female reproductive tract part 5: ovaries and fallopian tubes

Question 1

what are paratubal cysts of the fallopian tube?

Answer 1

benign cystic structures associated with the fallopian tube that are either remnants of the mullerian duct or from periotoneal mesothelial lining

Question 2

paratubal cysts are typically small but a subset of them are larger: what is this usbet called

Answer 2

hyatid custs of morgagni

Question 3

hydatid cysts are located near the _ of the fallopian tube and are dervied from _ remnants

Answer 3

fimbriae

mullerian duct

Question 4

often paratubal cysts are asymptomatic but they can cause pain or tosion or _

Answer 4

rupture

Question 5

what are the two benign cysts of the ovary

Answer 5

follicular cysts and luteal cyst

Question 6

what is a follicular cyst derived from? what is is lined by?

Answer 6

derived from an ovarian follicle

lined by innder granuloas cells and outer follicular cells

usually greater than 3cm

Question 7

what is a luteal cyst, when does it occur and what is it lined by?

Answer 7

this is a ovarian cyst that derived when the corpus luteum fails to regress

it is lined by lutenized inner granulosa cells and outer theca cells

Question 8

what are the symptoms of a follicular and luteal cyst?

Answer 8

usually asymptomatic but can cause pain upon rupture or torsion

Question 9

what is an adenomatoid tumor

Answer 9

this is a rare beingn tumor of meothelial origin typically in the fallopian tube

Question 10

how does an adenamatoid tumor look on histology/ grossly

Answer 10

histology: sieve like apperance with spaces of varios sizes

grossly: well circumscribed, gray/white in color

Question 11

PCOS is a complex syndrome characterized by what 4 things

Answer 11

1. hyperandrogenism
2. hormonal imbanlance with anovulation
3. insulin resistance
4. polycystic ovaries

Question 12

increased androgens in PCOS especially _ leads to virilization including _ and male pattern balding

Answer 12

testosterone

hirituism (abnormal deposition of hair)

Question 13

hormonal imbalance in PCOS can lead to abnormal menstrual cycles includeing _ and decreased _.

Answer 13

anovulation

decreased fertility

Question 14

paradoxically in PCOS there is increased _ which is because a major feature of PCOS is _ resistance which leads to obesity and peripheral conversion of steroids to _

Answer 14

estrogen

insulin

estrogen

Question 15

increased estrogen leads to an increased risk of ?

Answer 15

endometrial hyperplasia and carcinoma

Question 16

what is stromal hyperthecosis

Answer 16

PCOS without cysts

in postmenopausal women with hirituism, insulin resistance, obesity

enlarged ovaries and yellow representing the lutinized stomal cells that produce excess androgens

Question 17

what is theca lutein hyperplasia of pregnancy

Answer 17

this is theca lutein hyperplasia of the ovaries whcih causes ovarian enlargement due to increased gonadotropins and increased adogens

effects are mild because there is an increase in sex binding protein in pregnancy that reduces the androgen effect

Question 18

what are the categories of ovarian tumors?

Answer 18

epithelial
germ cell
sex cord-stromal
metastasis

EGSM- ovarian tumors

Question 19

epithelial ovarian tumors are derived from _ epithelium

Answer 19

mullerian

Question 20

what are the major type of epithelial ovarian tumors

Answer 20

Serous
Mucinous
Endometroid
Clear Cell
Transitional Cell/Brenner

SMECT

Question 21

what are the germ cell ovarian tumors

Answer 21

teratoma, dysgerminoma, tolk sac, choriocarcinoma

Question 22

what are the types of sex cord stromal ovarian tumors

Answer 22

granulosa cells
firbroma/tehcoma
seroli-leydig

Question 23

what are mestastitc tumors to the ovaries

Answer 23

krukenberg

and psuedomyoxoma peritonei

Question 24

what is the most common primary ovarian malignancy

Answer 24

serous carcinomas

Question 25

if an ovarian tumor is malignant it is most likelt to be _ however there is one major exception to this rule which is seen with _ tumors, these are often malignant and unilateral

Answer 25

bilateral mucinous tumors

Question 26

ovarian tumors are typically asymptomatic unless they have grown to an advanced stage: what are some general findings

Answer 26

adnexal mass on palpation vaginal bleeding abdominal pain urinary symptoms of pressing on bladder Gi sympotms like bloating/indigestion

Question 27

malignant ovarian tumors often show _ _ and _

Answer 27

weight loss and ascites with involvement of the peritoneum

Question 28

ovarian epithelial tumors can be classified into benign, intermediate, and malignant. If benign what are the different presentations

Answer 28

cystic: cystadenoma cystic and firbous: cystadenofibroma fibrous: adenofibroma

Question 29

explain the difference between type 1 and type 2 epithelial ovarian tumors

Answer 29

Type 1: starts as a benign precursor lesion that then forms a borderline malignant tumor to eventually a low grade carcinoma ex: low grade serous, mucinous, endometroid, clear cell, and transitional/brenner Type 2: arises from tubal or ovarian epithelium known as serous tubal intreaepithelial carcinoma (STIC) which then progresses to a high grade carcinoma. They are also involved with P53 mutations EX: high grade serous carcinoma

Question 30

a low grade serous tumor can be benign, intermediate or malignant and thay have a more _ apperance with _ like epithelium often in _ structures. They are associated with what mutations?

Answer 30

cystic tubal like epithelium papillary structures mutations: KRAS, BRAF, ERBB2

Question 31

a high grade serous tumor is malignant without a doubt and has a more _ apperance with marked _ . They are highly associated with _ mutations and are associated with _ and _ mutations which predipose to breast cancer. They are derived from _?

Answer 31

solid atypia P53 BRCA1 and BRCA2 serous tubal intrepithelial carcinoma ## Footnote people with BRCA1 and 2 are more at risk for breast cancer and high grade serous tumors so that might under go bilateral masectomy and bilateral salpingo-oophorecetomy

Question 32

ovarian mucinous tumors are epithelial ovarian tumors that have _ epithelium. There are two ttpes the more common is the _ type and the other a _ type.

Answer 32

columnar intestinal mullerian/endocervical

Question 33

mucinous ovarian tumors are usually _ (small/large) and _ (unilateral/bilateral)

Answer 33

large bilateral

Question 34

mucinous ovarian tumors are multiocular cystic tumors that are filled with _ fluid

Answer 34

mucinous

Question 35

all mucinous tumors whether beingn, borderline, or malignant contain the _ mutation

Answer 35

KRAS

Question 36

most of the endometroid ovarian tumors are _ (benign, borderline, malignant)

Answer 36

malignant

Question 37

if endometroid carcinoma is present in the ovary and the endometrium it is most likely a _

Answer 37

metastasis

Question 38

_ is the precursor for endometroid ovarian carcinoma

Answer 38

endometriosis ## Footnote endometrial glands (back to back glands)

Question 39

vast majority of clear cell carcinomas are _

Answer 39

malignant

Question 40

clear cell ovarian tumors are thought to be a variant of a _ tumor

Answer 40

endometroid

Question 41

histology of a ovarian clear cell carcinoma:

Answer 41

large epithelial cells with clear cytoplasm

Question 42

brenner cell tumor is also known as _ cell tumor and is comprised _ epithelium

Answer 42

ovarian transitional cell urogenital/transitional epithelium (will have urogenital nests in histology)

Question 43

brenner cell tumors derive from _ change of the surface epithelium of the ovary

Answer 43

metaplastic ## Footnote simple squamous to urothelial epithelium

Question 44

brenner tumors are typically _ (benign/borderline/malignant)

Answer 44

benign

Question 45

mature cystic teratoma (ovarian germ line tumor) is also known as?

Answer 45

dermoid cyst

Question 46

mature cystic teratomas (dermoid cysts) are usually _ (unilateral/bilateral) are _ (benign/malignant) and are comprised of?

Answer 46

unilateral benign mature tissues from all embryonic cell layers: ectoderm, mesoderm, endoderm ## Footnote can even contain teeth!!!

Question 47

from the ectoderm can form

Answer 47

skin, hair brain

Question 48

from the mesoderm can form

Answer 48

muscle/fat

Question 49

from the endoderm can form

Answer 49

carilage, mucinous epithelium

Question 50

an immature malignant ovarian teratoma is a _ germ cell tumor that can spread locally or metastasive remotely

Answer 50

malignant

Question 51

immature malignant teratomas of the ovary usually affect who?

Answer 51

prepuberty girls and young women

Question 52

the key to diagnosis of an immature malignant teratoma is the presence of?

Answer 52

immature malignant neuroepithelium ## Footnote grade of tumor depends on the amount of malignant neuropeithelium present

Question 53

what is a monodermal teratoma

Answer 53

a teratoma that is comprised of solely 1 cell type

Question 54

what are the two monodermal teratomas

Answer 54

struma ovarii carcinoid tumor

Question 55

struma ovarii is a monodermal teratoma comprised of mature _ tissue

Answer 55

thyroid tissue

Question 56

struma ovarii can cause _ with tachycardia, heat intolerance, tremor, and low _

Answer 56

hyperthyroidism TSH(thyroid stimulating hormone)

Question 57

what is a carcinoid teratoma/tumor of the ovary

Answer 57

this is a monodermal teratoma that shows carcinoid syndrome: flushing, diarrhea, and HTN 5' hydroxytryptamine is released directly into the ovarian veins and into systemic circulation ( liver cant remove the neuroamine)

Question 58

a dysgerminoma is the counterpart to the _ _ ## Footnote in the ovary

Answer 58

testicular seminoma

Question 59

a dysgerminoma is a _ (benign/malignant) germ cell tumor that has a mutation in _. It is associated with _ _

Answer 59

malignant KIT gonadal dysgenesis ## Footnote most common malignant germ cell tumor

Question 60

histology of a dysgerminoma

Answer 60

large epitheliod cleared cells with abundant lymphocytes

Question 61

a yolk sac tumor of the ovary is a _ cell tumor that is typically _ (benign/malignant) and develops from germ cells. This tumor creates _ which can be foind in the tumor tissue or serum. Histologivally there is the presence of _ _ _ which is a central vein surrounded by tumor cells (glomerulus like apperance) additionally there may be _ _ which are also a classiv finding

Answer 61

germ malignant Alpha Fetal Protein (AFP_ schillar duval bodies hyaline droplets

Question 62

an ovarian choriocarcinoma is an aggressive _ (benign/malignant) germ cell tumor that secrete _

Answer 62

malignant HCG

Question 63

ovarian choriocarcioma can mimic a ?

Answer 63

ectopic pregnancy (due to high HCG)

Question 64

other germ cell tumors can secrete _

Answer 64

HCG

Question 65

granulosa cell tumors are a sex cord tumor of the ovary that mimics _ cells in the developing follicle. What are the two types? is it low grade or high grade?

Answer 65

granulosa cells low grade malignancy adult type and juvinille type

Question 66

granulosa cell tumors of the ovary can release _ which can induce endometrial hyperplasia or _ _ in juvinieles

Answer 66

estrogen precocious puberty

Question 67

how does a granulosa cell look grossly?

Answer 67

yellow because it is hormonely active and produce lipids

Question 68

what are the histological findings of a granulosa cell tumor

Answer 68

oval grooved nuclei and call-exner bodies which mimic the follicle structure

Question 69

many different types of sex-cord stromal tumors are positive for _

Answer 69

inhibin stains brown (positive)

Question 70

fibroma of the ovary is?

Answer 70

benign tumor of fibroblasts

Question 71

thecoma of the ovary is

Answer 71

tumor of theca like cells of the ovary (usually benign) ## Footnote can be hormonally active

Question 72

fibrothecoma is

Answer 72

a benign tumor of both fibroblasts and theca cells ## Footnote can be hormonally active

Question 73

a fibroma is clinically associated with what syndroma

Answer 73

meigs syndrome

Question 74

what is meigs syndrome?

Answer 74

a triad od ascites, pleural effusion and a benign ovarian tumor (usually ovarian firboma)

Question 75

ovarian fibromas are also associated with a rare complex syndrome called?

Answer 75

basal cell neus syndrome

Question 76

what is basal cell nevus syndrome ?

Answer 76

nurmerous basal cell carcinomas before 20, medulloblastomas, odotogenic keratocysts, and pitting in the palms and soles ## Footnote medulloblastoma: brain tumor in children

Question 77

a thecoma can release _ which can cause what?

Answer 77

estrogen endometrial hyperplasia precoious puberty in kids

Question 78

what is a sertoli leydig cell, what is the associated mutation and what does it secrete? effects?

Answer 78

a sex cord stromal tumor thatis not very malignant and occurs in reproductive age women it is associated with the DICER1 mutation. It secretes testosterone which can lead to defeminizing and virilizing effects like male pattern baldness, hirituism, deepening of voice. MORE SEVERE THAN PCOS masculinization ## Footnote sertoli cell tubules are sex cord derived and ley dig cells are stromal derived

Question 79

if sertoli leydig cells manifest in children it may?

Answer 79

stop normal female development

Question 80

histology of sertoli leydig cells

Answer 80

sertoli tubules, eosinophilic leydig cells leydig cells have reinke cystals (rod like pink crystals)

Question 81

what is a krukenburg tumor

Answer 81

this is a metastatic tumor to the ovary that comes from the gastrointestinal tract and have mucin signet ring cells

Question 82

krukenberg tumor usually presentts with _ metastasis

Answer 82

bilateral

Question 83

what does a krukenberg tumor look like grossly

Answer 83

firm white mass

Question 84

what is a psuedomycoma peritonei

Answer 84

this is a jelly belly mucinous tumor that comes from an appendiceal mucinour tumor and frequently involves the ovary

Question 85

on histology what does the pseudomyoxoma peritoni look like

Answer 85

tumors cells with acellular mucin

Question 86

prognosis of a pseudomyoxoma peritonei depends on?

Answer 86

peritoneal spread and grade

Question 87

psuedomyoxoma peritonei clinical symptoms

Answer 87

lower right abdominal pain