Dobson: Pathology of the fallopian tube, ovary, and gestational trophoblastic disease Flashcards
1
Q
What does adnexa mean?
A
-the parts adjoining an organ
2
Q
What are the fallopian tubes formed from?
A
- mullerian duct
- remnants of the wolffian duct form paratubal cysts!
3
Q
What is the most common cause of Salpingitis?
A
- N. Gonorrhea 60%
- chlamydia most of remainder
4
Q
What will we see on imaging in salpingitis?
A
-tubo-ovarian abscess
5
Q
Tuberculous salpingitis
A
- rare in US
- cause of infertility where endemic
- multinucleated giant cells
- Ziel neilson stain*
6
Q
are fallopian tube tumors common
A
- no!
- B-9 adenomatoid tumor (mesothelial tumors)
- primary adenocarcinoma of the fallopian tube
7
Q
how does adenocarcinoma of fallopian tube present?
A
- bleeding not related to cycle
- one of the rarest gynecologic cancers
8
Q
What is PCOS combined clinically with?
A
-hyperandrogenism
9
Q
are cystic follicles in ovary common?
A
- hell yes
- can be palpable, may cause pain
- incidental finding
10
Q
what is the outer part of the corpus luteum colored?
A
yellow!
-because it’s secreting a bunch of hormones
11
Q
PCOS
A
- multiple cysts (follicles that don’t mature)
- hyperandrogenism
- menstrual irregularities
- chronic anovulation
- decreased fertility
12
Q
how is PCOS characterized?
A
- obesity
- DM type 2
- Early atherosclerosis
- lots of free estrone
13
Q
PCOS symptoms
A
- amenorrhea
- acne
- hirsutism or male pattern baldness
- acanthosis nigricans
- deepening voice
14
Q
what are the 3 kinds of tumors that can come from the ovary?
A
- Surface epithelial stromal tumors
- sex cord stomal tumors
- Germ cell tumors
15
Q
which tumors are commonly bilateral?
A
- serous tumors
- clear cell
- metastatic (duh)
16
Q
what age do serous tumors usually present at?
A
- younger
- 20-45
17
Q
B-9 tumors morphology
A
- smooth glistening cyst wall with no epithelial thickening or only small papillary projections
- cilia present!
18
Q
What do borderline tumors have?
A
-more complex growth patterns
19
Q
Where do malignant tumors spread to?
A
-peritoneum and omentum
20
Q
What is another good characteristic feature of serous tumors?
A
-PSAMMOMA BODIES!!!!
21
Q
what is the outlook if the malignant tumors get to the peritoneum?
A
-terrible… they’lll die
22
Q
What are some risk factors for serous ovarian tumors?
A
- Nulliparity
- FMH
- Heritable mutations: BRCA1 and BRCA2
23
Q
If we see psuedomyxoma peritonei, what do we think?
A
-appendiceal tumor
24
Q
What is the presentation of ovarian epithelial tumors?
A
-most commonly lower abdominal pain and abdominal enlargement (tumor or ascites)
25
what tumor marker is useful for ovarian neoplasms?
- CA-125
| - look at it to track the treatment process
26
what is the karyotype of almost all teratomas?
- normal!
| - 46,XX
27
Which tumors are the only ones that will be secreting androgens?
-the granulosa and theca cell tumors
28
what will a child that has a granulosa cell tumor present wiht?
-precocious puberty!
29
How would an adult with a granulos cell tumor present?
-with endometrial issues!
30
What is a Renke crystalloid charactieristic of?
- Hilus cell tumors
| - that is a pure leydig cell tumor
31
When I say Call Exner bodies, you say....
Granulosa cell tumors
32
What are Call Exner bodies?
-small, distinctive, glandlike structures filled with an acidophilic material
33
What is it called when a GI tract tumor metastasizes to the ovary
-Krukenburg tumor!
34
When is the peak incidence for a sertoli-leydig cell tumor?
- 2nd and 3rd decades
| - they are unilateral and may resemble granulosa cell tumors grossly
35
What mutation is usually in sertoli-lerydig cell tumors?
-DICER1
36
What is the cytotrophoblast?
-the cells that line the outer part of the embryo
37
What is the syncitiotrophoblast?
-the part that anchors the embryo into the endometrium
38
What is in the umbilical cord?
- vein
| - 2 arteries
39
What is considered a miscarriage?
-preggo loss before 20 weeks of gestation
40
What is the most common cause of spontaneous abortion?
-chromosomal abnormalities (turner syndrome 45,X)
41
What is the vascular abnormality that causes sponateous abortion?
-Anti Phospholipid syndrome
42
What are the Torch infections?
- Toxoplasmosis
- Rubella
- CMV (owl eye nucleii)
- Herpes
43
Where is ectopic pregnancies usually located?
-the fallopian tube!
44
What will show up on an ultrasound with an ectopic preggo?
-a "donut" sign
45
What is considered a disorder of late preggo?
-20 weeks to the third trimester
46
What is particularly common in second trimester losses?
-infections
47
What is Twin-twin transfusion syndrome (TTTS)?
- monochorionic twins
- vascular anastomosis (usualy deep arteiovenous anastomosis
- they steal blood from each other
48
What is placenta previa?
-when the placenta is attached close to or covering the cervix.... this
49
What do ppl with preeclampsia have?
-htn, edema, and proteinuria
50
What is eclampsia then?
-pre eclampsia with a seizure
51
what syndrome did we talk about with eclampsia?
- HELLP syndrome
| - Hemolysis, Elevated Liver enzymes, Low platelet counts (<100,000)
52
What is more common in primiparas?
-preeclampsia
53
Risk factors for Preeclampsia?
- >40
- black
- Fam hx
- multiple gestation
- Chronic renal disease
- Chronic HTN
- DM
- clotting disorders
- first prego
54
When do the symptoms of preeclampsia disappear?
-after delivery of the placenta
55
What is the thing that antagonizes VEGf which decreases maternal/placental angiogenesis?
-sFltl
56
What inhibits TGF beta which decreases endothelial production of NO and vasoconstriction, htn, and tissue hypoperfusion?
-endoglin
57
What is decreased in the hypercoagulable state associated with preeclampsia?
- PGI2
| - so great, now we get thrombi........
58
What organs are affects by preeclampsia?
- placenta
- liver
- kidney
59
What does the placenta look like in pre eclampsia?
- infarcts
- exaggerated ischemic changes
- retroplacental hematomas
- abnormal decidual vessels
60
What do the liver lesions look like in preeclampsia?
- irregular, focal, subcapsular, and intraparenchymal hemorrhages
- fibrin thrombi in the portal capillaries and foci of hemorrhagic necrosis
61
What are the gestational trophoblastic diseases?
- hydatidiform mole
- Invasive mole
- choriocarcinoma
- placental site trophoblastic tumor (PSTT)
62
When is a hydatidiform mole diagnosed?
- early in preggo (9 weeks)
| - 2x as common in SE asia
63
What does a complete mole look like?
-grapelike structures= edematous villi
64
Which kind of mole (partial or complete) has formation of fetal tissue?
- the partial mole
| - that one has an X and Y chromosome
65
What will be higher at nine weeks preggo with a mole?
-B-hCG
66
What is an invasive mole?
-penetrates through uterine wall
67
Choriocarcinoma
- rapidly invasive malignant neoplasm of trophoblastic cells derived from a previously normal or abnormal pregnancy
- uncommon
68
Presentation of choriocarcinoma?
- irregular vaginal bleeding
- hCG usually very high
- may present with mets to lung
69
What is the results of chemotherapy in Choriocarcinoma?
- amazing!
| - nearly 100% remission and high rate of cures
70
Placental site trophoblastic tumor?
- Uncommon
| - produce human placental lactogen hPL
71
How does PSTT clinically present?
- uterine mass with bleeding or amenorrhea
- moderate HCG elevation
- increase hPL
- if localized, excellent prognosis
