female reproductive tract part 5: ovaries and fallopian tubes Flashcards
what are paratubal cysts of the fallopian tube?
benign cystic structures associated with the fallopian tube that are either remnants of the mullerian duct or from periotoneal mesothelial lining
paratubal cysts are typically small but a subset of them are larger: what is this usbet called
hyatid custs of morgagni
hydatid cysts are located near the _ of the fallopian tube and are dervied from _ remnants
fimbriae
mullerian duct
often paratubal cysts are asymptomatic but they can cause pain or tosion or _
rupture
what are the two benign cysts of the ovary
follicular cysts and luteal cyst
what is a follicular cyst derived from? what is is lined by?
derived from an ovarian follicle
lined by innder granuloas cells and outer follicular cells
usually greater than 3cm
what is a luteal cyst, when does it occur and what is it lined by?
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
what are the symptoms of a follicular and luteal cyst?
usually asymptomatic but can cause pain upon rupture or torsion
what is an adenomatoid tumor
this is a rare beingn tumor of meothelial origin typically in the fallopian tube
how does an adenamatoid tumor look on histology/ grossly
histology: sieve like apperance with spaces of varios sizes
grossly: well circumscribed, gray/white in color
PCOS is a complex syndrome characterized by what 4 things
- hyperandrogenism
- hormonal imbanlance with anovulation
- insulin resistance
- polycystic ovaries
increased androgens in PCOS especially _ leads to virilization including _ and male pattern balding
testosterone
hirituism (abnormal deposition of hair)
hormonal imbalance in PCOS can lead to abnormal menstrual cycles includeing _ and decreased _.
anovulation
decreased fertility
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 _
estrogen
insulin
estrogen
increased estrogen leads to an increased risk of ?
endometrial hyperplasia and carcinoma
what is stromal hyperthecosis
PCOS without cysts
in postmenopausal women with hirituism, insulin resistance, obesity
enlarged ovaries and yellow representing the lutinized stomal cells that produce excess androgens
what is theca lutein hyperplasia of pregnancy
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
what are the categories of ovarian tumors?
epithelial
germ cell
sex cord-stromal
metastasis
EGSM- ovarian tumors
epithelial ovarian tumors are derived from _ epithelium
mullerian
what are the major type of epithelial ovarian tumors
Serous
Mucinous
Endometroid
Clear Cell
Transitional Cell/Brenner
SMECT
what are the germ cell ovarian tumors
teratoma, dysgerminoma, tolk sac, choriocarcinoma
what are the types of sex cord stromal ovarian tumors
granulosa cells
firbroma/tehcoma
seroli-leydig
what are mestastitc tumors to the ovaries
krukenberg
and psuedomyoxoma peritonei
what is the most common primary ovarian malignancy
serous carcinomas
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
bilateral
mucinous tumors
ovarian tumors are typically asymptomatic unless they have grown to an advanced stage: what are some general findings
adnexal mass on palpation
vaginal bleeding
abdominal pain
urinary symptoms of pressing on bladder
Gi sympotms like bloating/indigestion
malignant ovarian tumors often show _ _ and _
weight loss and ascites with involvement of the peritoneum
ovarian epithelial tumors can be classified into benign, intermediate, and malignant. If benign what are the different presentations
cystic: cystadenoma
cystic and firbous: cystadenofibroma
fibrous: adenofibroma
explain the difference between type 1 and type 2 epithelial ovarian tumors
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
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?
cystic
tubal like epithelium
papillary structures
mutations: KRAS, BRAF, ERBB2
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 _?
solid
atypia
P53
BRCA1 and BRCA2
serous tubal intrepithelial carcinoma
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
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.
columnar
intestinal
mullerian/endocervical
mucinous ovarian tumors are usually _ (small/large) and _ (unilateral/bilateral)
large
bilateral
mucinous ovarian tumors are multiocular cystic tumors that are filled with _ fluid
mucinous
all mucinous tumors whether beingn, borderline, or malignant contain the _ mutation
KRAS
most of the endometroid ovarian tumors are _ (benign, borderline, malignant)
malignant
if endometroid carcinoma is present in the ovary and the endometrium it is most likely a _
metastasis
_ is the precursor for endometroid ovarian carcinoma
endometriosis
endometrial glands (back to back glands)
vast majority of clear cell carcinomas are _
malignant
clear cell ovarian tumors are thought to be a variant of a _ tumor
endometroid
histology of a ovarian clear cell carcinoma:
large epithelial cells with clear cytoplasm
brenner cell tumor is also known as _ cell tumor and is comprised _ epithelium
ovarian transitional cell
urogenital/transitional epithelium (will have urogenital nests in histology)
brenner cell tumors derive from _ change of the surface epithelium of the ovary
metaplastic
simple squamous to urothelial epithelium
brenner tumors are typically _ (benign/borderline/malignant)
benign
mature cystic teratoma (ovarian germ line tumor) is also known as?
dermoid cyst
mature cystic teratomas (dermoid cysts) are usually _ (unilateral/bilateral) are _ (benign/malignant) and are comprised of?
unilateral
benign
mature tissues from all embryonic cell layers: ectoderm, mesoderm, endoderm
can even contain teeth!!!
from the ectoderm can form
skin, hair brain
from the mesoderm can form
muscle/fat
from the endoderm can form
carilage, mucinous epithelium
an immature malignant ovarian teratoma is a _ germ cell tumor that can spread locally or metastasive remotely
malignant
immature malignant teratomas of the ovary usually affect who?
prepuberty girls and young women
the key to diagnosis of an immature malignant teratoma is the presence of?
immature malignant neuroepithelium
grade of tumor depends on the amount of malignant neuropeithelium present
what is a monodermal teratoma
a teratoma that is comprised of solely 1 cell type
what are the two monodermal teratomas
struma ovarii
carcinoid tumor
struma ovarii is a monodermal teratoma comprised of mature _ tissue
thyroid tissue
struma ovarii can cause _ with tachycardia, heat intolerance, tremor, and low _
hyperthyroidism
TSH(thyroid stimulating hormone)
what is a carcinoid teratoma/tumor of the ovary
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)
a dysgerminoma is the counterpart to the _ _
in the ovary
testicular seminoma
a dysgerminoma is a _ (benign/malignant) germ cell tumor that has a mutation in _. It is associated with _ _
malignant
KIT
gonadal dysgenesis
most common malignant germ cell tumor
histology of a dysgerminoma
large epitheliod cleared cells with abundant lymphocytes
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
germ
malignant
Alpha Fetal Protein (AFP_
schillar duval bodies
hyaline droplets
an ovarian choriocarcinoma is an aggressive _ (benign/malignant) germ cell tumor that secrete _
malignant
HCG
ovarian choriocarcioma can mimic a ?
ectopic pregnancy (due to high HCG)
other germ cell tumors can secrete _
HCG
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?
granulosa cells
low grade malignancy
adult type and juvinille type
granulosa cell tumors of the ovary can release _ which can induce endometrial hyperplasia or _ _ in juvinieles
estrogen
precocious puberty
how does a granulosa cell look grossly?
yellow because it is hormonely active and produce lipids
what are the histological findings of a granulosa cell tumor
oval grooved nuclei and call-exner bodies which mimic the follicle structure
many different types of sex-cord stromal tumors are positive for _
inhibin
stains brown (positive)
fibroma of the ovary is?
benign tumor of fibroblasts
thecoma of the ovary is
tumor of theca like cells of the ovary (usually benign)
can be hormonally active
fibrothecoma is
a benign tumor of both fibroblasts and theca cells
can be hormonally active
a fibroma is clinically associated with what syndroma
meigs syndrome
what is meigs syndrome?
a triad od ascites, pleural effusion and a benign ovarian tumor (usually ovarian firboma)
ovarian fibromas are also associated with a rare complex syndrome called?
basal cell neus syndrome
what is basal cell nevus syndrome ?
nurmerous basal cell carcinomas before 20, medulloblastomas, odotogenic keratocysts, and pitting in the palms and soles
medulloblastoma: brain tumor in children
a thecoma can release _ which can cause what?
estrogen
endometrial hyperplasia
precoious puberty in kids
what is a sertoli leydig cell, what is the associated mutation and what does it secrete? effects?
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
sertoli cell tubules are sex cord derived and ley dig cells are stromal derived
if sertoli leydig cells manifest in children it may?
stop normal female development
histology of sertoli leydig cells
sertoli tubules, eosinophilic leydig cells
leydig cells have reinke cystals (rod like pink crystals)
what is a krukenburg tumor
this is a metastatic tumor to the ovary that comes from the gastrointestinal tract and have mucin signet ring cells
krukenberg tumor usually presentts with _ metastasis
bilateral
what does a krukenberg tumor look like grossly
firm white mass
what is a psuedomycoma peritonei
this is a jelly belly mucinous tumor that comes from an appendiceal mucinour tumor and frequently involves the ovary
on histology what does the pseudomyoxoma peritoni look like
tumors cells with acellular mucin
prognosis of a pseudomyoxoma peritonei depends on?
peritoneal spread and grade
psuedomyoxoma peritonei clinical symptoms
lower right abdominal pain
