CH13 - Female Genital System and Gestational Pathology Flashcards
1
Q
What is the vulva?
A
Anatomically includes the skin and mucosa of the female genitalia external to the hymen (labia majora, labia minora, mons pubis, and vestibule)
2
Q
What is the vulva lined by?
A
squamous epithelium
3
Q
What is a bartholin cyst?
A
Cystic dilation of the Bartholin gland
4
Q
What are the bartholin glands?
A
One Bartholin gland is present on each side of the vaginal canal and produces mucus-like fluid that drains via ducts into the lower vestibule.
5
Q
Bartholin cyst arises due to what?
A
inflammation and obstruction of gland
6
Q
In whom does bartholin cyst usually occur?
A
in women of reproductive age
7
Q
How does bartholin cyst present?
A
as a unilateral, painful cystic lesion at the lower vestibule adjacent to the vaginal canal
8
Q
What is condyloma?
A
Warty neoplasm of vulvar skin, often large
9
Q
What is condyloma most commonly due to?
A
HPV types 6 or 11 (condyloma acuminatum) secondary syphilis (condyloma latum) is a less common cause. Both are sexually transmitted.
10
Q
Histologically, how are HPV-associated condylomas characterized?
A
by koilocytes
11
Q
What is the relationship between condylomas and carcinoma?
A
They rarely progress to carcinoma (6 and 11 are low-risk HPV types)
12
Q
How is lichen sclerosis characterized?
A
by thinning of the epidermis and fibrosis (sclerosis) of the dermis
13
Q
How does lichen sclerosis present?
A
as a white patch (leukoplakia) with parchment-1ike vulvar skin
14
Q
What is lichen sclerosis most commonly seen in?
A
postmenopausal women
15
Q
What is a possible etiology for lichen sclerosis?
A
Possibly autoimmune etiology
16
Q
Is lichen sclerosis associated with carcinoma?
A
Benign, but associated with a slightly increased risk for squamous cell carcinoma
17
Q
What is lichen simplex chronicus?
A
Characterized by hyperplasia of the vulvar squamous epithelium
18
Q
How does lichen simplex chronicus present?
A
as leukoplakia with thick, leathery vulvar skin
19
Q
What is lichen simplex chronicus associated with?
A
chronic irritation and scratching
20
Q
Is lichen simplex chronicus associated with carcinoma?
A
Benign; no increased risk of squamous cell carcinoma
21
Q
What is vulvar carcinoma?
A
Carcinoma arising from squamous epithelium lining the vulva
22
Q
What is the frequency of vulvar carcinoma?
A
Relatively rare, accounting for only a small percentage of female genital cancers
23
Q
How does vulvar carcinoma present?
A
as leukoplakia
24
Q
In vulvar carcinoma what may be required and why?
A
biopsy to distinguish carcinoma from other causes of leukoplakia
25
What is the etiology for vulvar carcinoma?
may be HPV related or non-HPV related.
26
What is HPV-related vulvar carcinoma due to?
high-risk HPV types 16 and 18.
27
What are the risk factors for HPV-related vulvar carcinoma related to?
HPV exposure and include multiple partners and early first age of intercourse; generally occurs in women of reproductive age
28
From where does HPV related vulvar carcinoma arise?
It arises from vulvar intraepithelial neoplasia (VIN), a dysplastic precursor lesion characterized by koilocytic change, disordered cellular maturation, nuclear atypia, and increased mitotic activity
29
When does non-HPV related vulvar carcinoma arise?
most often, from long-standing lichen sclerosis,
30
What happens in non-HPV related vulvar carcinoma?
Chronic inflammation and irritation eventually lead to carcinoma
31
In whom is non-HPV related vulvar carcinoma generally seen?
in elderly women (average age is > 70 years)
32
How is extramammary paget disease characterized?
by malignant epithelial cells in the epidermis of the vulva
33
How does extramammary paget disease present?
as erythematous, pruritic, ulcerated vulvar skin
34
What does extramammary paget disease represent?
carcinoma in situ, usually with no underlying carcinoma
35
What is Paget disease of the nipple characterized by?
malignant epithelial cells in the epidermis of the nipple, but it is almost always associated with an underlying carcinoma.
36
What must paget disease be distinguished from?
melanoma, which rarely can occur on the vulva
37
How is pagets disease distinguished from melanoma?
1) Paget cells are PAS+. keratin+, and S100-. 2) Melanoma is PAS-, keratin-, and S100+.
38
What is the vagina?
Canal leading to the cervix
39
What lines the vagina?
Mucosa is lined by non-keratinizing squamous epithelium
40
What is adenosis?
Focal persistence of columnar epithelium in the upper 1/3 of the vagina
41
What happens to the epithelium of the vagina during development?
squamous epithelium from the lower 2/3 of the vagina grows upward to replace the columnar epithelium lining of the upper 1/3 of the vagina
42
What is the lower 2/3 of the vagina derived from?
urogenital sinus
43
What is the upper 1/3 of the vagina derived from?
Mullerian ducts
44
In whom is there an increased incidence for adenosis?
in females who were exposed to diethylstilbestrol (DES) in utero
45
What is clear cell adenocarcinoma?
malignant proliferation of glands with clear cytoplasm
46
What is the frequency for clear cell adenocarcinoma?
Its rare, but feared, complication of DES-associated vaginal adenosis
47
What is a feared complication of DES-associated vaginal adenosis?
Clear cell adenocarcinoma
48
What led to the cessation of DES usage?
Discovery of the clear cell carcinoma complication (along with other DES-induced abnormalities of the gynecologic tract such as abnormal shape of the uterus)
49
What is embryonal rhabdomyosarcoma?
Malignant mesenchymal proliferation of immature skeletal muscle; rare
50
How does embryonal rhabdomyosarcoma present?
as bleeding and a grape-1ike mass protruding from the vagina or penis of a child (usually < 5 yrs of age)
51
What is embryonal rhabdomyosarcoma also known as?
sarcoma botryoides.
52
What is the characteristic cell for embryonal rhabdomyosarcoma?
Rhabdomyomablast
53
What does rhabdomyomablast exhibit?
cytoplasmic cross-striations and positive immunohistochemical staining for desmin and myogenin.
54
What is vaginal carcinoma?
Carcinoma arising from squamous epithelium lining the vaginal mucosa
55
What is vaginal carcinoma usually related to?
high-risk HPV
56
What is the precursor lesion for vaginal carcinoma?
it is vaginal intraepithelial neoplasia (VAIN)
57
What happens when vaginal carcinoma spreads to regional lymph nodes?
cancer from the lower 2/3 of vagina goes to inguinal nodes, and cancer from the upper 1/3 goes to regional iliac nodes.
58
What is the cervix?
Anatomically, comprises the neck of the uterus
59
What is the cervix divided into?
the exocervix (visible on vaginal exam) and endocervix
60
What is the exocervix lined by?
nonkeratinizing squamous epithelium
61
What is the endocervix lined by?
a single layer of columnar cells
62
What is the function between the exocervix and endocervix called?
the transformation zone
63
What is HPV?
Sexually transmitted DNA virus that infects the lower genital tract, especially the cervix in the transformation zone
64
What usually happens to HPV?
Infection is usually eradicated by acute inflammation;
65
In HPV what does persistent infection lead to?
an increased risk for cervical dysplasia (cervical intraepithelial neoplasia, CIN)
66
In HPV, what does the risk of CIN depend on?
the HPV type
67
How is the HPV type determined?
DNA sequencing.
68
What are the HPV types that are high risk for cervical intraepithelial dysplasia?
High-risk?HPV types 16, 18, 31, and 33
69
What are the low-risk types for cervical intraepithelial neoplasia?
HPV types 6 and 11
70
In high risk HPV, what is responsible for p53 destruction?
Production of E6
71
In high risk HPV, what is responsible for Rb destruction?
Production of E7
72
What do the high-risk HPV types produce that leads to the increased risk for CIN?
E6 and E7 proteins which result in increased destruction of p53 and Rb, respectively. Loss of these tumor suppressor proteins increases the risk for CIN.
73
What is cervical intraepithelial neoplasia characterized by?
koiloeytic change, disordered cellular maturation, nuclear atypia, and increased mitotic activity within the cervical epithelium.
74
What is cervical intraepithelial neoplasia divided into?
grades based on the extent of epithelial involvement by immature dysplastic cells(CIN I, II, III)
75
What does CIN I involve?
< 1/3 of the thickness of the epithelium
76
What does CIN II involve?
< 2/3 of the thickness of the epithelium,
77
What does CIN III involve?
slightly less than the entire thickness of the epithelium
78
What does carcinoma in situ (CIS) involve?
the entire thickness of the epithelium.
79
How does CIN classically progress?
in a stepwise fashion through CIN I, CIN II, CIN 111, and CIS to become invasive squamous cell carcinoma.
80
Can CIN progression be reversed?
Progression is not inevitable (CIN 3 often regresses)
81
What is the relationship between the grade of dysplasia and carcinoma?
the higher the grade of dysplasia, the more likely it is to progress to carcinoma and the less likely it is to regress to normal.
82
What happens in cervical carcinoma?
Invasive carcinoma that arises from the cervical epithelium
83
In whom is cervical carcinoma most commonly seen?
in middle-aged women (average age is 40-50 years)
84
How does cervical carcinoma present?
It presents as vaginal bleeding, especially postcoital bleeding, or cervical discharge
85
What are the key risk factors for cervical carcinoma?
high-risk HPV infection; secondary risk factors include smoking and immunodeficiency (e.g cervical carcinoma with HIV is a potential AIDS-defining illness).
86
What are the most common subtypes of cervical carcinoma?
squamous cell carcinoma (80% of cases) and adenocarcinoma (15% of cases).
87
What are both of the most common types of cervical carcinoma related to?
Both types are related to HPV infection.
88
What happens to advanced tumors of cervical carcinoma?
they often invade through the anterior uterine wall into the bladder, blocking the ureters.
89
What is a common cause of death in advanced cervical carcinoma?
Hydronephrosis with postrenal failure
90
What is the goal of screening in cervical carcinoma?
it is to catch dysplasia (CIN) before it develops into carcinoma
91
How long does progression from CIN to carcinoma take?
on average, takes 10-20 years.
92
When does cervical carcinoma screening begin?
at age 21 and is initially performed yearly.
93
What is the gold standard for screening for cervical carcinoma?
pap smear
94
How is a pap smear used to screen for cervical carcinoma?
Cells are scraped from the transformation zone using a brush and analyzed under a microscope.
95
In a pap smear, how are the cells scraped from the transformation zone characterized?
Dysplastic cells are classified as low grade (CIN I) or high grade (CIN II and III)
96
What is high-grade dysplasia characterized by?
cells with hyperchromatic (dark) nuclei and high nuclear to cytoplasmic ratios
97
What is the most successful screening test for cervical carcinoma developed to date?
Pap smear
98
What effect has pap smear had on cervical carcinoma?
It is responsible for a significant reduction in the morbidity and mortality of cervical carcinoma (cervical carcinoma went from being the most common to one of the least common types of gynecologic carcinoma in the US).
99
What is usually the case for women who develop invasive cervical carcinoma?
they usually have not undergone screening
100
What is an abnormal pap smear followed by?
confirmatory colposcopy (visualization of cervix with a magnifying glass) and biopsy.
101
What are the limitations of the Pap smear?
they include inadequate sampling of the transformation zone (false negative screening) and limited efficacy in screening for adenocarcinoma
102
How has Pap smear screening affected the incidence of adenocarcinoma?
The incidence has not decreased significantly.
103
What is an effective way of preventing HPV infections?
immunization
104
What is the quadrivalent vaccine?
it covers HPV types 6,11,16, and 18,
105
What antibodies protect against condylomas?
Those generated against types 6 and 11
106
What antibodies protect against CIN, VAIN, VIN and carcinoma?
Those generated against types 16 and 18
107
For immunization, how long does protection last?
for 5 years.
108
Are pap smears necessary for someone who has been vaccinated?
Yes, due to the limited number of HPV types covered by the vaccine
109
What is the endometrium?
it is the mucosal lining of the uterine cavity
110
What is the myometrium?
it is the smooth muscle wall underlying the endometrium
111
Does the endometrium respond to hormones?
It is hormonally sensitive
112
What drives growth of the endometrium?
it is estrogen driven (proliferative phase).
113
What drives preparation of the endometrium for implantation?
it is progesterone driven (secretory phase)
114
When does shedding of the endometrium occur?
with loss of progesterone support (menstrual phase)
115
What is asherman syndrome?
It is secondary amenorrhea
116
What is asherman syndrome due to?
loss of the basalis and scarring
117
What is the basalis of the endometrium?
basalis
118
What does asherman syndrome result from?
overaggressive dilation and curettage (D&C)
119
What is the anovulatory cycle?
Lack of ovulation
120
What does the anovulatory cycle result in?
an estrogen-driven proliferative phase without a subsequent progesterone driven secretory phase
121
What happens in the anovulatory cycle?
Proliferative glands break down and shed resulting in uterine bleeding.
122
The anovulatory cycle represents a common cause of what?
dysfunctional uterine bleeding, especially during menarche and menopause
123
What is menarche?
The first menstrual period
124
What is acute endometritis?
Bacterial infection of the endometrium
125
What is acute endometritis usually due to?
retained products of conception (e.g., after delivery or miscarriage); retained products act as a nidus for infection.
126
What does acute endometritis present as?
fever, abnormal uterine bleeding, and pelvic pain
127
What is chronic endometritis?
Chronic inflammation of the endometrium
128
What is chronic endometritis characterized by?
lymphocytes and plasma cells
129
What are necessary for the diagnosis of chronic endometritis?
Plasma cells since lymphocytes are normally found in the endometrium.
130
What are the causes of chronic endometritis?
they include retained products of conception, chronic pelvic inflammatory disease (e.g., Chlamydia), IUD, and TB.
131
What does chronic endometritis present as?
abnormal uterine bleeding, pain, and infertility
132
What is an endometrial polyp?
Hyperplastic protrusion of endometrium
133
What does an endometrial polyp present as?
abnormal uterine bleeding
134
An endometrial polyp can arise as a side effect of what and why?
tamoxifen, which has anti-estrogenic effects on the breast but weak pro-estrogenic effects on the endometrium
135
What is endometriosis?
Endometrial glands and stroma outside of the uterine endometrial lining
136
What is endometriosis most likely due to?
retrograde menstruation with implantation at an ectopic site
137
What does endometriosis present as?
dysmenorrhea (pain during menstruation) and pelvic pain; may cause infertility
138
What happens to the cycle in endometriosis?
cycles just like normal endometrium
139
In endometriosis what is the most common site of involvement and what does this form?
the ovary, which classically results in formation o f a chocolate cyst
140
What are the other sites of involvement in endometriosis besides the ovary?
1) uterine ligaments 2) pouch of Douglas 3) bladder wall 4) bowel serosa 5) fallopian tube mucosa
141
In endometriosis how do the implants classically appear?
as yellow-brown [gun-powder] nodules
142
In endometriosis what indicates the involvement of the uterine ligaments?
pelvic pain
143
In endometriosis what indicates the involvement of the pouch of Douglas?
pain with defecation
144
In endometriosis what indicates the involvement of the bladder wall?
pain with urination
145
In endometriosis what indicates the involvement of the bowel serosa?
abdominal pain and adhesions
146
What does the involvement of the fallopian tube mucosa in endometriosis result in?
scarring that increases the risk for ectopic tubal pregnancy
147
For the involvement of the fallopian tube mucosa in endometriosis, how does the implants classically appear?
as yellow-brown gun-powder nodules
148
What is adenomyosis?
It is the involvement of the uterine myometrium in endometriosis
149
What does endometriosis increase the risk of?
there is an increased risk for carcinoma at the site of endometriosis, especially in the ovary.
150
What is endometrial hyperplasia?
Hyperplasia of the endometrial glands relative to stroma
151
What does endometrial hyperplasia occur as a consequence of?
unopposed estrogen (e.g., obesity, polycystic ovary syndrome, and estrogen replacement)
152
How does endometrial hyperplasia classically present?
as postmenopausal uterine bleeding
153
How is endometrial hyperplasia classified histologically?
It?s based on architectural growth pattern (simple or complex) and the presence or absence of cellular atypia
154
For endometrial hyperplasia, what is the most important predictor for progression to carcinoma (major complication)?
It is the presence of cellular atypia
155
What are the odds that endometrial hyperplasia will pregress to cancer?
simple hyperplasia with atypia often progresses to cancer (30%) whereas, complex hyperplasia without atypia rarely does (<5%)
156
What is endometrial carcinoma?
Malignant proliferation of endometrial glands
157
What is the most common invasive carcinoma of the female genital tract?
Endometrial carcinoma
158
How does endometrial carcinoma present?
as postmenopausal bleeding
159
How does endometrial carcinoma arise?
via two distinct pathways: hyperplasia and sporadic
160
What percentage of endometrial carcinoma cases arise from the hyperplasia pathway?
75% of carcinoma cases arise from endometrial hyperplasia
161
What are the risk factors for endometrial carcinoma?
They are related to estrogen exposure and include early menarche/late menopause, nulliparity, infertility with anovulatory cycles, and obesity.
162
What is the average age of presentation for endometrial carcinoma from endometrial hyperplasia?
it is 60 years.
163
What is the histology for endometrial carcinoma?
it is endometrioid (i.e., normal endometrium-like)
164
What percentage of endometrial carcinoma cases arise from the sporadic pathway?
25% of carcinoma cases arise from the sporadic pathway with an atrophic endometrium with no evident precursor lesion.
165
What is the average age at presentation for endometrial carcinoma from the sporadic pathway?
70 years.
166
What is the histology for endometrial carcinoma from the sporadic pathway?
It is usually serous and is characterized by papillary structures with psammoma body formation;
167
For endometrial carcinoma from the sporadic pathway what mutation is common?
p53 and the tumor exhibits aggressive behavior
168
What is leiomyoma?
(fibroids) Benign neoplastic proliferation of smooth muscle arising from myometrium;
169
What is the most common tumor in females?
leiomyoma
170
What is leiomyoma related to?
estrogen exposure
171
What is leiomyoma common in?
premenopausal women
172
Is leiomyoma occur as single or multiple fibroids?
Often multiple
173
What happens to leiomyoma during pregnancy?
They enlage
174
When does leiomyoma shrink?
after menopause
175
What does the gross exam of leiomyoma show?
multiple, well-defined, white, whorled masses that may distort the uterus and impinge on pelvic structures
176
What are the symptoms of leiomyoma?
Usually asymptomatic; when present, symptoms include abnormal uterine bleeding, infertility, and a pelvic mass
177
What is leiomyosarcoma?
Malignant proliferation of smooth muscle arising from the myometrium
178
How does leiomyosarcoma arise?
de novo; leiomyosarcomas do not arise from leiomyomas
179
Are leiomyosarcomas related to leiomyomas?
leiomyosarcomas do not arise from leiomyomas
180
In whom is leiomyosarcoma usually seen?
in postmenopausal women
181
What does the gross exam often show for leiomyosarcoma?
a single lesion with areas of necrosis and hemorrhage;
182
What are the histological features for leiomyomasarcoma?
they include necrosis, mitotic activity, and cellular atypia
183
What is the ovary?
The functional unit of the ovary is the follicle.
184
What does a follicle consists of?
an oocyte surrounded by granulosa and theca cells
185
On what does LH act?
on theca cells to induce androgen production
186
What does FSH do?
stimulates granulosa cells to convert androgen to estradiol (drives the proliferative phase of the endometrial cycle)
187
What does the estradiol surge induce?
an LH surge, which leads to ovulation (marking the beginning of the secretory phase of the endometrial cycle)
188
What happens after ovulation?
the residual follicle becomes a corpus luteum,
189
What does the corpus luteum do?
it primarily secretes progesterone (drives the secretory phase which prepares the endometrium for a possible pregnancy)
190
What is a hemorrhagic corpus luteal cyst?
Hemorrhage into a corpus luteum can result in a hemorrhagic corpus luteal cyst, especially during early pregnancy.
191
What does degeneration of follicles result in?
follicular cysts.
192
What is the clinical significance of follicular cysts?
Small numbers of follicular cysts are common in women and have no clinical significance
193
What is polycystic ovarian disease (PCOD)?
Multiple ovarian follicular cysts due to hormone imbalance
194
What is the frequency of PCOD?
Affects roughly 5% of women of reproductive age
195
What is PCOD characterized by?
increased LH and low FSH (LH:FSH > 2)
196
What does increased LH induce?
excess androgen production (from theca cells) resulting in hirsutism (excess hair in a male distribution).
197
Within PCOD what happens to androgen?
it is converted to estrone in adipose tissue
198
What does estrone feedback result in PCOD?
it decreases FSH resulting in cystic degeneration of follicles.
199
What do the high levels of circulating estrone do in PCOD?
increase risk for endometrial carcinoma
200
What is the classic presentation for PCOD?
is an obese young woman with infertility, oligomenorrhea, and hirsutism;
201
What may happen to some patients with PCOD?
they have insulin resistance and may develop type 2 diabetes mellitus 10-15 years later.
202
What are the cell types of the ovary?
Ovary is composed of three cell types: surface epithelium, germ cells, and sex cordstroma.
203
From which of these cell types can a tumor arise?
from any of these cell types or from metastases
204
What is the most common type of ovarian tumor?
Occurs in 70% of ovarian tumor cases
205
What are the surface epithelial cells derived from?
coelomic epithelium that lines the ovary;
206
What does the coelomic epithelium embryologically produce?
the epithelial lining of the fallopian tube (serous cells), endometrium, and endocervix (mucinous cells).
207
What are the two most common subtypes of surface epithelial tumors?
serous and mucinous; both are usually cystic.
208
What are serous tumors filled with?
They are full of watery fluid.
209
What are mucinous tumors filled with?
they are full of mucus-like fluid.
210
Are mucinous and serous tumors malignant?
they can be benign, borderline, or malignant
211
What are benign ovarian surface epithelial tumors?
cyst adenomas and are composed of a single cyst with a simple, flat lining
212
In whom does benign ovarian surface epithelial tumors most commonly arise?
in premenopausal women (30-40 years old)
213
What are malignant ovarian surface epithelial tumors?
They are cystadenocarcinomas and are composed of complex cysts with a thick, shaggy lining;
214
In whom do malignant ovarian surface epithelial tumors most commonly arise?
in postmenopausal women (60-70 years old)
215
What are boderline ovarian surface epithelial tumors?
Borderline tumors have features in between benign and malignant tumors, better prognosis than clearly malignant tumors, but still carry metastatic potential
216
Carriers of what mutation have an increased risk for serous carcinoma of the ovary and fallopian tube?
BRCA1
217
What do BRCA1 carriers often elect to have?
a prophylactic salpingo-oophorectomy (along with prophylactic mastectomy due to the increased risk for breast cancer)
218
What are some less common subtypes of [ovarian] surface epithelial tumors?
endometrioid and Brenner tumor.
219
What are endometrioid tumors composed of?
endometrial-like glands and are usually malignant
220
What may endometrioid tumors arise from?
endometriosis
221
What are 15% of endometrioid carcinomas of the ovary associated with?
An independent endometrial carcinoma (endometrioid type)
222
What are brenner tumors composed of?
bladder-like epithelium and are usually benign.
223
How do ovarian surface epithelial tumors clinically present?
late with vague abdominal symptoms (pain and fullness) or signs of compression (urinary frequency).
224
What is the prognosis for surface epithelial carcinoma?
Generally poor, worst prognosis of female genital tract cancers
225
Describe the spread of ovarial epithelial carcinomas?
they tend to spread locally, especially to the peritoneum.
226
What is CA-125?
it is a useful serum marker to monitor treatment response and screen for recurrence.
227
What are germ cell tumors?
They are the 2nd most common type of ovarian tumor (15% of cases)
228
In whom do germ cell tumors usually occur?
in women of reproductive age
229
What do germ cell tumor subtypes mimic?
tissues normally produced by germ cells.
230
What is the germ cell tumor subtype that mimics fetal tissue?
cystic teratoma and embryonal carcinoma
231
What is the germ cell tumor subtype that mimics oocytes?
dysgerminoma
232
What is the germ cell tumor subtype that mimics a yolk sac?
endodermal sinus tumor
233
What is the germ cell tumor subtype that mimic placental tissue?
choriocarcinoma
234
What is a cystic teratoma?
Cystic tumor composed of fetal tissue derived from two or three embryologic layers (e.g, skin, hair, bone, cartilage, gut, and thyroid)
235
What is the most common germ cell tumor in females (unilateral or bilateral)?
Cystic teratoma; bilateral in 10% of cases
236
Is a cystic teratoma benign or malignant?
Benign but presence of immature tissue (usually neural) or somatic malignancy (usually squamous cell carcinoma of skin) indicates malignant potential.
237
What would indicate malignant potential for a cystic teratoma?
presence of immature tissue (usually neural) or somatic malignancy (usually squamous cell carcinoma of skin) indicates malignant potential
238
What is struma ovarii?
it is a teratoma composed primarily of thyroid tissue.
239
What is dysgerminoma?
Tumor composed of large cells with clear cytoplasm and central nuclei;
240
What is the most common malignant germ cell tumor?
dysgerminoma
241
What is the testicular counterpart to dysgerminoma?
it is called seminoma, which is a relatively common germ cell tumor in males.
242
What is the prognosis for seminoma?
Good prognosis; responds to radiotherapy
243
In dysgerminoma, what levels may be elevated?
Serum LDH may be elevated
244
What is the endodermal sinus tumor?
It is a malignant tumor that mimics the yolk sac;
245
What is the most common germ cell tumor in children?
Endodermal sinus tumor
246
In an endodermal sinus tumor what levels are often elevated?
Serum AFP is often elevated.
247
What are classically seen on histology for endodermal sinus tumor?
Schiller-Duval bodies (glomerulus-like structures)
248
What is choriocarcinoma?
malignant tumor composed of trophoblasts and syncytlotrophoblasts;
249
What does choriocarcinoma mimic?
placental tissue, but villi are absent
250
Describe choriocarcinoma?
Small, hemorrhagic tumor with early hematogenous spread
251
High levels of what are characteristic of choriocarcinoma?
beta-hCG is characteristic (produced by syncytiotrophoblasts); may lead to thecal cysts in the ovary
252
How does choriocarcinoma respond to chemotherapy?
Poor response to chemotherapy
253
What is embryonal carcinoma?
malignant tumor composed of large primitive cells
254
Describe emryonal carcinoma?
Aggressive with early metastasis
255
What are sex cord stromal tumors?
Tumors that resemble sex cord-stromal tissues of the ovary
256
What is a granulosa-theca cell tumor?
Neoplastic proliferation of granulosa and theca cells
257
What does granulosa-theca cell tumors often produce?
estrogen; presents with signs of estrogen excess
258
What happens if a granulosa-theca cell tumor occurs prior to puberty?
precocious puberty
259
What happens if a granulosa-theca cell tumor occurs during reproductive age?
menorrhagia or metrorrhagia
260
What is the most common setting for granulosa-theca cell tumors?
Postmenopause
261
What happens with granulosa-theca cell tumors occurring in postmenopause?
endometrial hyperplasia with postmenopausal uterine bleeding
262
Are granulosa-theca cell tumors malignant or benign?
Malignant, but minimal risk for metastasis
263
What are sertoli-leydig cell tumors?
They are composed of Sertoli cells that form tubules and Leydig cells (between tubules) with characteristic Reinke crystals
264
What might sertoli-ledig cells produce?
May produce androgen; associated with hirsutism and virilization
265
What is fibroma in regard to sex cord stromal tumors?
Benign tumor of fibroblasts
266
What is fibroma in regard to sex cord stromal tumors associated with?
pleural effusions and ascites (Meigs syndrome); syndrome resolves with removal of tumor
267
What are examples of metastasis for ovarian surface epithelial tumors?
Krukenberg tumor and pseudomyxoma peritonei
268
What is a Krukenberg tumor?
it is a metastatic mucinous tumor that involves both ovaries
269
What is a Krukenberg tumor most commonly due to?
metastatic gastric carcinoma (diffuse type)
270
What helps distinguish metastases from primary mucinous carcinoma of the ovary?
Metastases (Krukenberg tumor) is bilateral as opposed to primary mucinous carcinoma which is unilateral.
271
What is pseudomyxoma peritonei?
It is massive amounts of mucus in the peritoneum.
272
What is pseudomyxoma peritonei due to?
a mucinous tumor of the appendix, usually with metastasis to the ovary
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What is ectopic pregnancy?
Implantation of fertilized ovum at a site other than the uterine wall;
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What is the most common site for ectopic pregnancy?
the lumen of the fallopian tube
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What are the key risk factors for ectopic pregnancy?
scarring (e.g., secondary to pelvic inflammatory disease or endometriosis).
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What is the classic presentation for ectopic pregnancy?
lower quadrant abdominal pain a few weeks after a missed period.
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What is the treatment for ectopic pregnancy?
Surgical emergency; major complications are bleeding into fallopian tube (hematosalpinx) and rupture
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What is spontaneous abortion?
Miscarriage of fetus occurring before 20 weeks gestation (usually during first trimester)
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What is the frequency of spontaneous abortion?
Its common and occurs in up to 1/4 of recognizable pregnancies
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How does spontaneous abortion present?
Presents as vaginal bleeding, cramp-like pain, and passage of fetal tissues
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What is spontaneous abortion most often due to?
chromosomal anomalies (especially trisomy 16);
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Aside from chromosomal anomalies what are some other causes for spontaneous abortion?
hypercoagulablc states (e.g antiphospholipid syndrome), congenital infection, and exposure to teratogens (especially during the first 2 weeks of embryogenesis).
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What does the effect of teratogens generally depend on?
the dose, agent, and time of exposure
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Teratogen exposure in the first two weeks of gestation results in what?
spontaneous abortion
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Teratogen exposure in weeks 3-8 results in what?
risk of organ malformation
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Tereatogen exposure in months 3-9 result in what?
risk of organ hypoplasia
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What is placenta previa?
Implantation of the placenta in the lower uterine segment; placenta overlies cervical os (opening).
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How does placenta previa present?
as third-trimester bleeding
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What does placenta previa often require?
delivery of fetus by caesarian section
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What is the decidua?
It is the term for the uterine lining during pregnancy which forms the maternal part of the placenta
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What is placental abruption?
Separation of placenta from the decidua prior to delivery of the fetus
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Placental abruption is a common cause of what?
still birth
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What does placental abruption present with?
third-trimester bleeding and fetal insufficiency
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What is placenta accreta?
Improper implantation of placenta into the myometrium with little or no intervening decidua
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How does the placenta accreta present?
with difficult delivery of the placenta and postpartum bleeding
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What are some common teratogens?
Alcohol, cocaine, thalidomide, cigarette smoke, isotretinoin, tetracycline, warfarin, plienytoin
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What is the teratogenic effect of alcohol?
Most common cause of mental retardation; also leads to facial abnormalities and microcephaly
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What is the teratogenic effect of cocaine?
Intrauterine growth retardation and placental abruption
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What is the teratogenic effect of thalidomide?
Limb defects
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What is the teratogenic effect of cigarette smoke?
Intrauterine growth retardation
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What is the teratogenic effect of isotretinoin?
Spontaneous abortion, hearing and visual impairment
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What is the teratogenic effect of tetracycline?
Discolored teeth
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What is the teratogenic effect of warfarin?
Fetal bleeding
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What is the teratogenic effect of plienytoin?
Digit hypoplasia and cleft lip / palate
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What does placenta acrreta often require?
hysterectomy
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What is preeclampsia?
Pregnancy-induced hypertension, proteinuria, and edema, usually arising in the third trimester
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How often is preeclampsia seen?
Its seen in approximately 5% of pregnancies
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In preeclampsia, what is the severity of the hypertension?
it may be severe, leading to headaches and visual abnormalities
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What is preeclampsia due to and how does it resolve?
abnormality of the maternal-fetal vascular interface in the placenta; resolves with delivery
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What is eclampsia?
it is preeclampsia with seizures
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What is HELLP?
it is preeclampsia with thrombotic microangiopathy involving the liver
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What is HELLP characterized by?
Hemolysis, Elevated Liver enzymes, and Low Platelets
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What do you typically do with both eclampsia and HELLP?
It usually warrants immediate delivery
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What is sudden infant death syndrome?
Death of a healthy infant (1 month to 1 year old) without obvious cause
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When does sudden infant death usually occur?
Infants usually expire during sleep
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What are the risk factors for sudden infant death syndrome?
include sleeping on stomach, exposure to cigarette smoke, and prematurity
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What is hydatidiform mole?
abnormal conception characterized by swollen and edematous villi with proliferation of trophoblasts
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What is observed with hydatidiform mole?
uterus expands as if a normal pregnancy is present, but the uterus is much larger and beta-hCG much higher than expected for date of gestation.
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How does hydatidiform mole classically present?
in the second trimester as passage of grape-like masses through the vaginal canal
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How are hydatidiform moles diagnosed?
With prenatal care, moles are diagnosed by routine ultrasound in the early first trimester.
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What is seen on ultrasound for hydatidiform mole?
Fetal heart sounds are absent, and a snowstorm appearance is classically seen on ultrasound
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How is the hydatidiform mole classified?
as complete or partial
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What is the treatment for hydatidiform moles?
It is dilatation and curettage.
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What is dilation and curettage?
D&C - Dilation (widening / opening) of the cervix and surgical removal of part of the lining of the uterus
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For hydatidiform moles what happens after the D&C?
subsequent beta-hCG monitoring is important to ensure adequate mole removal and to screen for the development of choriocarcinoma
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What might result as a complication of gestation?
Choriocarcinoma may arise as a complication of gestation (spontaneous abortion, normal pregnancy, or hydatidiform mole) or as a spontaneous germ cell tumor
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How does choriocarcinomas that arise from the gestational pathway respond to chemotherapy?
It responds well to chemotherapy, those that arise from the germ cell pathway do not.
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What are the genetics for the partial mole?
normal ovum fertilized by two sperm (or one sperm that duplicates chromosomes): 69 chromosomes
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What are the genetics for the complete mole?
Empty ovum fertilized by two sperm (or one sperm that duplicates chromosomes); 46 chromosomes
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Is there fetal tissue in the partial mole?
yes
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Is there fetal tissue in the complete mole?
No its absent
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What is villous edema in the partial mole?
Some villi are hydropic and some are normal
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What is villous edema for the complete mole?
Most villi are hydropic
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What is trophoblastic proliferation for partial moles?
Focal proliferation present around hydropic villi
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What is trophoblastic proliferation for complete moles?
Diffuse circumferential proliferation around hydropic villi
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What is the risk for choriocarcinoma in the partial mole?
Minimal
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What is the risk for choriocarcinoma in the complete mole?
2-3%
