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ENRP Exam 1 > Female Reproductive Tract Pathology Part 3 > Flashcards

Female Reproductive Tract Pathology Part 3 Flashcards

1
Q

What are the 4 different types of ovarian tumors?

A

epithelial, germ cell, sex cord-stromal, metastasis to ovaries

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2
Q

what is the most common primary ovarian malignancy?

A

serous carcinomas of the ovary

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3
Q

if an ovarian tumor is malignant it is fairly likely to be ______
however, ______ ________ _______ are often unilateral

A

bilateral

malignant mucinous carcinomas

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4
Q

which types of tumors fit under the ovarian epithelial tumor classification? (5)

A 
Serous
Mucinous
Endometrioid 
Clear Cell
Transitional Cell (brenner)
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5
Q

There are two general routes of pathogenesis in ovarian tumors.
What are they?

A

Type I ovarian tumors and Type II Ovarian Tumors

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6
Q

what are type II ovarian tumors thought to be derived from?

What are they associated with?

A

from tubal and/or ovarian surface epithelial abnormalities which give rise to a high grade aggressive tumor

p53 mutations

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7
Q

what is a classic type II tumor of the ovary?

A

high grade serous carcinoma

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8
Q

what does high grade serous carcinoma derive from?

A

from a fallopian tubal precursor termed serous tubal intraepithelial carcinoma (STIC)

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9
Q

What are the characteristics of low grade serous tumors?

A

cystic tumor with tubal-like epithelium, often papillary growth pattern

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10
Q

what are the characteristics of high grade serous tumors?

A

solid tumor with marked atypia
p53 mutation
derived from STIC
associated with BRACA1 and 2 mutations that predispose to breast cancer

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11
Q

what are the characteristics of ovarian mucinous tumors?

A

epithelial ovarian tumors which histologically show columnar epithelium

typically unilateral, large cystic lesion filled with thick, mucinous fluid

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12
Q

what are the two histological types of ovarian mucinous tumors?

A

intestinal type

mullerian (endocervical type)

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13
Q

All mucinous tumors (benign, borderline, carcinoma) are associated with what?

A

KRAS mutation

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14
Q

Most of the endometrioid ovarian tumors are what?

A

carcinomatous

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15
Q

What is a precursor to some cases of endometrioid ovarian tumors?

A

endometriosis

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16
Q

What are the vast majority of clear cell ovarian tumors?

A

carcinomas

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17
Q

What does histology show of a clear cell ovarain tumor?

A

large, epithelial cells with clear cytoplasm

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18
Q

What is Brenner Tumor (aka Ovarian Transitional Cell Tumor) comprised of?

A

urothelial-type, transitional epithelium

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19
Q

What are the characteristics of brenner tumor?

A

typically benign, unilateral, solid, or cystic tumors

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20
Q

What is a mature cystic teratoma (Dermoid Cyst)?

A

benign germ cell tumor, comprised of mature tissues from all embryonic cell layers

typically a unilateral cystic mass

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21
Q

What is the most common germ cell tumor?

A

Mature cystic teratoma (dermoid cyst)

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22
Q

What is an immature malignant teratoma?

A

malignant germ cell tumor with propensity for extraovarian spread

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23
Q

Who does immature malignant teratoma tend to affect?

A

younger age group: prepubertal female adolescents and young women

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24
Q

What is the histologic appearance of an immature malignant teratoma?

A

histologically like mature teratoma except for the presence of (malignant) immature neuroepithelium

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25
Q

What is a monodermal (specialized) teratoma?

A

a teratoma composed predominantly or solely of one tissue type

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26
Q

What are two monodermal (specialized) teratomas?

A

struma ovarii

carcinoid tumor

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27
Q

what is struma ovarii?

A

mature thyroid tissue

rarely causes hyperthyroidism (tachycardia, heat intolerance, tremor, low TSH)

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28
Q

What is carcinoid tumor: monodermal (specialized) teratoma?

A

can cause carcinoid syndrome: flushing, diarrhea, and hypotension

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29
Q

What are the two most common malignant germ cell tumors?

A

dysgerminoma and yolk sac tumor

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30
Q

What is dysgerminoma?

what mutation?

A

the ovarian counterpart of testicular seminoma

KIT mutation

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31
Q

What is yolk-sac tumor?

what do tumor cells create?

A

derived from cell differentiating to yolk sac lineage

tumor cells create alpha-fetoprotein

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32
Q

What are the key histologic features of a yolk-sac tumor?

A

schiller-duval body and hyaline droplets

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33
Q

What is ovarian choriocarcinoma?

A

an aggressive, malignant germ cell tumor with placental (trophoblastic) differentiation

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34
Q

What do ovarian choriocarcinomas secrete?

A

high levels of beta-hcg

*can mimic an ectopic pregnancy

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35
Q

What are the germ cell tumors that can cause increased levels of beta-hcg?

A

dysgerminoma, embryomal carcinoma, and ovarian choriocarcinoma

36
Q

what are the ovarian sex-cord stromal tumors?

A

granulosa cell tumor
fibroma/thecoma
sertoli-leydig cell tumor

37
Q

what are the two types of granulosa cell tumors?

A

adult granulosa cell tumor and juvenile granulosa cell tumor

38
Q

what is an important clinical feature of a granulosa cell tumor?

A

they can release estrogen, which can induce endometrial hyperplasia and ultimately endometrial carcinoma in adults and precocious puberty in juveniles

39
Q

hormonally active granulosa cell tumors are what color?

A

yellow

40
Q

what is the histologic appearance of a granulosa cell tumor?

A

coffee bean nuclei and call-exner bodies

41
Q

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

why is this relevant?

A

inhibin

inhibin is a great marker for sex-cord stromal tumors

42
Q

fibroma is a tumor of what?

A

fibroblasts

43
Q

thecoma is a tumor comprised of what?

A

theca cells which can be hormonally active

44
Q

What is an important clinical association of an ovarian fibroma?

A

Meigs syndrome

45
Q

what is the triad associated with Meigs syndrome?

A

ascites, pleural effusion, and benign ovarian tumor

46
Q

sertoli-leydig cell tumor is associated with what germline mutation?

A

DICER1

47
Q

what is the sertoli-leydig tumor comprised of?

A

sertoli cell tubules (sex cord derived) and leydig cells (stromal derived)

48
Q

what does a sertoli-leydig tumor secrete?

A

testosterone

49
Q

what are the clinical effects of a sertoli-leydig cell tumor?

A

defeminization, virilization (severe), can block female sexual development in children

50
Q

in a well-differentiated sertoli-leydig cell tumor, what do the leydig tumor cells often have associated with them?

A

Reinke crystals (rod-like pink crystals)

51
Q

What is a Krukenberg tumor?

A

a metastatic tumor to the ovary from a non-ovarian primary source

52
Q

what are the characteristic features of a krukenberg tumor?

A

comprised of mucin-rich signet ring cells

53
Q

what is the typical origin of a krukenberg tumor?

A

gastrointestinal origin (stomach or colonic origin)

54
Q

how does a krukenberg tumor typically present?

A

bilateral metastases

55
Q

what is a pseudomyxoma peritonei?

A

a conditioned characterized by a gelatinous, mucinous ascites termed “jelly belly”

56
Q

what is a pseudomyxoma peritonei typically caused by?

A

appendiceal mucinous tumor

57
Q

although the ovary is often involved in a pseudomyxoma peritonei, the tumor is almost always of what origin?

A

primary appendiceal origin

58
Q

on histologic examination, what does the pseudomyoma peritonei consist of?

A

mucinous epithelium surrounded by abundant acellular mucin

59
Q

what are the clinical features associated with a pseudomyxoma peritonei?

A

nonspecific symptoms, lower right abdominal pain

prognosis depends on peritoneal spread and grade

60
Q

What is the most common site for an ectopic pregnancy to occur?
What is the primary risk factor for ectopic pregnancy?

A 
fallopian tube is the most common site
#1 risk factor for ectopic pregnancy is PID (chlamydia or gonorrhea)
61
Q

What are the pathologic findings associated with an ectopic pregnancy?

A

swollen fallopian tube, fetus and hemorrhage in fallopian tube, fetal chorionic villi and hemorrhage

62
Q

Twin-to-twin transfusion syndrome only occurs in what type of twins?

A

monochorionic twins

63
Q

what is twin-to-twin transfusion syndrome caused by?

A

arteriovenous anastomoses deep in the placenta

64
Q

what is placenta accerta spectrum?

A

absence of the placental decidua allows fetal villi to directly adhere/invade to myometrium

65
Q

what is a major risk factor for placenta accreta?

A

previous C-section or other uterine surgery (such as endometrial ablation)

66
Q

What is the pathogenesis of preeclampsia and eclampsia?

A

abnormal trophoblast implantation causes lack of enlargement of maternal vessels to the placenta causing placental ischemia which results in factors being released that cause hypertension and fibrin thrombi to form more easily

it is the fibrin thrombi which involve the kidney which cause proteinuria or when they involve the brain can result in eclampsia

67
Q

What is HELLP syndrome?

A

disorder of the third trimester of pregnancy and has a classic triad of findings:

  1. hemolysis
  2. elevated liver enzymes
  3. low platelets
68
Q

what does histology of HELLP syndrome show?

A

microangiopathic anemia: schistocytes

69
Q

What is a hydatiform mole?

A

abnormal pregnancy characterized by cystic swelling of chorionic villi, trophoblastic proliferation

70
Q

Molar pregnancy often comes to a clinical attention due to what?

A

abnormally elevated beta-HCG

71
Q

when is hydatiform mole often diagnosed?

A

9 weeks gestation by pelvic ultrasound

72
Q

what is complete molar pregnancy characterized by?

A

multi-cystic mass lesion comprised of thin-walled, sometimes transparent grape like cysts

73
Q

what does ultrasound show of a complete molar pregnancy?

A

has a multi-cystic appearance that has been likened to the appearance of a snowstorm

74
Q

complete molar pregnancy is a major risk factor for the development of what?

A

choriocarcinoma, a malignant tumor of trophoblastic cells, and invasive mole, a condition where the molar pregnancy continues to invade into and sometimes through the uterine wall

75
Q

what is the appearance of a partial molar pregnancy?

A

enlarged abnormal villi, admixed with normal villi

associated with fetal parts/abnormal fetus

76
Q

what is there marked proliferation of in a complete molar pregnancy?

A

trophoblastic proliferation

77
Q

a complete mole is _________ derived

A

paternally derived

all genetic material is from sperm

78
Q

partial mole derives from?

A

both parents

79
Q

In partial mole, fertilization occurs by?

which results in what?

A

two sperm (or disoermy)

results in a triploid phenotype, which contains genetic material from both father and mother

80
Q

how can you histologically differentiate a complete vs partial mole?

A

complete: does not show p57 staining
partial: shows p57 staining

81
Q

what is gestation choriocarcinoma?

A

uncommon, malignant trophoblastic tumor

82
Q

what are the risk factors for gestational choriocarcinoma?

A

complete mole

83
Q

what is often present at the initial diagnosis of gestational choriocarcinoma?

A

widespread metastases are often present

increased beta HCG

84
Q

what is the gross appearance of a gestational choriocarcinoma?

A

fleshy, hemorrhagic tumor

85
Q

what is placental site trophoblastic tumor?

A

very rare malignant tumor of intermediate trophoblasts

86
Q

how does placental site trophoblastic tumor present?

A

as a uterine mass with abnormal uterine bleeding or amenorrhea most commonly following a normal pregnancy or spontaneous aborton

ENRP Exam 1 (30 decks)

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