Female Repro Tract Pathology (Hillard) Flashcards
(163 cards)
1
Q
Mayer-Rokitansky -Kuster-Hauser Syndrome
A
mullerian ageneis; missing fallopian tubes, uterus, and upper third of the vagina, presents with amenorrhea; but normal breast, pubic hair and vulvar development
2
Q
Bartholin Cyst
A
benign vulvar lesion; results from obstruction of the Bartholin glands; cysts are non tender, unilateral, soft mass (3-5 cm) in the posterior aspect of the vaginal introitus; fluid is white or clear
3
Q
Infected Bartholin Cyst
A
benign vulvar lesion; abscess; fluid is green or yellow; lesion is painful, warm, +/- surrounding edema and cellulitis; most common bug is E. coli
4
Q
Lichen Sclerosus
A
benign vulvar and anogenital skin lesion; inflammatory disorder with activated T cells; most common in postmenopausal women; pruritis, dyspareunia, dysuria; white plaques; risk for TP53 positive keratinizing squamous cell carcinoma; histo thinning (atrophy), edematous band with lymphocytic infiltrate
5
Q
Dyspareunia
A
painful sexual intercourse
6
Q
Lichen Sclerosus has increased risk for what?
A
TP53 positive keratinizing squamous cell carcinoma
7
Q
Histology of Lichen Sclerosus
A
thinning (atrophy), edematous band with lymphocytic infiltrate
8
Q
Squamous Cell Hyperplasia (Lichen Simplex Chronicus)
A
thickening of skin (vulva) due to chronic, uncontrolled rubbing or scratching, appears as thickened reddened surface which can whiten over time. Associated with contact dermatitis, lichen sclerosis, and squamous cell carcinoma
9
Q
Squamous Cell Hyperplasia (Lichen Simplex Chronicus) can be associated with other disorders?
A
contact dermatitis, psoriasis, lichen sclerosis, and squamous cell carcinoma
10
Q
Condyloma Acuminatum
A
anogenital wart caused by HPV (6,11); sexual intercourse; laten phase can last weeks to months; skin-colored exophytic plaques; cauliflower-like appearance
11
Q
Fleshy, skin-colored papules and plaques with a cauliflower appearance around the anogenital region should make you consider what?
A
Condyloma Acuminatum caused by HPV (6,11); low risk for progression to SCC
12
Q
Histological findings of Condyloma Acuminatum?
A
hyperplastic papillary projections compromised of squamous cells with parakeratosis (surface keratinocytes with nuclei); some cells are kolicytic atypia (enlarged hyperchromic nuclei with a surrounding cleared-out halo space)
13
Q
Vulvar carcinoma
A
SCC is the most common. 2 types:
1. Basaloid/Warty SCC
2. Keratinizing SCC
both arise from Vulvar intraepithelial neoplasia (VIN)
14
Q
HPV related SCC of the vulva arises from what?
A
Vulvar intraepithelial neoplasia (VIN)
15
Q
Basaloid / Warty Squamous Cell Carcinoma
A
Avg age 60 yrs; “Classic VIN”, associated with HPV (16 and 18)
16
Q
Keratinizing Squamous Cell Carcinoma
A
Avg age 76 yrs; “Differentiated VIN”; caused by chronic irritation (lichen sclerosus or squamous cell hyperplasia); freq with TP53 mutations
17
Q
Keratinizing Squamous Cell Carcinoma has a high frequency with what mutation?
A
TP53 mutations; causes an abnormal p53 tumor suppressor protein
18
Q
Classic VIN
A
high risk HPV driven Basaloid / Warty SCC; full thickness atypia; lots of mitotic figures on histo; can progress to invasive SCC
19
Q
Differentiated VIN
A
Non-HPV related vulvar SCC; basal/parabasal atypia; can lead to keratinizing SCC; with KSCC will show invasive nest of squamous cells showing keratinization
20
Q
Papillary Hidradenoma
A
benign neoplasm; solitary, well-circumscribed vulvar dermal or subcutaneous nodule; columnar and myoepithelial cells with apocrine (sweat gland) differentiation; arises from the mammary-type glands along the primitive milk-line
21
Q
What embryonic structure does papillary hidradenoma of the vulvar arise?
A
arises from the mammary-type glands along the primitive milk-line
22
Q
What identical lesion of the papillary hidradenoma is seen in the breast?
A
intraductal papilloma
23
Q
Extramammary Paget’s Disease (EMPD)
A
intraepithelial adenocarcinoma; sweat gland and keratinocyte differentiation; pruritic, ill-defined, erythematous +/- white crusted lesion with a “map-like” quality; immunostain CK7 positive
24
Q
A pruritic, ill-defined, erythematous +/- white crusted lesion with a “map-like” quality in the anogenital region should make you think of what?
A
Extramammary Paget’s Disease (EMPD)
25
Lesion that is immunostain CK7 positive
Extramammary Paget's Disease (EMPD)
26
What are Gartner duct cyst derived from?
Wolffian (mesonephric) remnants
27
What are Mullerian cyst derived from?
Mullerian (paramesonephric) duct
28
Gartner duct cyst and Mullerian cyst
submucosal cyst in reproductive age women; found on the anterior lateral walls of the vagina, can protrude into the orifice; asymptomatic, when symptomatic can cause vaginal pressure and painful intercourse
29
Diethylstilbestrol (DES) exposure
in utero exposure to DES predisposes women to vaginal clear cell adenocarcinoma; females exposed have increased patches of vaginal adenosis that turns into clear cell adenocarcinoma
30
Why was DES used?
nonsteroidal estrogen that addressed issues in pregnancy including miscarriage, preterm delivery, and post-partum lactation suppression
31
Why was DES discontinued?
discontinued in 1971 because linked to vaginal clear cell carcinoma in daughters of women who used the drug during pregnancy
32
Vaginal Embryonal Rhabdomyosarcoma (Sarcoma Botryoides)
uncommon tumor found in infants and young girls, protruding bulky; polypoid, grape-like mass; invasion can result in death; embryonal rhabdomyoblasts
33
Histogenesis of Vaginal Embryonal Rhabdomyosarcoma (Sarcoma Botryoides)?
Malignant cells are embryonal rhabdomyoblasts
34
Vaginal Squamous Cell Carcinoma and VAIN
starts with premalignant lesions VAIN; high-risk HPV (16 and 18); metastasizes in lymphatic pattern
35
Premalignant lesion of vaginal squamous cell carcinoma
Vaginal intraepithelial neoplasia (VAIN); caused by high risk HPV (16 and 18)
36
VAIN
Vaginal intraepithelial neoplasia (VAIN); caused by high risk HPV (16 and 18); Premalignant lesion of vaginal squamous cell carcinoma
37
Lymphatic spread of vaginal SCC of lower 2/3rd of vagina?
inguinal and femoral lymph nodes
38
Lymphatic spread of vaginal SCC of upper vagina?
regional iliac lymph nodes to periaortic lymph nodes
39
Which type of HPV is the most common cause of carcinoma?
HPV 16
40
HPV
Human papillomavirus; DNA virus; causes almost all cervical and vaginal carcinomas; most common cause is HPV 16; second runner up is HPV 18
41
Pathogenesis of HPV?
High-risk HPV integrates into the squamous cell genome of E6 and E7 oncogenes and promotes oncogenesis.
E6: increases telomerase (no division limit)
E6: degrades p53 (removes the brakes)
E7: drives cell proliferation by inactivating p21 and binding to RB
42
How does HPV affect E6?
E6: increases telomerase (no division limit)
E6: degrades p53 (removes the brakes)
43
How does HPV affect E7?
E7: drives cell proliferation by inactivating p21 and binding to RB
44
HPV has a predilection for which zone in the cervix?
transformation zone (T zone)
45
Progression of cervical dysplasia
normal squamous epithelium to low grade dysplasia (LSIL/CIN I) to moderate dysplasia (CIN II) and then severe dysplasia / carcinoma in situ (HSIL/CIN III)
46
CIN I
low-grade squamous cervical intraepithelial neoplasia (CIN) lesion, lack of maturation in the lower third of epithelium with koilocytes seen in upper layers; LSIL
47
LSIL
Low-grade squamous intraepithelial lesion; 60% regress, 30% persist and 10% progress to high-grade SIL; CIN I
48
HSIL
High-grade squamous intraepithelial lesion; 30% regress, 60% persist, and 10% progress to carcinoma! (CIN II and III)
49
What is the screening tool for cervical dysplasia?
a pap test; sample is taken from the cervix at the transformation zone, sample is stained with a Papanicolaou stain - specifically used to stain for squamous cells
50
Molecular screening techniques for cervical neoplasms
Real-time PCR-based assays or Hybrid capture are used to check for high risk HPV (16 and 18); is it a true dysplastic atypia?
51
What are the screening guidelines for Pap Testing
Start at age 21yrs; cytology every 3 yrs until 30 yrs; 30-60 yrs every 5 yrs w/ molecular test; stop screening at >65 yrs
52
Colposcopy
if pap test picks up abnormality cervix can be visualized through a coloscope; acetic acid is applied, causing coagulation and dysplasia turn acetowhite.
53
Low grade lesions vs high grade lesions on colposcopy
low-grade lesions show faint or fine punctation;
high-grade lesions show more coarse punctation
54
Punctation
refers to a dotted or stippling vascular pattern seen on colposcopy of the cervix
55
Treatment for high-grade dysplasia of the cervix
Cervical conization -cone-shaped piece of tissue is cut out from the cervix;
or LEEP (loop electrosurgical excision) - electric current runs through wire loop and cuts away abnormal tissue
56
Cervical adenocarcinoma in situ (AIS)
most cervical cancers are squamous but sometimes ENDOcervix is infected and causes glandular lesions; causing AIS; characterized by hyperchromatic nuclear enlargement with pseudostratification; can progress to invasive adenocarcinoma
57
Average age for cervical cancer?
45-50 yrs
58
Most common type of cervical cancer?
SCC (80%) and adenocarcinoma (15%)
59
Vaccination for cervical cancer?
three vaccines; recommended for both males and females age 11 or 12
60
Endocervical polyps
common benign growth in the ENDOcervix that protrudes beyond the epithelial surface of the cervix; occurs during reproductive years; can present with spotting; simple excision (polypectomy) is curative
61
Histology of proliferative phase endometrium in the menstrual cycle?
cellular blue stroma; tubular glands with pseudostratification; mitotic figures
62
Histology of secretory phase endometrium in the menstrual cycle?
tortuous, serrated glands with secretory material; decidualized stroma; "piano key" vacuoles
63
"piano key" vacuoles on histology
The early secretory phase of the menstrual cycle; subnuclear vacuoles that mimic the appearance of piano keys
64
Anovulatory
lack of ovulation
65
What are the 3 most common causes of AUB caused by hormonal imbalances during menarche and during the perimenopausal period?
1. Ovarian lesion (PCOS - polycystic ovarian syndrome
2. Metabolic disorder - obesity
3. Endocrine disorders - thyroid, adrenal, pituitary
66
Acute endometritis
acute infection of the endometrium; common cause of post-partum fever, uterine tenderness, and abdominal pain; infiltrate of neutrophils (microabscesses); commonly caused by Group A Strep after delivery; can also be associated with chlamydia
67
What is the common bacterial agent that causes acute endometritis?
Group A Strep or staphylococci after delivery
68
Chronic endometritis
characterized by the presence of plasma cells; eccentrically placed nucleus and a perinuclear hof (or cleared halo); variety of causes - retained products of conception, chronic pelvic inflammatory disease, and IUD (Actinomyces)
69
What is the histological hallmark of chronic endometritis?
Plasma cells within the stroma
70
What are the 3 most common causes of chronic endometritis?
1. Retained products of conception
2. Chronic Pelvic Inflammatory Disease (PID)
3. IUD (Actinomyces)
71
Long-standing intrauterine devices can cause what?
infections by the fungus-like bacteria actinomyces; chronic endometritis
72
Endometriosis
"ectopic" endometrial tissue OUTSIDE of the uterus; commonly ovaries and pelvic tissues; severe dysmenorrhea (painful menses) and ovarian mass.
73
What structures are commonly affected by endometriosis?
ovaries and pelvic tissue
74
Pathogenesis of endometriosis?
persistence and survival of endometrial tissue via release of proinflammatory and inflammatory factors; increase aromatase enzyme production causing increase in estrogen; mutations in tumor suppressors and oncogenes
75
Histological findings of endometriosis?
red-brown to blue-black "powder burn" lesions; if involves ovaries (ovarian endometrioma) - "chocolate cysts"
need 2 of the 3 findings:
1. endometrial glands
2. endometrial stroma
3. evidence of hemorrhage (hemosiderin laden macrophages)
76
Adenomyosis
endometriotic tissue in the muscle of the uterus (myometrium); presents with dysmenorrhea, pelvic pain, dyspareunia, and infertility; uterus will show multiple foci of hemorrhagic spaces
77
Endometrial polyps
benign exophytic, hyperplastic polypoid neoplastic-like mass; benign glands and stroma; can be caused by use of tamoxifen
78
Tamoxifen can cause what pathology?
endometrial polyps
79
Endometrial hyperplasia
increase in the number of endometrial glands relative to the stroma; premalignant condition; two types:
1. Typical hyperplasia (low-risk to carcinoma)
2. Atypical hyperplasia (high-risk to carcinoma)
80
What are the 5 risk factors to hyperplasia/carcinoma?
1. Obesity
2. Polycystic ovarian syndrome (PCOS)
3. Estrogen replacement therapy
4. Tamoxifen therapy
5. Estrogen-producing tumors (granulosa cell tumor and thecoma of ovary)
** early menarche, late menopause and nulliparity also increase risk
81
What is the most common finding in endometrial cancer?
abnormal uterine bleeding; most often seen in post menopausal women
82
What are the three types of endometrial cancer?
1. Endometrioid Carcinoma of the uterus
2. Serous Carcinoma of the uterus
3. Malignant Mixed Mullerian Tumor (MMMT)
83
Endometrioid Carcinoma of the uterus
most common (85%); mimics normal endometrium; slow progression; mutations of PTEN and KRAS
84
Serous Carcinoma of the uterus
(15% of cancers); postmenopausal atrophic; blacks; papillary growth pattern with marked cytologic atypia; TP53 mut; aggressive tumor, poor prognosis
85
Malignant Mixed Mullerian Tumor (MMMT)
rare tumor; postmenopausal atrophic; blacks; BOTH malignant glandular and malignant stroma; TP53 mut; aggressive tumor, poor prognosis with heterologous component (chondrosarcoma or rhabdomyosarcoma)
86
Lynch Syndrome
AD with mismatch repair gene mut (MLH1 or MSH2) leading to microsatellite instability (MSI); also increases risk for colon, endometrial and ovarian cancers
87
Mutations in mismatch repair genes MLH1 and MSH2
Lynch Syndrome; increased risk for colon, endometrial and ovarian cancers
88
Adenosarcoma
rare, low grade malignancy; benign glands and malignant stroma (sarcoma); compare to MMMT (malignant glands AND stroma); can be mistaken for benign polyps
89
Low Grade Endometrial Stromal Sarcoma
rare malignant tumor of endometrial stroma; invades myometrium and/or has lymph/vascular invasion; JAZF1 gene translocation
90
Pathology with JAZF1 gene translocation?
Low Grade Endometrial Stromal Sarcoma; rare malignant tumor of endometrial stroma; invades myometrium and/or has lymph/vascular invasion
91
Leiomyoma
Fibroids; benign smooth muscle tumors, bland, spindled cells; multiple white to tan circumscribed nodules; can cause uterine bleeding and infertility; MED12 mutation
92
What mutation is associated with leiomyomas?
MED12 mutation (70%)
93
Leiomyosarcoma
uncommon malignant neoplasm of smooth muscle origin (similar to leiomyoma - both have MED12 mut); aggressive (50% metastasize); 3 features that separate it from leiomyomas:
1. atypia
2. increased mitosis
3. tumor necrosis
94
What are the three characteristics that separate leiomyosarcomas from leiomyomas?
1. atypia
2. increased mitosis
3. tumor necrosis
95
Paratubal cysts of the fallopian tube
very common benign cysts derived from embryological ducts or mesothelium; asymptomatic
subtype: hydatid cyst of Morgagni; larger and derived from Mullerian remnants near fimbriae
96
Name of the ovarian cyst derived from Mullerian remnants near fimbriae?
Hydatid cyst of Morgagni; subtype of paratubal cysts
97
Follicular cysts are derived from what and contain what type of cells?
Ovarian follicle; both follicular and granulosa cells
98
Luteal cysts are derived from what and contain what type of cells?
when the corpus luteum fails to regress; luteinized granulosa cells and theca cells
99
Adenomatoid Tumor
most common tumor of the fallopian tube; well-circumscribed benign tumor of mesothelial origin
100
Polycystic Ovarian Syndrome (PCOS)
1. Hyperandrogenism (testosterone) - look for hirsutism/ male pattern balding
2. Hormonal imbalance (LH/FSH) - chronic anovulation, decreased fertility, increased estrogen
3. Insulin resistance (DM2) - obesity
4. Polycystic ovaries
101
What are the 5 ovarian epithelial tumors?
1. Serous
2. Mucinous
3. Endometrioid
4. Clear Cell
5. Brenner tumor (transitional tumor)
102
What are the 4 ovarian germ cell tumors?
1. Teratoma
2. Dysgerminoma
3. Yolk sac tumor
4. Choriocarcinoma
103
What are the 3 ovarian sex-cord tumors?
1. granulosa cell tumor
2. fibroma/thecoma
3. Sertoli-Leydig cell tumor
104
What are the 2 ovarian metastatic tumors?
1. Krukenberg tumor
2. Pseudomyxoma peritonei
105
What is the most common ovarian malignancy?
Serous carcinoma (epithelial tumor)
106
What is the one exception ovarian tumor that is unilateral?
Mucinous tumors (unilateral); all else are bilateral
107
Name some clinical features of ovarian tumors.
Can be asymptomatic or have vague symptoms: adnexal mass on palpation (can lead to urinary urgency), vaginal bleeding, abdominal pain/distention
if malignant - weight loss and ascites
108
What are the 3 ovarian epithelial tumor classifications?
1. benign
2. borderline
3. malignant
109
Pathogenesis of type I ovarian tumors?
benign precursor lesion and then to a borderline tumor and finally to a low grade carcinoma
110
What are the 5 type I ovarian tumors?
All of the epithelial ovarian tumors:
1. LOW-GRADE serous
2. Mucinous
3. Endometrioid
4. Clear Cell
5. Brenner
111
Pathogenesis of type II ovarian tumors?
derived from tubal/ovarian surface and associated with p53 mutation
112
What is the ONE type II ovarian tumor to know?
HIGH-GRADE serous carcinoma; derived from fallopian tubal precursor termed Serous tubal intraepithelial carcinoma (STIC); associated with p53 mut
113
The two types of ovarian serous tumors?
type I LOW-GRADE serous tumor; cystic tumor with tubal-like epithelium with a papillary growth pattern
type II HIGH-GRADE serous tumor; solid tumor with marker atypia; p53 mutation; associated with BRCA1 and BRAC2 mut (breast cancer)
114
What mutations are associated with type II ovarian tumors?
pathogenesis involves p53 mutation and is associated with BRCA1 and BRAC2 mut (breast cancer)
115
LOW-GRADE ovarian serous tumor
type I serous tumor; can be benign, borderline, or malignant; cystic tumor with tubal-like epithelium with a papillary growth pattern
116
HIGH-GRADE ovarian serous tumor
type II serous tumor; malignant; solid tumor with marker atypia; p53 mutation; associated with BRCA1 and BRAC2 mut (breast cancer)
117
Ovarian mucinous tumors
UNILATERAL (exception); columnar epithelium; large cystic lesion with mucinous fluid; KRAS mutation
118
What mutation is strongly associated with ovarian mucinous tumors?
KRAS mutation
119
Endometrioid ovarian tumors
most are carcinomas; similar to endometrial endometrioid carcinomas; endometriosis is a precursor in some cases
120
Clear cell ovarian tumors
vast majority are malignant; variant of endometrioid tumor; large epithelial cells with clear cytoplasm (cytoplasmic clearing)
121
What are the 3 types of ovarian teratoms?
1. Mature Cystic Teratoma (Dermoid Cyst)
2. Immature malignant teratoma
3. Monodermal (Specialized) Teratoma
122
Mature cystic teratoma
AKA Dermoid Cyst
benign; comprised of all three germ layers; 46XX karyotype; most common germ cell tumor; unilateral cystic mass
123
What is the most common ovarian germ cell tumor
Mature cystic teratoma (Dermoid Cyst)
124
Immature malignant teratoma
malignant (watch for extra ovarian spread); prepubertal female adolescents and young women; key feature is presence of malignant immature neuroepithelium
125
What key feature is required for the diagnosis of an ovarian immature malignant teratoma?
presence of malignant immature neuroepithelium
126
Monodermal (Specialized) Teratoma
composed predominately or solely of ONE tissue type; two types:
1. Struma ovarii - mature thyroid tissue; unique presentation of hyperthyroidism symptoms
2. Carcinoid tumor - carcinoid syndrome; flushing, diarrhea, hypotension
127
What are the two types of ovarian monodermal (Specialized) teratomas?
1. Struma ovarii - mature thyroid tissue; unique presentation of hyperthyroidism symptoms
2. Carcinoid tumor - carcinoid syndrome; flushing, diarrhea, hypotension
128
Struma ovarii
type of ovarian monodermal (Specialized) teratoma; composed predominately or solely of ONE tissue type; mature thyroid tissue; unique presentation of hyperthyroidism symptoms (tachycardia, heat intolerance, tremor, LOW TSH)
129
Carcinoid tumor
type of ovarian monodermal (Specialized) teratoma; composed predominately or solely of ONE tissue type; causes carcinoid syndrome; flushing, diarrhea, hypotension
130
Dysgerminoma
most common malignant ovarian germ cell tumor; ovarian counterpart to testicular seminoma; KIT mutation
131
What mutation is associated with a dysgerminoma?
KIT mutation
132
Ovarian yolk sac tumor
second most common malignant ovarian germ cell tumor; alpha-fetoprotein (AFP); hallmark is Schiller-Duval body and hyaline droplets
133
What pathology as the histological hallmark of hallmark is Schiller-Duval body and hyaline droplets?
Ovarian yolk sac tumor; alpha-fetoprotein (AFP) positive
134
Ovarian choriocarcinoma
aggressive, malignant germ cell tumor; placental (trophoblastic) differentiation; secretes high levels of beta-hCG
135
Which ovarian tumor can mimic an ectopic pregnancy?
Ovarian choriocarcinoma; secretes high levels of beta-hCG
136
What are the two types of a granulosa cell tumors?
1. Adult granulosa cell tumor - peri & postmenopausal women (endometrial hyperplasia/carcinoma)
2. Juvenile granulosa cell tumor - younger (precocious puberty)
137
A granulosa cell tumor stains strongly for what?
inhibin; brown is positive
138
Granulosa cell tumor characterisitcs?
tumor cells in developing follicles; low-grade malignancy; can release estrogen and cause endometrial hyperplasia/carcinoma in adults and precocious puberty in juveniles; histo - coffee bean nuclei and Call-Exner bodies
139
What color are hormonally active granulosa cell tumors?
yellow; they release large amounts of estrogen
140
Fibroma
benign tumor of fibroblasts; clinical features - Meigs Syndrome: Triad
1. Ascites
2. Pleural effusion
3. Benign ovarian tumor
141
Meigs Syndrome
Clinical presentation of fibroma; triad
1. Ascites
2. Pleural effusion
3. Benign ovarian tumor
142
Thecoma
tumor of theca-like cells; can release estrogen; can cause endometrial hyperplasia/carcinoma and precocious puberty
143
Sertoli-Leydig Cell Tumor
tumor of cells normally seen in male testis; secretes testosterone; DICER1 mut; clinical effects of defeminization and severe virilization; more severe than PCOS; association with Reinke crystals (rod-like pink crystals)
144
Krukenberg Tumor
malignant non-ovarian origin tumor; typically GI origin; bilateral metastases; mucin-rich signet ring cells
145
Pseudomyxoma Peritonei
tumor of non-ovarian origin tumor; almost always appendiceal mucinous tumor; gelatinous, mucinous ascites termed "jelly belly"; nonspecific symptoms
146
#1 risk factor for ectopic pregnancy
pelvic inflammatory disease (PID); fallopian tube is the most common site
147
Clinical findings seen in ectopic pregnancy
abdominal pain; bleeding 6-8 weeks after last period; if rupture life threatening EMERGENCY; severe hemorrhagic shock
148
Definition of spontaneous abortion
AKA miscarriage; pregnancy loss before 20 weeks
149
Dizygotic fraternal twins always result in what type of placenta in utero?
"Di-Di"
dichorionic diamniotic placenta
150
Twin-to-Twin Transfusion Syndrome
ONLY occurs in monochorionic twins; just one chorion; arteriovenous anastomoses occurs; one twin becomes under perfused and the other becomes fluid overloaded
151
Placenta Accreta Spectrum
no placenta decidua so fetal villi directly adhere/invade the myometrium; failure of placenta to separate and leads to post-partum hemorrhage; different types - remember AIP (accreta, increta, percreta)
152
Placenta Previa
placenta implantation in the lower uterine segment of cervix and covers internal os; 3rd trimester bleeding;
C-section required
153
Preeclampsia
HTN (>140/90) and proteinuria in pregnancy; occurs >20 weeks of pregnancy; if severe can display headache and visual changes
154
Eclampsia
preeclampsia plus the appearance of a grand mal seizure (complete loss of consciousness and violent muscle contractions)
155
Three main symptoms of preeclampsia?
1. HTN
2. swollen hands and feet
3. protein in urine
156
Pathogenesis of preeclampsia
1. abnormal placenta vasculature (placenta ischemia)
2. maternal vasoconstriction (HTN)
3. hypercoagulable state (increased fibrin thrombi - can lodge in organs such as kidneys, liver or brain)
157
HELLP Syndrome
H Hemolysis, microangiopathic anemia (schistocytes)
EL Elevated Liver Enzymes
LP Low Platelets
158
Complete molar pregnancy
abnormal pregnancy; subtype of a hydatiform mole; multi-cystic mass lesion "snow storm" on US; NO FETAL PARTS; increased risk for both choriocarcinoma and invasive mole; PATERNALLY derived (46 XX) most common
159
What karyotype is most common in a complete molar pregnancy?
PATERNALLY derived (all generic material); 46 XX most common karyotype; p57 negative
160
Partial molar pregnancy
abnormal pregnancy; subtype of a hydatiform mole; fetal parts/abnormal fetus present; small risk for invasive mole; genetic material from BOTH parents; 69 XXX / 69 XXY / 69 XYY karyotypes
161
Karyotypes associated with a partial molar pregnancy?
genetic material from BOTH parents; 69 XXX / 69 XXY / 69 XYY karyotypes; p57 positive
162
Gestational Choriocarcinoma
malignant trophoblastic tumor; greatest risk factor is previous complete mole; INCREASED beta - hCG; very high cure rate with chemotherapy (contrast to ovarian choriocarcinoma)
163
Trophoblastic tumor
rare tumor of intermediate trophoblast; presents with uterine mass with abnormal uterine bleeding or amenorrhea; increased beta-hCG
