GYN Pathology Flashcards

Question

Theca lutein cysts

Answer 1

Result of over-stimulation by high levels of hCG associated with gestational trophoblastic disease or hCG administration during infertility treatment Largest of the functional cysts Multilocular and bilateral May persist for a few days/weeks but generally resolve without surgery

Answer 2

Ovarian cyst that hemorrhages into the lumen because of its large size, spontaneous rupture or torsion Patient's present with sudden onset of pelvic pain Sonographic findings: - Typical cystic characteristics - Acute hemorrhage= hyperechoic, mimicking solid mass but with posterior acoustic enhancement - Subacute= complex appearance with internal echoes, strands, rarely a fluid-fluid level - Sono appearance will vary with time with clot lysis

Answer 3

Result from persistent developmental remnants of Wolffian ducts Not ovarian in origin but located adjacent to ovary and may be mistaken for ovarian cysts Sonographic findings: - Simple cystic characteristics - Thin wall - Located adjacent to ovary - Attempt to demonstrate cyst separate from ovarian tissue

Answer 4

Tumors arising from the surface epithelium that covers the ovary Account for 65-75% of all ovarian neoplasms and approximately 90% of all ovarian malignancies Divided into 5 categories based on epithelial differentiation 1) Serous 2) Mucinous 3) Transitional cell (Brenner) 4) Endometroid 5) Clear cell

Answer 5

Common, accounting for 25-30% of all ovarian neoplams - 50 to 70%= benign, sometimes bilateral and occur most commonly in women 40-50 years old - 40 to 50%= malignant (serous cystadenocarcinoma)- bilateral 50% of time and occur commonly in peri/post-menopausal women * *Usually smaller than mucinous tumors Sono findings of benign: - Sharply marginated - Anechoic - Large but usually unilocular - Possibly internal thin-walled septations Sono findings of malignant: - Multilocular - Multiple papillary projections/septations - Occasionally echogenic material within - Possible multiple echogenic foci - Ascites

Answer 6

Benign: - Comprise 20-25% of all benign ovarian neoplasms - More common in women 30-50 years old - Very rare bilateral - Sono findings: * Multiloculated with thicker and more numerous septations * Fine, gravity-dependent echoes * Up to 50 cm in diameter Malignant: -Account for only 5-10% all malignant primary neoplasms -Occur most frequently in women 40-70 years old -15 to 20% are bilateral Sono findings: * Multiloculated cystic lesions measuring 15-30 cm in diameter *Contain echogenic material and papillary excrescences

Answer 7

Also called ovarian fibroepithelioma Account for only 1-2% of all primary ovarian tumors Almost always benign Women 40-80 years old (most frequently in their 50's) Small percent are bilateral Most are smaller than 2 cm Sono findings: - Hypoechoic solid mass, may have small cystic spaces - Calcifications may be present - May mimic ovarian fibroma

Answer 8

80% are malignant but have better prognosis than serous or mucinous carcinomas Identical to endometrial adenocarcinoma -30% of patients with this tumor have associated endometrial cancer Sono findings: - Mixed cystic and solid mass - In some cases, there may be predominately solid mass, possibly with areas of hemorrhage/ necrosis - May have associated endometrial abnormality

Answer 9

Nearly always malignant Occur in women 50-70 years old Bilateral (20% of time) and range in size up to 30 cm Variant of endometroid and serous carcinomas Sono findings: - Non-specific - Complex predominately solid mass

Answer 10

Derived from primitive germ cells of embryonic gonad and account for 20% of all ovarian neoplasms Adults: - Majority are benign - 95% being cystic teratomas Children/Adolescents: - >60% of ovarian neoplasms are of germ cell origin - 1/3 are malignant Three types: 1) Benign cystic teratoma (BCT)/ Dermoid 2) Dysgerminoma 3) Endodermal Sinus (Yolk Sac) Tumor

Answer 11

Most common germ cell tumor (15-25% of ovarian neoplasms) Usually reproductive age women Composed of three germ layers (endoderm, mesoderm, ectoderm) and is bilateral up to 15% of time Usually asymptomatic and found incidently Most common complication is ovarian torsion, and less common is rupture. Symptoms can include: - Abdominal pain (esp. with torsion) - Abdominal mass/ swelling ``` Immature teratomas (teratocarcinoma) is very rare -rapidly growing solid malignant tumors that most commonly occur in first 2 decades of life ``` Sono findings: - Predominately cystic adnexal mass - Complex mass with calcifications - Fat-fluid level (move pt around to see) - Diffusely echogenic - "Tip of the iceburg" - highly echogenic mass that shadows and obscures posterior wall of lesion - "Dermoid plug" - predominately cystic mass with echogenic mural nodule, typically casting acoustic shadow - "Dermoid mesh" - multiple echogenic linear interfaces floating within cystic mass (hair fibers)

Answer 12

Malignant germ cell tumor (bilateral 15% of time) Originates from primordial germ cells of the ovary 3-5% of all ovarian malignancies Primarily women 30 years and younger Highly malignant but highly radiosensitive -5 year survival rate up to 90% Sono findings: - Multiloculated solid mass, size variable' - May be bilateral

Answer 13

2nd most common germ cell malignancy Occur in young adulthood (20-30's) Usually unilateral and vary in size Highly malignant and metastasize to surrounding structures Patients have increased levels of serum AFP Sono findings: -Predominately solid mass with necrosis

Answer 14

Arise from sex cords of embryonic gonad or ovarian stroma 1/2 of these tumors are fibromas Approximately 8% of all ovarian tumors Four types: 1) Fibroma 2) Granulosa cell 3) Thecoma 4) Sertoli-Leydig

Answer 15

Benign and occur all ages (most frequently in 40-50's) Usually unilateral and range from microscopic to very large in size Ascites with fibromas over 10 cm Sono findings: - Homogeneous hypoechoic mass with posterior acoustic enhancement (highly attenuating) - Rarely focal or diffuse calcifications - Associated with ascites and pleural effusion - Similar to pedunculated fibroid or Brenner tumor * **Meig's Syndrome - Association of ascites and pleural effusion with fibrous ovarian tumor (fibroma) - Disappears after excision of tumor

Answer 16

95% are of the adult type Most often in women 50-55 years old Tumors commonly produce estrogen Juvenile tumors result in precocious puberty Sono findings: - Small tumors predominately solid, similar to uterine fibroids - Large tumors multiloculated and cystic, similar to cystadenomas - Possibly abnormally thick endo secondary to hormonal stimulation

Answer 17

Estrogen producing tumors that are most common in post-menopausal women who present with clinical signs of estrogen/androgen activity 97% of cases are unilateral and rarely malignant Range in size from small to 5-10 cm Sono findings: - Solid hypoechoic ovarian mass with posterior acoustic enhancement - Possibly abnormally thick endo secondary to hormonal stimulation

Answer 18

Also called Arrhenoblastoma/ Androblastoma Rare tumor that is unilateral and typically occur in women under age of 30 Up to 20% are malignant Androgen (testosterone) producing and approximately 50% of pts present with symptoms of masculinization Most are 5-15 cm Sono findings: - Solid echogenic mass - Similar appearance to granulosa cell tumor

Answer 19

Usually bilateral solid ovarian mass that accounts for 5-10% of ovarian tumors Most common sites for metastases are tumors of the breast and GI tract Tumors spread to ovary by several routes: -Direct invasion ~Occurs usually from carcinomas of the uterus and fallopian tubes ~Occurs occasionally from malignancies of colon and retroperitoneum -Peritoneal fluid ~Carries malignant cells from anywhere in peritoneal cavity -Blood vessels and lymphatics ~Bring malignant cells from more distant sites

Answer 20

Type of ovarian metastatic tumor/cancer that arises from GI primarily (usually gastric carcinoma) but also from colon or appendix Usually bilateral and more common on the right if unilateral Cannot be distinguished from primary carcinoma on ultrasound Sono findings: - Bilateral solid hypoechoic or complex predominately solid masses - Possible ascites

Answer 21

Also called Stein-Leventhal Syndrome Endrocrinologic disorder associated with chronic anovulation which is usually diagnosed in women in their late teens and early 20's Diagnosis of PCOS is actually made based on clinically and serologic findings (not necessarily US) Clinical signs: - Infertility - Obesity - Amenorrhea - Hirsutism Sono findings: - Bilateral multiple cysts (<1 cm) throughout subcapsular and stromal ovarian tissue (>/= 12-19 follicles per ovary) - Ovarian volume > 10 cm cubed - Small symmetrical cysts in the periphery "string of pearls" - Always bilateral

Answer 22

Partial or complete rotation of the ovarian pedicle on its axis which leads to lymphatic and venous drainage being compromised, causing congestion and edema of the ovary, eventually leading to loss of arterial perfusion and resultant infarction Clinical Presentation: - Typically sudden onset of pelvic pain - Right sided torsion can clinically mimic acute appendicitis Risk Factors: - Pre-existing ovarian cyst or mass (usually benign) - Children and young females with mobile adnexa (ovary usually normal) - Pregnancy Sono findings: -Enlarged ovary, often with multiple follicles -Doppler findings depend on degree and chronicity of torsion ~Absent color and spectral Doppler flow ~Dampened arterial flow (compare both ovaries) ~Possible arterial Doppler flow but absent venous flow ~"Whirlpool sign" = twisted ovarian vessels -Possible adnexal mass

Answer 23

Presence of functional endometrial tissue outside of the endometrium and myometrium which responds to the hormonal influence of the ovulatory cycle Benign proliferative disease that may cause severe pain or may be asymptomatic Most commonly found: - Ovaries (80% of cases) - Fallopian tubes - Broad ligament - Posterior cul-de-sac - Pelvic peritoneum More common in: - Caucasians - Women of reproductive age - Women of higher socioeconomic status who postpone having children until later in life Clinical signs: - Chronic pain - Infertility - Dysmenorrhea - Dyspareunia - Dysuria - Dyschezia (difficult defecation)

Answer 24

1) Diffuse: scattered minute implants - Rarely detectable by ultrasound 2) Localized: endometrioma, which is a discrete mass sometimes called a chocolate cyst - Hypoechoic, homogeneous mass - Thick, well-defined, sometimes slightly irregular walls - May be solid, cystic or complex - Fluid/Fluid level

Answer 25

Inflammation of pelvic and adnexal structures which is typically from an infection that spreads from cervix through the endometrial cavity to the fallopian tubes and adnexa Most often sexually transmitted from: - Chlamydia - Gonorrhea - E. Coli Can also be caused from pathogens introduced by: - HSG - D&C - Ruptured appendix - Diverticulitis - Abortion - Postpartum Inflammation can be localized or diffuse Predisposes women to infertility, tubal scarring and ectopic pregnancy Clinical signs: - Fever - Leukocytosis - Lower abdominal pain - Purulent vaginal discharge - Pelvic tenderness (Bilateral/diffuse) - Cervical motion tenderness - Constant dull pain worsened by sexual activity

Answer 26

1) Early PID- endometriosis Sono findings: -Thickening and irregularity of endo -Fluid, debris, or gas within endo cavity -Diffuse hypoechogenicity of uterus -Indistinct borders of pelvic structures -Fluid in posterior cul-de-sac (may be complex) 2) Subacute/Acute salpingitis: may produce pyosalpinx Sono findings: -Pyosalpix= dilated, enlarged tube with debris/ echogenic material -Tubular adnexal cystic masses -Shaggy tubal walls -Usually unilateral but may be bilateral 3) Severe PID: broad ligament and ovarian involvement -If purulent material leaks out of fimbriated end of the tube, TOA may result -Patient may also develop peritonitis and acute perihepatitis (Fitz-Hugh-Curtis syndrome) Sono findings: -TOA= complex adnexal mass(es) uni/bilateral with hyperemic flow on Doppler -Indistinct walls surrounding the mass ~ Tubo-ovarian complex (TOC)- visible tube and ovary, inflamed, no abscess 4) Chronic -Long standing, subacute condition which follows acute PID -Adhesions may cause pelvic organs to merge centrally, leading to the "indefinite uterus sign"

Answer 27

Collection of simple serous fluid within a scarred or obstructed fallopian tube Can occur because of: - PID - Endometriosis - Post-op adhesions Clinical findings: - Asymptomatic - Pelvic fullness - Infertility

Answer 28

Accumulation of pus in the fallopian tube Caused by: - Bacterial infection - Diverticulitis - Appendicitis Clinical findings: - Asymptomatic - Low grade fever - Pelvic fullness

Answer 29

Inflammation of the fallopian tube Caused by: -Pelvic infection Clinical findings: - Pelvic pain - Fever - Dyspareunia - Leukocytosis

Answer 30

Infection that involves the fallopian tube and the ovary Caused by: - Pelvic infection - STD's Clinical findings: - Severe pelvic pain - Fever - Leukocytosis - Nausea/ vomiting

Answer 31

Generic term for the collection of fluid, blood, or pus within the vagina, which may extend into the cervix and uterine cavity In a pediatric patient, this may be secondary to an imperforate hymen Frequently goes undetected until after menarche, when the collection of menstrual blood trapped in the vagina and/or uterus leads to lower abdominal pain and mass - Patient will also have primary amenorrhea - May also be seen in older women undergoing radiation therapy Specific types (combine these locations and types): - Hemato= blood - Pyo= pus - Hydro= watery serous fluid - Metro=uterus - colpos= vagina Sono findings - Hypoechoic distention of vagina and/or endo cavity - Posterior acoustic enhancement - Internal echoes may be present and represent debris or clot - Hydronephrosis may be present in cases of severe obstruction - Attempt should be made to identify possible other genitourinary anomalies

Answer 32

Occurs on the anterolateral wall of the vagina and arises from the caudal remnants of the mesonephric (Wolffian) duct

Answer 33

Congenital absence of the vagina

Answer 34

Presence of transverse septations within the vagina

Answer 35

Presence of two complete vaginas