Fallopian Tube/Ovary/Trophoblastic Path Flashcards
Salpingitis
Types (2) with Descriptions
Suppurative
Infective salpingitis, mostly from Gonorrhea and Chlahmydia
Tuberculous
Sequelae of tuberculosis
Important cause for infertility in endemic areas
Fallopian Tube Lesions
Types (2) with Descriptions
Paratubal cysts
Most common primary lesion of fallopian tube
Hydatids of Morgagni if near fimbriae or Broad L.
Translucent cysts with serous fluid
Adenomatoid Tumors
Benign tumors found in subserosa
Ovarian Cyst Types (2)
Morphological and Clinical Differences
Follicle Cysts
Gray membrane, contain serous fluid
From unruptured graffian follicles
Usually multiple cysts
Luteal Cysts
Lined by rim of bright yellow tissue with granulosa cells
From the corpus luteum
Normal in reproductive age females
Polycystic Ovarian Syndrome
Morphology, Presentation (5) and Clinical Associations (4)
Numerous cystic follicles that enlarge ovaries
Hyperandrogenism Menstrual irregularities Chronic anovulation Infertility Increased serum Estrone
Endometrial hyperplasia/carcinoma (from estrone)
Obesity
Type 2 Diabetes
Early atherosclerosis
Serous Epithelial-Stromal Tumors
Origin Tissue, Commonness/Bilaterality, Risk Factors (3) Low/High Grade Precursors and Mutations
Morphology (2) and Behavior
Mullerian epithelium
Most common malignant ovarian tumor
Often Bilateral
Nulliparity
Family History
BRCA1/BRCA2
Low grade lesions come from serous borderline tumors
KRAS/BRAF/ERBB2 mutations
High Grade lesions from serous tubal intraepithelial carcinoma (STIC)
TP53 mutations
Psammoma bodies
Complex patterns of growth
Propensity to invade omentum and peritoneum
Mucinous Epithelial-Stromal Tumors
Origin Tissue, Commonness/Bilaterality, Mutation,
Morphology and Behavior
Mullerian Epithelium
Relatively common tumor
Usually unilateral
KRAS mutation
Confluent glandular growth
Expansile invasion
Endometrioid Epithelial Stromal Tumors
Origin Tissue, Commonness/Bilaterality, Mutations (4), Association, Morphology
Mullerian epithelium
10-15% of all ovarian tumors
Often bilateral
PTEN
PI3K/AKT pathway
CTNNB1
TP53
Comorbidity with Endometriosis
Tubular glands resembling endometrium
Pseudomyxoma peritonei
Etiology and Clinical Features (3)
From spread of appendiceal tumors
Mucinous ascites
Cystic epithelial implants on peritoneum
Adhesions that can cause intestinal obstruction
Mature Teratomas
Morphology, Pathogenesis and Prognosis
Stratified squamous epithelium overlying skin adnexal structures
Arise from ovum after first meiotic division
Benign but some progress to squamous cell carcinoma
Monodermal Teratomas
Types (2) with Descriptions
Struma ovarii:
Made of Thyroid tissue
If functional, causes hyperthyroidism
Ovarian carcinoid:
Made of Intestinal tissue
Produce serotonin and can cause Carcinoid syndrome
Dysgerminoma
Genetics (4), Morphology (2), Clinical Features (2)
Express OCT3, OCT4 and NANOG transcription factors
(maintain pluripotency)
KIT gene mutations
Unilateral
Large vesicular cells with clear cytoplasm
Malignant
Responsive to chemotherapy
Yolk Sac Tumor
Tissue Origin, Secretion, Morphology (2) Presentation (3)
Malignant germ cells from extraembryonic yolk sac lineage
alpha-Fetoprotein (AFP)
Glomerulus-like structure (Schiller Duval Body)
Intra/Extracellular hyaline droplets
Kids or young women
Abdominal pain
Unilateral rapidly growing pelvic mass
Granulosa Cell Tumors
Morphology (3) Secretions (2),
Juvenile/Adult Presentations (1/3), Genetics
Unilateral
Call-Exner bodies
Tumors have yellow lining
Large amounts of Estrogen
Inhibin (useful diagnostically)
Juvenile: Precocious puberty
Adult: Uterine Bleeding, Endometrial hyperplasia and Proliferative breast disease
FOXL2 mutation
Fibrothecomas
Morphology (3) and Clinical Features (4)
Fibroblasts (firbomas)
Plump spindle cells with lipid droplets (thecomas)
Unilateral
Benign and hormonally inactive
Meigs Syndrome: Fibroma, Ascites, Pleural Effusion
Sertoli-Leydig Cell Tumors
Mutation, Morphology (4) and Presentation
DICER1
Unilateral
Gray to golden brown gross appearance
Tubules of Sertoli and Leydig cells
Sarcomatous pattern if poorly differentiated
Masculinization from androgen proliferation
Leydig Cell Tumors (Hilus Cell)
Morphology (3), Prognosis and Presentation (3)
Lipid laden Leydig cells
Reinke Cystalloids
Unilateral
Benign
Hirsutism
Voice deepening
Clitoral enlargement
Gonadoblastoma
Morphology and Clinical Features (3)
Germ cells resembling Sertoli and granulosa cells
Presents in people with abnormal sexual development with gonads of indeterminate nature
Comorbidity with dysgerminoma
Excellent prognosis with excision
Krukenberg Tumor
Primary Tumor Sites (6) and Morphology (2)
Breast Stomach Colon Pancreas Biliary Tract Rarely from pseudomyxoma peritonei (appendix)
Bilateral metastases to ovary
Mucin producing Signet Ring cells
Placental Blood Flow (5)
Spiral Arteries carry maternal blood to intervillous space
Deoxygenated blood flows through decidua to endometrial veins
2 umbilical arteries carry deoxygenated fetal blood to chorionic villi via chorionic artery branches
Villous capillary and endothelial cells allow gas exchange
Oxygenated fetal blood travels back up 1 umbilical vein
Spontaneous Abortions
Etiologies (4) and Definition
Chromosomal Abnormalities (45XO and Trisomy 16)
Maternal Endocrine Factors
Uterus Physical Defects
Systemic Vascular Diseases (Antiphospholipid Ab)
TORCH infections
Loss of pregnancy before 20 weeks gestation
Ectopic Pregnancy Risk Factors (4), Location, Complications (2)
Chronic Salpingitis from Pelvic Inflammatory Disorder
IUD
Smoking
Fallopian Scarring from Appendicitis, Endometriosis or Tubal Ligation
Fallopian Tubes mostly
Hematosalpinx
Tubal rupture causing intraperitoneal hemorrhage
Twin-Twin Transfusion Syndrome
Clinical Setting, Description (2) and Complication
Seen in monochorionic twin pregnancies
Arteriovenous shunt of blood from one fetus to the other
One fetus is hypoperfused while other is fluid overloaded
Death of one or both infants
Placental Implantation Abnormality Descriptions
Previa (3) and Accreta (4)
Placenta Previa:
Implantation in lower uterus or over cervix
Severe third Trimester bleeding
Requires delivery via C section
Placenta Accreta: Caused by absence of the decidua Placental villous tissue adheres to myometrium Severe post-partum bleeding Associated with placenta previa
Pre-Eclampsia and Eclampsia
Symptoms (4) Pathophysiologic Aberrations (3)
Hypertension Edema Proteinuria Seizures (makes it eclampsia) HELLP syndrome
Abnormal Placental Vasculature:
From abnormal trophoblastic implantation
Endothelial Angiogenesis Dysfunction:
soluble FMS-like Tyrosine Kinase increases tunica media proliferation and disrupts blood flow
Coagulation abnormalities:
From reduced PGI2
Pre Eclampsia and Eclampsia
Morphology (5) and Hepatic Disease Description (2)
Infarcted placental tissue Increased syncytial knots Retroplacental hematomas Abnormal decidual vessels Liver/Kidney/Brain/Heart lesions
Fibrin deposits in periportal sinusoids from hemorrhage into space of Disse
Leads to hepatocellular coagulative necrosis
Hydatidiform Mole
Types (2) with Morphology (2), Lab Findings, Clinical Features (4)
Complete: Sperm fertilize empty egg (46 XX karyotype)
Partial: Polyspermy fetilization (Triploid karyotype)
Delicate friable mass of translucent grapelike cysts
Complete: No fetal tissue present
Elevated b-hCG
Most common in teens, 40-50 year olds and SE Asians
Causes Spontaneous Abortions
Snowstorm pattern on ultrasound
Partial: no risk of choriocarcinoma
Choriocarcinoma
Morphology (2) Lab Finding, Etiology, Clinical Features (5)
Proliferating syncytiotrophoblasts and cytotrophoblasts
Abundant mitoses
Massive increase in b-hCG
Complete hydatidiform mole
Malignant Irregular vaginal bleading Hematogenous metastasis to lungs Enlarged uterus Nearly 100% cure rate with chemo and hysterectomy
Placental Site Trophoblastic Tumor Lab Findings (2) Prognosis
Elevated human Placental Lactogen (hPL)
Elevated hCG
Excellent prognosis if localized disease
