Female Genital Pathology 2 Flashcards
Salpingitis
Inflammation of the fallopian tubes
Very common
Almost always a component of pid
Non gonococcal infections are more invasive
Increases risk of tubal ectopic pregnancy
All forms may produce fever, abdominal pain, pelvic masses
Tubo ovarian abscesses and obstruction of tubal lamina may produce permanent sterility.
True my guy
Physiologic cysts of the ovary include
Follicular cysts- Occurs when the follicle of the ovary doesn’t rupture or release its egg but instead grows until it becomes a cyst
Luteal cyst- Changes in the follicle of the ovary after an egg has been released can cause the eggs escape opening to seal off. Fluid builds up inside and a luteal cyst develops
Polycyclic ovarian syndrome
Also known as Stein Leventhal syndrome.
Increased estrogen and androgen production due to presence of more than 9 tiny cysts less than 8mm in size.
Features of POS
Clinically
H-hirsutism/hyperandrogenism
A- Amenorrhea/oligomenorrhea
P-polcyystic ovaries on ultrasound
I-infertility
Histological
Thickened outer tunica and hypertrophic luteinized theca interna and corpora lutea is absent
Biochemical
Excessive production of androgens
Increased Lh
Decreased Fsh
The 5th most common cancer in U.S women
Ovarian cancer
What are the 3 cell types that make up the ovary
The multipotential surface (coelomic) covering epithelium
The totipotential germ cells
Multipotential sex cord or stromal cells
Two of the most common risk factors of ovarian cancer
Nulliparity and family history cuz it’s not FON to have ovarian cancers of course
Mutations of BRCA 1 and 2 genes
HER2/NEU is overexposed in 35%, poor prognosis
K-RAS in 30% , mostly mucinous cystadenocarcinoma
P53 is mutated in about 50% of all ovarian cancers
About serous tumours
Most frequent , account for 60% of all ovarian cancers
Benign-30-40 yrs
Malignant 45-65 years
Poor prognosis in malignant cases
About Mucinous tumors
Differ from mucinous tumors in that epithelium consists of mucin secreting cells similar to those of the endocervical mucosa
10% malignant, 10% of low malignant potential, 80% benign
Better prognosis
About endometroid tumors
May be solid or cystic
Sometimes develop as a mass projecting from the wall of a cyst filled with chocolate coloured fluid.
15-30% of women with this tumor have a concomitant endometrial carcinoma
Also have mutations in PTEN gene
What are brenners tumors
Typically unilateral transitional like epithelium seen in the ovary
About teratomas
Neoplasms of germ cell origin
Constitute 15-20% of ovarian tumors
Arise in first 2 decades of life school that the younger the person is the greater the likelihood of malignancy
Benign mature cystic teratomas
Differentiation of
T-totipotential germ cells, teeth
E- epidermis
R- representing
A-all
T- three germ layers
O- torsion occurs for unknown reason
M-mature tissue
A
Be -benign
Mature
Immature malignant teratomas
Found early in life, mean age 18yrs
Rare
Differ from benign in that they are often bulky, solid or near solid on transection rather than producing secretions and are punctuated by areas of necrosis
Distinctive feature microscopically- immature areas of differentiation towards cartilage bone,muscle, nerve.
Stroma ovarii
Specialised teratoma composed entirely of mature thyroid tissue that may hyperfunction and produce hyperthyroidism
Torch syndrome
A group of infectious diseases that can be passed to a baby during pregnancy, at delivery or after birth
T- toxoplasmosis
O-other agents like varicella
R-rubella
C-CMV
H- HSV
S-Syphilis
Gestational trophoblaatic diseases include
Hydatidiform mole
Invasive mole
Choriocarcinomas
Hydatidiform mole
Also known as molar pregnancy
Abnormal form of pregnancy in which a non viable fertized egg implants in the uterus
Appears as a voluminous mass of swollen, sometimes cystically dilated chorionic villi, appearing like grape like structures.
Types of hydatidiform moles
Complete hydatidiform- in which an enucleated egg is fertilised either by two sperms or more commonly a haploid sperms that endoreduplicates, resulting in expression of only paternal DNA.
Does not permit embryogenesis and thus never contains fetal parts
All the chorionic villi are abnormal and epithelial cells are diploid
(46XX or uncommonly 46XY)
Gives rise to choriocarciomas
Partial hydatidiform mole
Here a haploid ovum either duplicatesand is fertilised by a normal sperm or a haploid ovum is fertilised by 2 sperms resulting in both the expression of maternal and paternal DNA
Compatible with early embryo formation
Have some normal chorionic villi almost always tripled (69,XXY)
Rarely gives rise to choriosarcomas
Invasive mole
Complete moles
Hydropic villi
Aggressive locally but do not have Aggressive metastatic potential of a choriocarcinoma….rather embolism to distant organs
Difficult to remove by curettage and thus hCG levels remain elevated
Choriocarcinoma
Very Aggressive malignant tumor
Arise from gestational chorionic epithelium or less frequently from totipotential cells within the gonads or elsewhere
50% arise in complete hydatidiform moles ,25% after abortion and the rest in normal pregnancy
Highest level of high
Due to chemo, nearly 100% of cases can be cured
Why is it that choriocarcinomas originating from the gonads have a poor prognosis
May be due to presence of paternal antigens on placental choriocarcinoma but not gonadal lesion because maternal response against paternal antigens help by acting as an adjunct to chemo
