) When?

Answer 8

1) Hemorrhage in Corpus luteum cyst

2) 2-3 days post ovulation

Question 9

Theca-lutein cysts

1) Bilateral or Unilateral
2) Size?
3) May develop in patients with what?
4) What causes that?

Answer 9

1) Bilateral
2) Large
3) High levels of hCG
4) Pregnancy, Choriocarcinoma, hydatidiform molar pregnancy

Question 10

What are Luteoma of pregnancy caused by?

What color nodules do they appear as?

Answer 10

1) Hyperplastic reaction of ovarian theca cells (secondary to prolonged hCG stimulation during pregnancy)
2) Reddish-brown

Question 11

What is Polycystic ovarian cysts associated with?

Answer 11

Chronic Anovulation (no ovulation)
Hyperandrogenism*
Insulin Resistance

(This is because PCOS cause Increased LH->Stimulate Thecal Cells->Increased Androgen*->Increased estrogen-| FSH-> NO OVULATION)

Question 12

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

Answer 12

1) LH
2) Androgen
3) Androstenedione and testosterone
4) FSH

Question 13

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

Answer 13

1) OCP’s
2) To suppress gonadotropins and prevent development of other cysts
3) Ectopic Pregnancy, Torsion, Tubo-ovarian abscess

Question 14

What are the three types of Benign Neoplastic Ovarian Tumors?

Answer 14

1) Epithelial
2) Sex Cord Stroma
3) Germ Cell tumors

Question 15

As a group which benign neoplastic ovarian tumors are the most common?

What are the tumors that make up this group?

Answer 15

1) Epithelial ovarian neoplasms

2) Serous cystadenoma, mucinous cystadenoma, and Brenner tumors

Question 16

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?

Answer 16

1) Mesothelial
2) Endocervical epithelium
3) Endometrium
4) Fallopian tube Lining

Question 17

What are the most common epithelial ovarian tumors (75%)?

2) What can be seen histologically
3) Where is that seen more often in?

Answer 17

1) Serous cystadenoma
2) Psammoma bodies
3) Psammoma bodies seen more in Malignant serous cystadenocarcinoma

Question 18

Mucinous cystadenoma

1) Size?
2) Associated with?
3) Can lead to what?

Answer 18

1) Huge size (fills pelvis/abdomen)
2) mucocele of Appendix
3) Pseudomyxoma peritonei

Question 19

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?

Answer 19

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

Question 20

What are the sex-cord stromal benign neoplastic cysts?

Answer 20

1) Fibromas
2) Granulosa-theca cell
3) Sertoli-Leydig

Question 21

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.

Answer 21

1) Granulosa-theca

2) Sertoli leydig

Question 22

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?

Answer 22

Granulosa-theca cell tumors

Endometrial cancer

Question 23

Which sex cord-stromal ovarian tumor can cause hirsutism, temporal baldness, deepening of the voice, and clitormegaly?

Answer 23

Sertoli leydig tumors

Question 24

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?

Answer 24

1) Sex Cord-stromal ovarian tumor
2) Interlacing bundles of Fibrocytes
3) Sex steroids
4) Meigs syndrome
5) Ascites and right pleural effusion (hydrothorax)

Question 25

A

Answer 25

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Question 26

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?

Answer 26

1) Dermoid Cyst
2) Germ Cell Tumor
3) Benign
4) All three: ectoderm, mesoderm, and endoderm
5) Ectoderm

Question 27

What can rupture of a cystic teratoma or mucinous tumor can result in?

Answer 27

Peritonitis

Question 28

What finding related to calcification can be diagnostic of a dermoid cyst when using ultrasonography?

Answer 28

Seeing a tooth

Question 29

What tumor serum marker is used to monitor ovarian tumors

Especially in who?

Answer 29

1) CA-125

2) Post-menopausal women

Question 30

1) Epithelial benign ovarian tumors are usually managed with what?
2) But if mucinous cystadenoma tumor is diagnosed, then do what?
3) Why?

Answer 30

1) Unilateral Salpingo-oophorectomy (Remove ovary and Fallopian Tube)
2) Appendectomy
3) Removal of Mucocele in appendix

Question 31

What is the treatment for stromal cell tumors?

When what is considered?

Answer 31

Unilateral salpingo-oophorectomy

Future Pregnancy

Question 32

__1__ is characterized by fluid filled fallopian tubes from previous infection.

__2__ is characterized by purulent filled fallopian tube from active infection.

Answer 32

1) Hydrosalpinx

2) Pyosalpinx

Question 33

What refers to the complete or partial rotation of the ovary on its ligamentous supports, which often results in impedance of its blood supply?

Answer 33

Ovarian torsion

Question 34

Adnexal torsion is when the ____ and ____ both twists.

Answer 34

Ovary and fallopian tube

Question 35

What is the classic presentation for ovarian torsion?

What is first line imaging study to identify mass causing torsion?

Answer 35

1) Acute onset of unilateral pain
2) Nausea and possibly vomiting

Ultrasound