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Repro 2 > Fallopian Tubes and Ovaries - Dobson > Flashcards

Fallopian Tubes and Ovaries - Dobson Flashcards

1
Q

Tiny, translucent cysts filled w/ clear serous fluid lined by serous epithelium along the outside of the fallopian tube

A

Paratubal cysts - remnant of mullerian or wolffian duct

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2
Q

Large cystic mass near the tubal fimbriae or in the broad ligaments

A

Hydatids of Morgagni - remnant of mullerian or wolffian duct

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3
Q

Most common cause of salpingitis
Second most common cause

Salpingitis is part of what?

A

N. gonorrhea
Chlamydia

PID

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4
Q

Salpingitis + infertility outside the US - important cause?

A

TB

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5
Q

Salpingitis can progress to form what?

A

Tubo-ovarian abscess

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6
Q

Abnormal bleeding, watery/bloody vaginal discharge, abdominal swelling/pain, palpable pelvic mass – fallopian tube mass

A

Primary adenocarcinoma of fallopian tubes

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7
Q

Cystic follicle vs. follicle cyst (ovaries)

A

Cystic follicle = small un-ruptured/resealed follicle w/ serous fluid
Follicle cyst = cystic follicle that is >2cm, may be diagnosed by palpation and cause pain

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8
Q

Follicle cyst – outer theca cells become easily visible with increased pale cytoplasm

If severe, often accompanied by?

A

Luteinization

Increased estrogen production and endometrial abnormalities

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9
Q

Normal ovaries, cysts lined by bright yellow tissue w/ luteinized (clear) granulosa cells

A

Luteal cysts

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10
Q

Describe polycystic ovarian syndrome (symptoms)

A
  • Multiple cystic follicles (enlarged ovaries)
  • Hyperandrogenism (hirsutism, acne, baldness, deep voice)
  • Acanthosis nigricans (insulin resistance)
  • Menstrual irregularities
  • Chronic anovulation
  • Decreased fertility
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11
Q

PCOS - associations (3)

A

Obesity, DM2, Atherosclerosis

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12
Q

How does PCOS occur?

A

Insulin resistance and high insulin –> altered hypothalamic hormone feedback –> high FSH and LH –> high androgens

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13
Q

3 estrogens (how/where are they made)

A 
E1 = estrone (aromatization of androstenedione in fat)
E2 = estradiol (aromatization of testosterone in follicle)
E3 = estriol (conversion from fetal DHEA in placenta)
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14
Q

PCOS - why the polycystic ovaries?

A

High androgens = follicles don’t mature = become cystic

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15
Q

PCOS - risk of what?

A

Endometrial cancer/hyperplasia (anovulation, high androgens)

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16
Q

Post-menopause, bilateral uniform enlargement of ovaries, virilization, high estrogen

A

Stromal hyperthecosis (cortical stromal hyperplasia)

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17
Q

3 classes of ovarian neoplasms

A
  • Mullerian epithelium (tubal epithelium and endometriosis)
  • Germ cells (pluripotent)
  • Sex cord-stromal cells (endocrine portion)
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18
Q

3 types of epithelial ovarian tumors

A
  • Serous
  • Mucinous
  • Endometreoid
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19
Q

3 classifications (“grade”) of epithelial ovarian tumors

A
  • Benign
  • Borderline
  • Malignant
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20
Q

3 subclasses of benign epithelial ovarian tumors

A
  • Cystic
  • Cystic and fibrous
  • Fibrous
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21
Q

3 benign serous epithelial tumors

A

Cystadenoma
Cystadenofibroma
Adenofibroma

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22
Q

Benign/borderline vs malignant serous tumors - ages

A 
B/B = 20-45
Mal = older
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23
Q

Smooth glistening cyst wall w/ no epithelial thickening or only small papillary projections, WITH CILIA

Increased number of papillary projections

Fixation/nodularity of capsule, invasion into stroma

A

Benign epithelial tumors

Borderline epithelial tumors

Malignant epithelial tumors

24
Q

Risk factors for malignant serous ovarian tumors

Reduced risk factors?

A

Nulliparity, FMH, BRCA1/2 mutations

OCPs, tubal ligation

25
Q

Type 1 vs Type 2 serous carcinoma – genetics

A

Type 1 = from borderline tumor, normal p53, less nuclear atypia
Type 2 = poorly differentiated, TP53 mutation, PIK3CA amplification, RB deletions, BRCA mutations (if familial)

26
Q

Type 2 serous carcinoma - precursors (2 potentials)

A
  • Serous tubal intraepithelial carcinoma (STIC) - sporadic from fallopian tube
  • Ovarian inclusion cysts – sporadic from ovary only
27
Q

Ovarian tumor w/ psammoma bodies (calcification)

A

Serous tumor - CHARACTERISTIC

28
Q

Serous tumors - spread?

A

Peritoneal surface and omentum (omental cake)

29
Q

How do mucinous tumors differ from epithelial? (5)

A
  • Mucinous epithelium (gastric, intestinal, endocervical)
  • NO CILIA
  • Surface of ovary RARELY involved
  • RARELY bilateral
  • LARGE, MULTILOCULAR cystic mass
30
Q

Mucinous tumors + bilateral…think what?

Often the cause of what clinical condition?

A

Non-ovarian origin (APPENDIX)

Pseudomyxoma peritonei

31
Q

Endometrioid ovarian cancer tends to arise w/ what other things?

A

Ovarian endometriosis or uterine endometrial carcinoma

32
Q

Endometrioid tumors - mutations

A

Same ones as endometrial neoplasia - PTEN, KRAS, ARID1A, TP53

33
Q

Common symptoms of epithelial ovarian tumors

Other potential symptoms due to location and size

Malignant forms - symptoms

Peritoneal seeding - symptom

A

Lower abdominal pain, abdominal enlargement

GI issues, urinary frequency, dysuria, pelvic pressure

Weakness, weight loss, cachexia

Massive ascites

34
Q

Epithelial tumors - metastases

A

Regional nodes, liver, lungs, GI, other ovary

35
Q

Bad metastatic sign for epithelial tumor

A

Metastasis to other ovary

36
Q

CA-125

A

Monitoring epithelial tumor disease recurrence/progression

37
Q

Young woman, cystic (unilocular) ovarian mass, 46XX, wall of stratified squamous epithelium with hair and sebaceous glands

Why does it have that name?

A

Dermoid cyst (mature teratoma)

Dermoid = lined by skin-like tissue

38
Q

Rokitansky tubercle

A

Abortive tooth structures w/in a dermoid cyst

39
Q

Dermoid cyst - usually what other tissues can be found?

A

Cartilage, bone, thyroid, neural

40
Q

Rare transformation of dermoid cyst

A

Squamous cell carcinoma (1%)

41
Q

Hyperthyroidism, normal thyroid, ovarian mass

What is the mass?

What else could this mass type potentially produce?

A

Struma ovarii - thyroid tissue w/in the teratoma

Monodermal (specialized) teratoma

5-hydroxytryptamine –> carcinoid syndrome

42
Q

10-30 female, unilateral ovarian mass, soft and fleshy, large cells w/ clear cytoplasm and central nucleus (fried eggs), fibrous stroma w/ lymphocytes

Tumor marker?

A

Dysgerminoma

hCG (some)

43
Q

Dysgerminoma - genetics

A

OCT3, OCT4, NANOG

44
Q

Postmenopausal woman w/ ovarian mass (unilateral). Tumor cells have yellow coloration. Small gland-like structures filled w/ an acidophilic material

What are the things described in the last sentence?

A

Granulosa cell tumors

Call-Exner bodies

45
Q

2 important possible behaviors of granulosa cell tumors

A
  • May elaborate a lot of estrogen

- May behave like low-grade malignancies

46
Q

Child w/ granulosa cell tumor - symptom

A

Precocious sexual development (early breast, menarche, and pubic/underarm hair development)

47
Q

Adult w/ granulosa cell tumor - symptoms

A

Proliferative breast disease, endometrial hyperplasia, endometrial carcinoma

48
Q

Granulosa cell tumor + androgen production (kid vs adult)

A

Pseudo-hermaphroditism in child

Masculinization in adult

49
Q

Lab finding and genetics for granulosa cell tumor

A 
Elevated INHIBIN level
FOXL2 mutation (adult type)
50
Q

Unilateral ovarian mass w/ fibroblasts
Unilateral ovarian mass w/ spindle cells and lipid droplets

Which one shows hormonal activity?

A

Fibroma
Thecoma

Thecoma

51
Q

Ovarian tumor, R side hydrothorax, ascites

A

Meigs syndrome - associated w/ fibroma, thecoma, or fibrothecoma

52
Q

Girl 10-30, ovarian tumor, breast atrophy, amenorrhea, infertility, hair loss, masculinization symptoms, gray-golden brown surface, potentially w/ mucinous glands, bone, and cartilage

Genetics?

A

Sertoli-Leydig cell tumors

DICER1 mutation (50%)

53
Q

Most common metastatic tumors to the ovary

A

Uterus, fallopian tube, other ovary, pelvic peritoneum (mullerian origin)

54
Q

Other metastatic tumors to ovary (extra-mullerian)

A

Breast, GI

55
Q

Bilateral, mucin-producing, signet-ring cancer cells

A

Krukenberg tumor (metastatic from GI)

Repro 2 (28 decks)

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