Chapter 22 - Female Genital Tract Flashcards
1
Q
cervix is divided into ______ and what is their epithelium
A
vaginal portio (visible to eye on exam - stratified nonkeratinizing squamous epithelium) and the endocervix (columnar, mucous-secreting epithelium)
2
Q
point where the squamous and endocervical mucinous columnar epithelium meet
A
squamocolumnar junction
3
Q
area in the cervix where the columnar epithelium is replaced by squamous epithelium
A
transformation zone
4
Q
herpes simplex virus involves these female organs in decreasing order
A
cervix, vagina, vulva
5
Q
HSV-1 gives rise to a _______ infection
A
oropharyngeal
6
Q
HSV-2 gives rise to a ______ infection
A
genital mucosa and skin infection
7
Q
clinically, what do the lesions of HSV look like initially and when they become more advanced in the female
A
red papules that progress to vesicles and then to painful ulcers with purulent discharge and pelvic pain
8
Q
where does the herpes virus establish a latent infection
A
the lumbosacral nerve ganglia
9
Q
reactivation of the herpes virus is more likely with which infection, and which group of people
A
HSV-2 and in immunocompromised women
10
Q
in what stage of the virus can the virus transmit
A
active and latent phases
11
Q
does HSV go into the fetus
A
yes during birth –> need cesarian section
12
Q
anti-HSV Abs in serum indicates
A
recurrent/latent infection
13
Q
conditions that may lead to symptomatic herpes infection
A
DM, antibiotics, pregnancy, compromised cell-mediated immunity
14
Q
symptoms in herpes infection
A
vulvovaginal pruritus, erythema, swelling, curlike vaginal dishcarge
15
Q
diagnosis of vaginal fungal infection, like Candida
A
pseudospores or filamentous funal hyphae in wet KOH
16
Q
discharge in Trichomonas vaginalis
A
yellow, frothy vaginal discharge
17
Q
vaginal/cervical mucosa in trichomonas vaginalis infection
A
fiery red appearance, dilation of cervical mucosal vessels –> STRAWBERRY CERVIX :)
18
Q
main cause of baceterial vaginosis (vaginitis)
A
Gardnerella vaginalis
19
Q
discharge from garderella vaginalis
A
thin, green-gray malodorous (fishy) vaginal discharge
20
Q
pap smear of garnerella vaginalis
A
shaggy coat on coccobacilli
21
Q
what effect does bacterial vaginosis have in pregnancy/labor
A
premature labor
22
Q
common cause of PID
A
gonococcus (gram negative diplococcus) and chlamydia
23
Q
site of initial involvement with gonococcus
A
endocervical mucosa
24
Q
how do non-gonococcal infections following surgical procedures spread from the uterus
A
through lymphatic/venous channels instead of mucosal surfaces
25
acute complications of PID
peritonitis and bacteremia
26
late complications of PID
endocarditis, meningitis, and suppurative arthritis
27
bartholin cysts lined by
ductal squamous epithelium
28
presentation of bartholin cyst
painful unilateral cystic lesion that has been inflamed
29
lichen sclerosis involves thinning of what layer?
epidermis
30
surface appearance of lichen sclerosis
white smoothed out plaques that resemble parchment
31
lichen sclerosis is more common in pre/post menopausal women?
postmenopausal
32
lichen sclerosis is associated with an increased chance of developing
squamous cell carcinoma
33
squamous cell hyperplasia of the vulva is called
lichen simplex chronicus
34
clinically lichen simplex chronicus has an area of
leukoplakia (white plaque like mucosal thickening)
35
lichen simplex chronicus has an increased risk of..
NOTHING!! no predisposition to cancer.. but so sneaky its present at the margins of an established vulva cancer
36
sexually transmitted, benign warty lesions
condyloma acuminatum
37
what forms of HPV is condyloma acuminatum most associated with
6 and 11
38
what type of cytologic changes occur in condyloma acuminatum
koilocytotic atypia
39
koilocytotic atypia is characterized by
nuclear enlargement and atypia with a perinuclear halo
40
two groups of vulvar cancer, and they are associated with what
(1) basaloid and warty carcinomas - high risk HPVs 16 and 18,31 and (2) keritanizing squamous cell carcinomas not related to HPV infection
41
precancerous lesion of basaloid and warty carcinomas
classic vulvar intraepithelial neoplasia (classic VIN)
42
risk factors for vulvar carcinoma
reproductive-age women with young age at first intercourse, multiple sexual partners, or male partner with multiple sexual partners
43
keratinizing squamous cell carcinomas of the vulva typically arise in patients with
long-standing lichen sclerosus or squamous cell hyperplasia
44
mean age of keratinizing squamous cell carcinomas of the vulva
76 years
45
premalignant lesion for keratinizing squamous cell carcinomas of the vulva
differentiated vulvar intraepithelial neoplasia (differentiated VIN), VIN simplex
46
initial spread of vulvar cancer is to..
inguinal lymph nodes
47
vulva contains what kind of glands
modified apocrine sweat glands
48
you might confuse this with a carcinoma because of its tendency to ulcerate; a sharply circumscribed nodule on the labia majora/interlabial folds
papillary hidradenoma
49
pruritic red crusted sharply demarcated maplike area usually on the labia majora
extramammary paget disease
50
what layer can extramammary paget disease be found in
the epidermis of skin and adjacent hair follicles and sweat glands
51
what is seen on histology with extramammary paget disease
clear separation like a halo from the surrounding epithelial cells with mucopolysaccharide cytoplasm staining with PAS
52
how likely is it that invasion will develop in extramammary paget disease
rarely
53
how to differentiate extramammary paget disease from melanoma
a lack of mucopolysaccharides
54
exposure to DES to prevent abortions can lead to
congenital developmental anomalies like bifid vagina, vaginal adenosis, and clear cell carcinoma
55
normal vaginal epithelium --> vaginal adenosis when what?
Normally the vagina is lined by squamous epithelium (normally pale pink) – adenosis is when there is columnar persistence in the upper 1/3 (red granular areas)
56
where are gartner duct cysts located and what are they derived from
lateral walls of the vagina and derived from wolffian ducts
57
greatest risk factor for cancer of the vagina
previous carcinomma of the cervix or vulva
58
vaginal tumor occuring in kids less than 5 years old
embryonal rhabdomyosarcoma
59
what does an embryonal rhabdomyosarcoma look like
grapelike clusters --> polypoid rounded bulky masses that sometimes fill and project out of the vagina
60
second most common cancer in women
cervical carcinoma
61
normal vaginal and cervical flora is dominated by
lactobacilli
62
what is the lactobacilli's role in the female
produce lactic acid maintaing vaginal pH at 4.5; produce bacteriotoxic H2O2
63
benign exophytic growth in the cervix producing irregular vaginal spotting
endocervcical polyps
64
most important factor in cerical oncogenesis
high oncogenic risk HPVs
65
high oncogenic risk HPVs
16&18
66
risk factors for cervical cancer
multiple sexual partners, male partner with multiple previous or current sexual partners, young age at first intercourse, high parity, persistent infection with high risk HPV, immunosuppression, HLA subtypes, oral contraceptive use, nicotine use
67
most of HPV infections will be cleared within
2 years, 50% cleared in 8 months
68
epithelium of cervix
large areas of immature squamous metaplastic epithelium
69
what is koilocytic atypia and what does it look like
changes that occur during replication of HPV; it has nuclear atypia and a cytoplasmic perinuclear halo
70
how does HPV activate the cell cycle, what specific parts of HPV activate the cycle
interfering with the function of Rb and p53; E7 and E6
71
what is the role of E7 and E6 in HPV
E6: degrades p53 and proteolyzes it inhibiting cell death, E7: cyclin E (E7) destroys hypophosphorylated Rb-E2F (active form) complex --> this complex usually inhibits S-phase entry of cell cycle
72
genetic abnormalities associated with HPV 16
deletions at 3p and amplifications of 3q
73
describe the dysplasia present in each classification of CIN and its grade of squamous intraepithelial lesion
CIN I - mild dysplasia/low-grade, CIN II - moderate dysplasia/high-grade, CIN III - severe dysplasia/high, CIN III - carcinoma in situ/high
74
what is the difference in the squamous cell distribution between high and low grade cervical lesions
low grade: squamous cells confined to lower one third of epithelium; high grade: expand to thwo thirds of epithelial thickness
75
there is an overexpression of what cell cycle regulatory protein in oncogenic HPVs
p16
76
what is p16 and what is its role in HPV infection
a cyclin kinase inhibitor that inhibits the cell cycle by preventing phosphorylation of RB; the E7 from the virus inactivates RB so cells proliferate and p16 can't inhibit
77
most common HPV
HPV 16
78
most high grade cervical lesion develop from
low grade cervical lesions
79
immediate precursor of cervical squamous cell carcinoma
high grade squamous intraepithelial lesion
80
2nd most common tumor type of the cervix
cervical adenocarcinoma
81
low grade lesions of the cervix have what percent of a change to regress, persist and progress (progress to what)
60%, 30%, 10% to high grade
82
high grade lesions of the cervix have what percent of a change to regress, persist and progress (progress to what)
30%, 60%, 10% to carcinoma
83
peak incidence age of invasive cervical carcinoma
45 years
84
what do most patients with stage IV cervical cancer die from
consequence of local extension of tumor rather than distant metstases (like into bladder and ureters)
85
what part of the cervix is the pap test taken from
cervical transformation zone
86
available HPV vaccine types
6, 11, 16, 18
87
two major components of the endometrium
myometrium and endometrium
88
upper half to 2/3 of the endometrium
functionalis - shed during menses
89
lower 1/3 of the endometrium
basalis
90
what happens during the proliferative phase of the menstrual cycle
granulosa cells of developing follicle in ovary gives off estrogen causing the endometrium undergoes rapid growth
91
when does the endometrium slow its growth
ovulation
92
uterine bleeding not caused by any underlying organic/structureal abnormality
dysfunctional uterine bleeding
93
what is the cause of too much estrogen stimulation without the counteracting effect of the progestational phase
anovulatory cycle
94
when are anovulatory cycles the most common
menarche and perimenopausal period
95
what happens to the endometrium in an anovulatory cycle
mild architectural changesfrom prolonged endometrial stimulation
96
inadequate corpus luteum function resulting in low progesterone output and early menses
inadequate luteal phase
97
how does an inadequate luteal phase manifest clinically
infertility with increased bleeding or amenorrhea
98
what does biopsy of the endometrium show with an inadequate luteal phase
secretory endometrium that is late in its expected secretory characteristics by that date
99
under what conditions would acute endometritis arise
bacterial infections that arise after delivery or miscarriage
100
causative agents in acute endometritis
group a strep, staph
101
how would you treat an acute endometritis infection
removal by curettage with antibiotics
102
chronic endometritis occurs in these type of patients:
patients with chronic PID, postpartum/post abortion patients who have retained gestational tissue, IUDs, women with TB
103
what kind of cells are seen in chronic endometritis
plasma cells
104
what organism may be associated with chronic endometritis
Chlamydia
105
presence of endometrial tissue outside the uterus
endometriosis
106
sites of endometriosis in descending order
ovaries, rectovaginal septum, large/small bowel and appendix, fallopian tubes --> can have symptoms associated with where the tissue is
107
endometriosis presents clinically as...
infertility, dysmenorrhea, pelvic pain
108
what age group does endometriosis affect
women in active reproductive life, third/fourth decades
109
theories for endometriosis: (2)
1. implanted at abnormal locations and retrograde menstruation through the fallopian tubes occur, possible reason for metastasis (2) endometrium could arise directly from coelomic epithelium
110
what can happen to the ovaries in endometriosis
they can become filled with brown fluid from a previous hemorrhage --> CHOCOLATE CYST
111
histologic diagnosis of endometriosis requires
endometrial glands and stroma
112
symptoms of endometriosis
dysmenorrhea, dyspareunia, pelvic pain and possible pain on defection if the rectal wall is involved
113
what is commonly a presenting complaint with endometriosis
infertility
114
presence of endometrial tissue within the uterine wall
adenomyosis
115
in adenomyosis, where does the endometrial tissue extend into
between the smooth muscle fascicles of the myometrium
116
what does adenomyosis look like on histology
endometrial stroma with or without glands in the myometrium separated from the basalis
117
symptoms of adenomyosis
menometrorrhagia, colickly dysmenorrhea, dyspareunia, and pelvic pain
118
symptoms of endometrial polyps
asymptomatic or abnormal bleeding
119
hyperplastic polyps are responsive to..
estrogen, not progestrone
120
what cancer may arise within endometrial polyps
adenocarcinoma
121
causes of endometrial hyperplasia
obesity, menopause, PCOD, granulosa cell tumors of the ovary, estrogen replacement therapy
122
genetic alteration found in endometrial hyperplasia
inactivation of the PTEN tumor suppressor gene
123
patients with what disease share a mutation with the one found in endometrial hyperplasia
Cowden syndrome
124
types of endometrial hyperplasia
simple hyperplasia without atypia, simple hyperplasia iwth atypia, complex hyperplasia without atypia, complex hyperplasia with atypia
125
which endometrial hyperplasia has glands with cystic dilation
simple hyperplasia without atypia
126
which endometrial hyperplasia has increased # and size of glands with crowding and branching, intervening strom and abundant mitotic figures
complex hyperplasia without atypia
127
how can you treat complex hyperplasia with atypia
hysterectomy
128
most common invasive cancer of the female genital tract
endometrial carcinoma
129
what age group does endometrial carcinoma arise in
postmenopausal women (55-65) because they present with postmenopausal bleeding
130
most common type of endometrial carcinoma
type I carcinoma
131
where does type I endometrial carcinoma invade into
myometrial invasion with extension into the periuterine structures by direct continuity
132
metastases of type I endometrial carcinoma
lungs
133
what are most typeI endometrial carcinomas called, and how do they look like on histology
endometrioid adenocarcinoma with gland patterns resembling normal endometrial epithelium
134
type II endometrial carcinomas arise in what stage of the endometrium
endometrial atrophy
135
what discharge can be found in type II endometrial carcinoma and what is another symptom
excessive leukorrhea (thick, whitish discharge from vagina), irregular or postmenopausal vaginal bleeding
136
endometrial adenocarcinomas with malignant changes in the stroma
malignant mixed mullerian tumors
137
in a malignant mixed mullerian tumor can differentiate into a variety of malignant components of what embryonic layer
mesodermal, like muscle, cartilage, osteoid
138
what age group does malignant mixed mullerian tumors present in and what is a presenting symptom
postmenopausal womean with postmenopausal bleeding
139
on gross appearance, malignant mixed mullerian tumors differ from adenocarcinomas because they are
fleshy, bulky, and protrude through the cervial os
140
prognosis of malignant mixed mullerian tumors
highly malignant
141
what kind of neoplasm is a leiomyoma (what is it composed of and malignant potential)
benign smooth muscle
142
histology of leiomyomas
whorled pattern of smooth muscle bundles
143
symptoms of leiomyomas
abnormal bleeding, compression of the bladder (urinary frequency), sudden pain on disruption of blood supply, imparied fertility
144
how do you distinguish a leiomyosarcoma from a leiomyoma on histology
there is nuclear atypia, mitotic index, and zonal necrosis
145
hydatids of morgagni are remnants of what and where is it found
mullerian duct, its a larger variety cyst near the fimbriated ennd of the fallopian tube
146
paratubal cysts are filled with
clear serous fluid; 0.1-2 cm; fallopian tube cyst
147
Where do cystic follicles of the ovary originate from?
Unruptuured graafian follicles or in follicles that have ruptured and immediately sealed
148
Larger cystic follicles in the ovary may cause what symptom
Pelvic pain
149
Uniform and usually b/l enlargement of the ovary with hypercellular stroma and luteinization of stromal cells (look like nests of cells with vacuolated cytoplasm)
Stromal hyperthecosis
150
Most ovarian tumors are benign/malignant? And what age group do they occur in
Benign; 20-45 years
151
Malignant ovarian tumors are more common in what age group?
45-65 years
152
what 3 parts of the ovary do tumors derive from
(1) surface epithelium derived from the coelomic epithelium, (2) germ cells - migrate to ovary from yolk sac, (3) stroma of ovary (including sex cords)
153
3 major histologic types of surface epithelium ovarian tumors
serious, mucinous, and endometrioid
154
extent of peithelial proliferation in surface epithelium ovarian tumors (3 types, describe them)
benign (minimal proliferation), borderline (moderate proliferation), malignant (marked epithelial proliferation + stromal invasion)
155
benign surface epithelium ovarian tumors can be broken down into 3 types
cystadenomas, cystadenofibromas, adenofibromas
156
if borderline and malignant surface epithelium ovarian tumors have a cystic component and are malignant, what are they called
cystadenocarcinomas
157
how are the surface layers of the ovary derived embryologically and what part gets transformed in ovarian tumors
mullerian ducts formed from the coelomic epithelium evolve into the 3 types of ovarian surface epithelium; this coelomic epithelium transforms into tumors
158
serous surface epithelial ovarian tumors are lined by what type of cells and what are they filled with
cystic neoplasms lined by talll, columnar, ciliated and nonciliated epithelial cells and are filled with clear serous fluid
159
most common malignant ovarian tumors, what age do they arise in
serous surface epithelial ovarian tumors; 20-45 years
160
what percentage of serous surface epithelial ovarian tumors are benign/borderline/malignant
70% benign/borderline and 30% malignant
161
risk factors for malignant serous surface epithelial ovarian tumors
nulliparity, family history, and heritable mutations
162
what mutations increase susceptibility to ovarian cancer
BRCA1 and BRCA2
163
borderline serous surface epithelium ovarian tumors have an increased number of ______ on histology
papillary projections
164
serous surface epithelial ovarian tumors are mostly unilateral/bilateral
bilateral
165
in benign serous surface epithilial ovarian tumors what is there an abundance of on histology
cilia
166
which type of ovarian tumor has psammoma bodies
serous surface epithelium ovarian tumor
167
most mucinous surface epithelium ovarian tumors are benign/malignant?
benign/borderline
168
risk factor for mucinous surface epithelium ovarian tumor
smoking
169
how does a mucinous tumor differ from a serous surface epithelium ovarian tumor (3)
rare surface involvement, mostly unilateral larger cystic masses, no cilia
170
on histology, what kind of epithelial cells are present in mucinous surface epithelium ovarian tumors
columnar epithelial cells with apical mucin w/o cilia
171
condition with extensive mucinous ascites, cystic epithelial implants on the peritoneal surfaces, adhesions, and frequently mucinous tumor involving the ovaries
pseudomyxoma peritonei
172
how do endometriod tumors differ from serous or mucinous surface epithelial ovarian tumors
presence of tubular glands that look like benign/malignant endometrium
173
in what disease state my endometriod surface epithelium ovarian cancers arise in
in the setting of endometriosis
174
if you have a primary mucinous ovarian tumor and it presents bilaterally, what do you need to exclude
tumor of a non-ovarian origin
175
which type of surface epithelium ovarian tumor has bilaterality that is typical
serous type
176
if bilaterality is present in an endometriod surface epithelium ovarian tumor, what does this imply
extension of the neoplasm beyond the genital tract
177
characterized by large epithelial cells with abundant clear cytoplasm similar to the hypersecretory gestational endometrium
clear cell adenocarcinoma
178
what other disease may clear cell adenocarcinoma of the ovaries be associated with
endometriosis or endometriod carcinoma of the ovary
179
what kind of epithelium does a brenner tumor have
nests of transitional type epthial cells like those from the urinary bladder
180
brenner tumors are usually bilateral/unilaterl? what kind of tumors are they?
unilateral; adenofibroma
181
if there is an ovarian tumor that has neoplastic epithium like the bladder, but without a brenner component, what is it
transitional cell carcinoma
182
where will an ovarian tumor go if it extends past the capsule? and what symptom will it present with
it will seed the peritoneal cavity; presents with ascites
183
marker for ovarian tumors
CA-125
184
what can elevations in CA-125 also appear in other than ovarian tumors
peritoneal irritation
185
what reduces the risk of ovarian cancer
fallopian tube ligation and oral contraceptive therapy
186
at what stage of growth are ovarian tumors diagnosed
only diagnosed when they are large or originate on the ovarian surface where they easily spread to the pelvis
187
most germ cell ovarian tumors are
benign cystic teratomas
188
categories of ovarian teratomas
mature (benign), immature (malignant) and monodermal/highly specialized
189
another name for benign ovarian teratomas and what age do they typically present in
dermoid cysts, young women of active reproductive years
190
about 1% of dermoid teratomas most commonly undergo malignant transformation into what type of cancer
squamous cell carcinoma
191
what kind of structures are found in an ovarian teratoma
collections of tissues and structures from all 3 germ layers
192
most common specialized ovarian teratomas
struma ovarii and carcinoid
193
specialized ovarian teratomas are unilateral/bilateral?
unilateral
194
what kind of tissue is struma ovarii composed of
mature thyroid tissue
195
what syptom might struma ovarii cause
hyperthyroidism
196
where does the ovarian carcinoid tumor typically arise from
intestinal epithelium in a teratoma
197
what does the ovarian carcinoid tumor produce and what syndrom may be associated with it
5-hydroxytryptamine and the carcinoid syndrome
198
what age do malignant teratomas present in and what kind of tissue is found?
embryonal and immature fetal tissue and found mainly in prepubertal adolescents around 18 years
199
risk factor for subsequent extra-ovarian spread in a malignant teratoma is based on the proportion of tissue containing:
immature neuroepithelium
200
ovarian counterpart of the seminoma of the testis
dysgerminoma
201
most dysgerminomas occur in what age group
2nd and third decades
202
dysgerminomas are bilateral/unilateral
unilateral
203
what is located in the fibrous stroma of a dysgerminoma
mature lympocytes and occasional granulomas
204
dysgerminomas are benign/malignant
malignant
205
what kind of prognosis do dysgerminomas have
good prognosis: responsive to chemo even if they extend beyond the ovary
206
what is a yolk sac tumor rich in
alpha-fetoprotein and alpha1antitrypsin
207
what kind of histology is seen in a yolk sac tumor
schiller-duval body
208
what is a schiller-duval body
glomerulus-like structure composed of a central blood vessel enveloped by germ cells within a space lined by germ cells
209
what is the clinical presentation of a yolk sac tumor
children or a young woman with abdominal pain and a rapidly developing pelvic mass
210
extra-embryonic differentiation of malignant germ cells that have high levels of chorionic gonadotropins
choriocarcinoma
211
how can you determin that a choriocarcinoma is of germ cell origin
you can only do this in a pre-pubertal girl because after this age you can't exclude it from an ectopic pregnancy
212
most ovarian choriocarcinomas exist with what other disease
other germ cell ttumors
213
prognosis and chemo for ovarian choriocarcinomas
aggressive tumors that metastaze widely through bloodstream to lungs/liver and are unresponsive to chemo (unlike those that arise from placental tissue) - fatal :(
214
tumor with granulosa and theca cell differentiation arising in postmenopausal women; what epithelial layer does it arise from
granulosa-theca cell tumor; sex-cord stromal
215
what histology is seen with granulosa-theca cell tumors?
call-exner bodies
216
what are call-exner bodies
small, distinctive, gland-like structures filled with acidophilic material
217
what do granulosa-theca cell tumors give off
estrogen and inhibin (from granulosa cells)
218
tumors arising in the ovarian stroma that are composed of fibroblasts; what epithelial layer is it from
fibromas; sex cord-stroma
219
tumors arising in the ovarian stroma that are composed of plump spindle cells with lipid droplets; what epithelial layer is it from
thecomas; sex cord stroma
220
what symptoms are associated with fibromas, thecomas, and fibrothecomas; what epithelial layer is it form
pelvic mass, ascites, hydrothorax only of the right side; sex-cord stroma
221
Meigs syndrom is composed of...
ovarian tumor, hydrothorax, ascites
222
tumors of the ovary that produce masculinization or least defeminzation
sertoli-leydig cell tumors/androblastomas
223
sertoli-leydig cell tumors/androblastomas are usually bilateral/unilater? what epithelial layer are they derived from
unilateral; sex-cord stroma
224
what is a consequence of sertoli-leydig cell tumors in women
virilization
225
a ovarian tumor with lipid-laden cells and reinke crystalloids
hilus cell tumors, pure leydig cell tumors
226
uncommon tumor composed of germ cell sand sex cord-stroma derivatives; individuals have abnormal sexual development and gonads of indeterminate nature
gonadoblastoma
227
metastatic gastrointestinal neoplasia to the overies
krukenberg tumor
228
what kind of cells are present in a krukenberg tumor
mucin-producing, signet-ring cancer cells of gastric origin
229
pregnancy loss before 20 weeks gestation
spontaneous abortion or miscarriage
230
causes of spontaneous abortion
chromosomal anomalies, luteal-phase defect, poorly controlled diabetes, other uncorrected endocrine disorders, vasculature disorders (antiphospholipid Ab syndrome, coagulopathies, HTN), infections (toxoplasma, mycoplasma, listeria, viral infections)
231
implantation of the fetus in another site other than inside the uterus
ectopic pregnancy
232
most common site of ectopic pregnancy
fallopian tubes!! other sites are ovary, abd cavity, intrauterine porition of fallopian tube
233
predisposing condition to ectopic pregnancy
prior PID --> fallopian tube scarring, IUDs also increase risk
234
fertilization and trapping of ovum within the follicle just at the time of its rupture results in
ovarian pregnancy
235
what may develop of the fertilized ovum fails to enter or drops out of the fimbriated end of the tube
abdominal pregnancy
236
tubal pregnancy is the most common cause of
hematosalpinx (blood-filled fallopian tube)
237
consequence of fallopian tube rupture
massive intraperitoneal hemorrhage
238
clinical presentation of an ectopic pregnancy
severe abdominal pain about 6 weeks after a previous normal menstrual period caused by a rupture of the tube --> pelvic hemorrhage
239
what is a serious complication from ectopic pregnancy
hemorrhagic shock with signs of an acute abdomen
240
identical twins are from what type of placenta
monochorionic
241
in a monochorionic twin placenta, if there is a vascular anastomoses between the circulation of both twins
twin-twin transfusion syndrome
242
placenta implants in the lower uterine segment or cervix with serious third-trimester bleeding
placenta previa
243
if a patient had a complete placenta previa, how must the baby be delivered, and why does the baby have to be delivered this way
via cesarean section to avert placental rupture and fatal maternal hemorrhage during vaginal delivery
244
partial or complete absence of the decidua with adherence of placental villous tissue directly to the myometrium and failure of placental separation
placenta accreta
245
risk factors for poastpartum bleeding
placenta previa and history of previous cesarean section
246
what are 2 ways infections in the placenta can develop, which is more common
ascending infection (most common) through the birth canal and hematogenous transplacental infection
247
what does the amniotic fluid look like histologically with infection
polymorphonuclear leukocytic infiltrate with edema and congestion of the vessels
248
what are the organisms that can cross through the placenta
TORCH (toxoplasmosis, others-syphilis, TB, listeriosis, rubella, CMV, herpes)
249
how does preeclampsia present clinically
with HTN, edema, proteinuria in the last trimester
250
what is it called when preeclampia patient becomes more seriously ill? and what additional symptom is seen with this state
ecclampsia with convulsions
251
some women with sever preeclampsia can develop this syndrom composed of
HELLP syndrome - hemolysis, elevated liver enzymes, low platelets
252
preeclampsia without proteinuria
gestational htn
253
at what point of pregnancy does preeclampsia symtoms disapper
with delivery of the placenta
254
what are the abnormalities associated with preeeclampsia
endothelial dysfunction, vasoconstriction, increased vascular permeability
255
microscopic changes associated with preeclampsia
placental infarcts with increased syncytial knots and in the decidual vessels indicating abnormal implantation
256
in what case will preeclampsia be found earlier than 34 weeks gestation
in patients wiht a hydatidiform mole
257
what are indications for delivery no matter the age of the fetus with preeclampsia states
maternal end-organ dysfunction, fetal compromise, HELLP syndrome
258
cystic swelling of the chorionic villi
hydatidiform mole
259
hydatidiform moles are associated with an increased risk of..
persistant trophoblastic disease (invasive mole) or choriocarcinoma
260
what ages are molar pregnancies more common in
far ends of reproductive life: teens and between ages of 40 and 50 years
261
difference in ferilization in a complete and partial mole
complete: fertilization of an egg that has lost its chromosomes and genetic material is completely paternally derived - partial: fertilization of an egg with 2 sperm
262
karyotype of complete and partial moles
complete: (46, XX or XY) and partial: (69,XXY or 92XXXY)
263
complete mole histology
most villi enlarged and edematous with diffuse trophoblast hyperplasia arpimd tje emtore circumference of the villi
264
which type of mole has an increased risk of choriocarcinoma
complete mole
265
partial mole histology:
villous enlargement and architectural disturbance in only a proportion of villi
266
what gene mutation in found in hydatidiform moles. are they in partial or complete moles
p57KIP2 in patial moles becuase it is maternally transcribed but paternally imprinted (complete moles have an emplty ovum)
267
what lab value is elevated with a molar pregnancy
HCG
268
how is choriocarcinoma dervied and what is its prognosis
malignant neoplasm of trophoblastic cells dervied from a previously normal or abnormal pregnancy ; its rapidly invasive and metastasizes widely but responds well to chemo (nearly 100% remission)
269
most choriocarcinomas arise with what condition, what are some other common conditions
with hydatidiform moles, also in patients with previous abortions and 22% in normal pregnancies
270
histology of choriocarcinomas
large pale areas of ischemic necrosis, foci of cystic softening and extensive hemorrhage
271
how does choriocarcinoma manifest clinically
vaginal spotting of a bloddy, brown fluid
272
what lab value is elevated in choriocarcinoma and where does metastases go
HCG, lungs
