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Endo/Repro II Block 1 > Fallopian Tube/Ovary/Trophoblastic Path > Flashcards

Fallopian Tube/Ovary/Trophoblastic Path Flashcards

1
Q

Salpingitis

Types (2) with Descriptions

A

Suppurative
Infective salpingitis, mostly from Gonorrhea and Chlahmydia

Tuberculous
Sequelae of tuberculosis
Important cause for infertility in endemic areas

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2
Q

Fallopian Tube Lesions

Types (2) with Descriptions

A

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

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3
Q

Ovarian Cyst Types (2)

Morphological and Clinical Differences

A

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

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4
Q

Polycystic Ovarian Syndrome

Morphology, Presentation (5) and Clinical Associations (4)

A

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

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5
Q

Serous Epithelial-Stromal Tumors
Origin Tissue, Commonness/Bilaterality, Risk Factors (3) Low/High Grade Precursors and Mutations
Morphology (2) and Behavior

A

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

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6
Q

Mucinous Epithelial-Stromal Tumors
Origin Tissue, Commonness/Bilaterality, Mutation,
Morphology and Behavior

A

Mullerian Epithelium

Relatively common tumor
Usually unilateral

KRAS mutation

Confluent glandular growth

Expansile invasion

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7
Q

Endometrioid Epithelial Stromal Tumors

Origin Tissue, Commonness/Bilaterality, Mutations (4), Association, Morphology

A

Mullerian epithelium

10-15% of all ovarian tumors
Often bilateral

PTEN
PI3K/AKT pathway
CTNNB1
TP53

Comorbidity with Endometriosis

Tubular glands resembling endometrium

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8
Q

Pseudomyxoma peritonei

Etiology and Clinical Features (3)

A

From spread of appendiceal tumors

Mucinous ascites
Cystic epithelial implants on peritoneum
Adhesions that can cause intestinal obstruction

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9
Q

Mature Teratomas

Morphology, Pathogenesis and Prognosis

A

Stratified squamous epithelium overlying skin adnexal structures

Arise from ovum after first meiotic division

Benign but some progress to squamous cell carcinoma

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10
Q

Monodermal Teratomas

Types (2) with Descriptions

A

Struma ovarii:
Made of Thyroid tissue
If functional, causes hyperthyroidism

Ovarian carcinoid:
Made of Intestinal tissue
Produce serotonin and can cause Carcinoid syndrome

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11
Q

Dysgerminoma

Genetics (4), Morphology (2), Clinical Features (2)

A

Express OCT3, OCT4 and NANOG transcription factors
(maintain pluripotency)
KIT gene mutations

Unilateral
Large vesicular cells with clear cytoplasm

Malignant
Responsive to chemotherapy

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12
Q

Yolk Sac Tumor

Tissue Origin, Secretion, Morphology (2) Presentation (3)

A

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

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13
Q

Granulosa Cell Tumors
Morphology (3) Secretions (2),
Juvenile/Adult Presentations (1/3), Genetics

A

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

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14
Q

Fibrothecomas

Morphology (3) and Clinical Features (4)

A

Fibroblasts (firbomas)
Plump spindle cells with lipid droplets (thecomas)
Unilateral

Benign and hormonally inactive
Meigs Syndrome: Fibroma, Ascites, Pleural Effusion

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15
Q

Sertoli-Leydig Cell Tumors

Mutation, Morphology (4) and Presentation

A

DICER1

Unilateral
Gray to golden brown gross appearance
Tubules of Sertoli and Leydig cells
Sarcomatous pattern if poorly differentiated

Masculinization from androgen proliferation

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16
Q

Leydig Cell Tumors (Hilus Cell)

Morphology (3), Prognosis and Presentation (3)

A

Lipid laden Leydig cells
Reinke Cystalloids
Unilateral

Benign

Hirsutism
Voice deepening
Clitoral enlargement

17
Q

Gonadoblastoma

Morphology and Clinical Features (3)

A

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

18
Q

Krukenberg Tumor

Primary Tumor Sites (6) and Morphology (2)

A 
Breast
Stomach
Colon
Pancreas
Biliary Tract
Rarely from pseudomyxoma peritonei (appendix)

Bilateral metastases to ovary
Mucin producing Signet Ring cells

19
Q

Placental Blood Flow (5)

A

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

20
Q

Spontaneous Abortions

Etiologies (4) and Definition

A

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

21
Q 
Ectopic Pregnancy
Risk Factors (4), Location, Complications (2)
A

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

22
Q

Twin-Twin Transfusion Syndrome

Clinical Setting, Description (2) and Complication

A

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

23
Q

Placental Implantation Abnormality Descriptions

Previa (3) and Accreta (4)

A

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
24
Q

Pre-Eclampsia and Eclampsia

Symptoms (4) Pathophysiologic Aberrations (3)

A 
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

25
Q

Pre Eclampsia and Eclampsia

Morphology (5) and Hepatic Disease Description (2)

A 
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

26
Q

Hydatidiform Mole

Types (2) with Morphology (2), Lab Findings, Clinical Features (4)

A

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

27
Q

Choriocarcinoma

Morphology (2) Lab Finding, Etiology, Clinical Features (5)

A

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
28
Q 
Placental Site Trophoblastic Tumor
Lab Findings (2) Prognosis
A

Elevated human Placental Lactogen (hPL)
Elevated hCG

Excellent prognosis if localized disease

Endo/Repro II Block 1 (6 decks)

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