Female Genital Tumors Flashcards
___ are the most common subtype of ovarian germ cell neoplasms and occur most frequently in women age 10-30. They are benign and show mature tissues derived from multiple germ layers. Most patients are asymptomatic and found to have an incidental mass on pelvic examination or ultrasound, but some can present with __________.
Teratomas pain or abdominal discomfort
Histologic features include
- ovarian stromal invasion by atypical cells (jagged, crumply, stippled white)
- forming papillae/glandular spaces with a
- fibrovascular core (looks like fibrous blood vessel- kinda looks like a leaf vein)
usually presents in older women.
High-grade serous ovarian carcinoma
Risk factors for this tumor include:
- Tamoxifen use
- Pelvic radiation
- Postmenopausal status
Uterine Sarcoma
Presents with:
Abnormal/postmenopausal bleeding
Pressure symptoms
- pelvic pressure
- bloating
- Constipation
- Urinary frequency
Immobile uterine/pelvic mass
Uterine Sarcoma
Arises from uterine smooth muscle or endometrial stromal cells (Malignant)
Uterine Sarcoma
Malignant features:
- Cellular atypia
- Abundant mitoses
- Tumor cell necrosis
Uterine Sarcoma
rare but aggressive malignant tumor of the uterine myometrium and/or endometrial stromal tissue.
Presents with
- post-menopausal bleeding
- an immobile mass
Uterine sarcoma
unregulated endometrial gland proliferation increased gland-to-stroma ratio
thickened endometrial lining
(+/– heavy menses)
Endometrial hyperplasia
Risk factors:
- unopposed estrogen from chronic anovulation
- obesity
Endometrial hyperplasia
- Irregularly enlarged, non-tender uterus =
vs
- Diffusely enlarged, tender uterus=
Leiomyoma (Fibroids)
Adenomyosis
benign myometrial smooth muscle cell tumors.
Leiomyomas (ie, uterine fibroids)
Cause regular, heavy menses due to increased endometrial surface area
- Leiomyoma (Fibroids)
- Adenomyosis
- Endometrial hyperplasia
Heavy, prolonged menses
Pressure symptoms
- Pelvic pain
- Constipation
- Urinary frequency
Obstetric complications
- Impaired fertility
- Pregnancy loss
- Preterm labor
Uterine leiomyomas (fibroids)
African American women are 2-3 times more likely than Caucasian women to develop
fibroids (Leiomyomas)
the presence of endometrial glands within the uterine myometrium.
Abnormal uterine bleeding and painful menses are common, Uterus is generally enlarged.
Adenomyosis
common in
- multiparous women
- Prior uterine surgery (cesarean delivery)
Adenomyosis
- ________and cyclic bleeding within the myometrium leads to dysmenorrhea and uterine tenderness
- abnormal _____________ results in a concentric, uniformly enlarged uterus
- uterine enlargement and subsequently increased endometrial surface area causes ___,___ menstrual bleeding
Definitive therapy for Adenomyosis is with hysterectomy.
endometrial gland proliferation
myometrial hyperplasia and hypertrophy
regular, heavy
multiparous women with dysmenorrhea, heavy menses, and a uniformly enlarged uterus.
Diagnosis?
Adenomyosis
small uterus
low TSH
Cystic, Oily ovarian mass
Adnexal mass
Struma ovarii
an ovarian germ cell tumor composed of >50% mature thyroid tissue that can secrete thyroid hormone (T4).
can be a rare cause of thyrotoxicosis
- weight loss
- irregular menses
- low TSH level
Struma ovarii
composed of cells that support the normal ovarian structure for ovulation (serous, mucinous epithelial cells).
Surface epithelial-stroma Tumors
(serous, mucinous, Endometrioid, Clear cell, Transitional cell)
composed of cells that support and surround the oocyte. These cells secrete sex hormones including estrogen (granulosa cells) and testosterone (Sertoli-Leydig cells).
Sex cord-stroma Tumors
(Granulosa, Fibroma, Sertoli-Leydig)
composed of cells that can develop into an embryo or placenta.
These tumors are composed of varying amounts of germ layers (ie, endoderm, mesoderm, ectoderm), yolk sac, or placenta (ex: chorion).
They often have associated hormonal activity (ex: increased hCG, alpha fetoprotein).
Germ cell Tumors
(Teratoma, Dysgerminoma, Yolk sac, Embryonal Carcinoma)
What causes each
Fibroids (Leiomyoma)
Adenomyosis
Endometrial Hyperplasia/Cancer
Grossly, ____ appear as discrete, yellow-gray tumors with a thin pseudocapsule that separates the fibroid from the normal uterine myometrium.
Diagnosis is confirmed with microscopy, which typically reveals monoclonal proliferation of ___ & ___ because each fibroid arises from a single progenitor smooth muscle cell.
cells are uniform in size and shape and have minimal mitotic figures.
fibroids (Leiomyomas)
myocytes and fibroblasts
*Patients with symptomatic uterine fibroids are often treated surgically with a hysterectomy.
endometrial glands and stroma within the uterine myometrium
Adenomyosis
benign, intracavitary, focal hyperplastic growths of endometrial tissue. In contrast to adenomyosis, they cause painless intermenstrual bleeding rather than painful, cyclic, heavy menses. There is also no associated uterine tenderness or enlargement.
Endometrial polyps
PCOS has a long-term risk for endometrial hyperplasia and ____.
adenocarcinoma
a primary gastric cancer that has metastasized to the ovary, often presenting with bilateral ovarian lesions. The cardinal histologic feature is nests of signet ring cells. The appearance is a result of large amounts of mucin displacing the nucleus.
Krukenberg tumor
ectopic endometrial glands induce myometrial hyperplasia and hypertrophy, creating a globular, uniformly enlarged uterus.
Adenomyosis
Adhesions may interfere with ovulation and fallopian tube function, resulting in infertility. Implants and adhesions involving the uterosacral ligament can result in a fixed, retroverted uterus.
Infiltration of the posterior cul-de-sac can result in painful intercourse and tenderness with palpation of the posterior vaginal fornix. Shedding of the ectopic tissue causes dysmenorrhea (painful menses).
Diagnosis
Endometriosis
