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ENRP II > female reproductive tract part 5: ovaries and fallopian tubes > Flashcards

female reproductive tract part 5: ovaries and fallopian tubes Flashcards

1
Q

what are paratubal cysts of the fallopian tube?

A

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

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2
Q

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

A

hyatid custs of morgagni

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3
Q

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

A

fimbriae

mullerian duct

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4
Q

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

A

rupture

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5
Q

what are the two benign cysts of the ovary

A

follicular cysts and luteal cyst

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6
Q

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

A

derived from an ovarian follicle

lined by innder granuloas cells and outer follicular cells

usually greater than 3cm

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7
Q

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

A

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

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8
Q

what are the symptoms of a follicular and luteal cyst?

A

usually asymptomatic but can cause pain upon rupture or torsion

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9
Q

what is an adenomatoid tumor

A

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

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10
Q

how does an adenamatoid tumor look on histology/ grossly

A

histology: sieve like apperance with spaces of varios sizes

grossly: well circumscribed, gray/white in color

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11
Q

PCOS is a complex syndrome characterized by what 4 things

A
  1. hyperandrogenism
  2. hormonal imbanlance with anovulation
  3. insulin resistance
  4. polycystic ovaries
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12
Q

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

A

testosterone

hirituism (abnormal deposition of hair)

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13
Q

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

A

anovulation

decreased fertility

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14
Q

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 _

A

estrogen

insulin

estrogen

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15
Q

increased estrogen leads to an increased risk of ?

A

endometrial hyperplasia and carcinoma

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16
Q

what is stromal hyperthecosis

A

PCOS without cysts

in postmenopausal women with hirituism, insulin resistance, obesity

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

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17
Q

what is theca lutein hyperplasia of pregnancy

A

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

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18
Q

what are the categories of ovarian tumors?

A

epithelial
germ cell
sex cord-stromal
metastasis

EGSM- ovarian tumors

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19
Q

epithelial ovarian tumors are derived from _ epithelium

A

mullerian

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20
Q

what are the major type of epithelial ovarian tumors

A

Serous
Mucinous
Endometroid
Clear Cell
Transitional Cell/Brenner

SMECT

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21
Q

what are the germ cell ovarian tumors

A

teratoma, dysgerminoma, tolk sac, choriocarcinoma

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22
Q

what are the types of sex cord stromal ovarian tumors

A

granulosa cells
firbroma/tehcoma
seroli-leydig

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23
Q

what are mestastitc tumors to the ovaries

A

krukenberg

and psuedomyoxoma peritonei

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24
Q

what is the most common primary ovarian malignancy

A

serous carcinomas

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25
Q

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

A

bilateral

mucinous tumors

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26
Q

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

A

adnexal mass on palpation

vaginal bleeding

abdominal pain

urinary symptoms of pressing on bladder

Gi sympotms like bloating/indigestion

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27
Q

malignant ovarian tumors often show _ _ and _

A

weight loss and ascites with involvement of the peritoneum

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28
Q

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

A

cystic: cystadenoma

cystic and firbous: cystadenofibroma

fibrous: adenofibroma

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29
Q

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

A

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

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30
Q

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?

A

cystic

tubal like epithelium

papillary structures

mutations: KRAS, BRAF, ERBB2

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31
Q

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 _?

A

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

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32
Q

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.

A

columnar

intestinal

mullerian/endocervical

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33
Q

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

A

large

bilateral

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34
Q

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

A

mucinous

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35
Q

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

A

KRAS

36
Q

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

A

malignant

37
Q

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

A

metastasis

38
Q

_ is the precursor for endometroid ovarian carcinoma

A

endometriosis

endometrial glands (back to back glands)

39
Q

vast majority of clear cell carcinomas are _

A

malignant

40
Q

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

A

endometroid

41
Q

histology of a ovarian clear cell carcinoma:

A

large epithelial cells with clear cytoplasm

42
Q

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

A

ovarian transitional cell

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

43
Q

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

A

metaplastic

simple squamous to urothelial epithelium

44
Q

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

A

benign

45
Q

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

A

dermoid cyst

46
Q

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

A

unilateral

benign

mature tissues from all embryonic cell layers: ectoderm, mesoderm, endoderm

can even contain teeth!!!

47
Q

from the ectoderm can form

A

skin, hair brain

48
Q

from the mesoderm can form

A

muscle/fat

49
Q

from the endoderm can form

A

carilage, mucinous epithelium

50
Q

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

A

malignant

51
Q

immature malignant teratomas of the ovary usually affect who?

A

prepuberty girls and young women

52
Q

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

A

immature malignant neuroepithelium

grade of tumor depends on the amount of malignant neuropeithelium present

53
Q

what is a monodermal teratoma

A

a teratoma that is comprised of solely 1 cell type

54
Q

what are the two monodermal teratomas

A

struma ovarii

carcinoid tumor

55
Q

struma ovarii is a monodermal teratoma comprised of mature _ tissue

A

thyroid tissue

56
Q

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

A

hyperthyroidism

TSH(thyroid stimulating hormone)

57
Q

what is a carcinoid teratoma/tumor of the ovary

A

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)

58
Q

a dysgerminoma is the counterpart to the _ _

in the ovary

A

testicular seminoma

59
Q

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

A

malignant

KIT

gonadal dysgenesis

most common malignant germ cell tumor

60
Q

histology of a dysgerminoma

A

large epitheliod cleared cells with abundant lymphocytes

61
Q

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

A

germ

malignant

Alpha Fetal Protein (AFP_

schillar duval bodies

hyaline droplets

62
Q

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

A

malignant

HCG

63
Q

ovarian choriocarcioma can mimic a ?

A

ectopic pregnancy (due to high HCG)

64
Q

other germ cell tumors can secrete _

A

HCG

65
Q

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?

A

granulosa cells

low grade malignancy

adult type and juvinille type

66
Q

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

A

estrogen

precocious puberty

67
Q

how does a granulosa cell look grossly?

A

yellow because it is hormonely active and produce lipids

68
Q

what are the histological findings of a granulosa cell tumor

A

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

69
Q

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

A

inhibin

stains brown (positive)

70
Q

fibroma of the ovary is?

A

benign tumor of fibroblasts

71
Q

thecoma of the ovary is

A

tumor of theca like cells of the ovary (usually benign)

can be hormonally active

72
Q

fibrothecoma is

A

a benign tumor of both fibroblasts and theca cells

can be hormonally active

73
Q

a fibroma is clinically associated with what syndroma

A

meigs syndrome

74
Q

what is meigs syndrome?

A

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

75
Q

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

A

basal cell neus syndrome

76
Q

what is basal cell nevus syndrome ?

A

nurmerous basal cell carcinomas before 20, medulloblastomas, odotogenic keratocysts, and pitting in the palms and soles

medulloblastoma: brain tumor in children

77
Q

a thecoma can release _ which can cause what?

A

estrogen

endometrial hyperplasia

precoious puberty in kids

78
Q

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

A

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

79
Q

if sertoli leydig cells manifest in children it may?

A

stop normal female development

80
Q

histology of sertoli leydig cells

A

sertoli tubules, eosinophilic leydig cells

leydig cells have reinke cystals (rod like pink crystals)

81
Q

what is a krukenburg tumor

A

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

82
Q

krukenberg tumor usually presentts with _ metastasis

A

bilateral

83
Q

what does a krukenberg tumor look like grossly

A

firm white mass

84
Q

what is a psuedomycoma peritonei

A

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

85
Q

on histology what does the pseudomyoxoma peritoni look like

A

tumors cells with acellular mucin

86
Q

prognosis of a pseudomyoxoma peritonei depends on?

A

peritoneal spread and grade

87
Q

psuedomyoxoma peritonei clinical symptoms

A

lower right abdominal pain

ENRP II (25 decks)

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