gynecologic Pathologies Flashcards
1
Q
What is the pathogenesis of acute and chronic cervicitis (sir-vah-site-is)?
A
Involves inflammation of the cervix due to various etiologic organisms.
Specific organisms include Candida, Gardnerella, Trichomonas, Chlamydia, and Herpes.
2
Q
What are the clinicopathological features of vaginitis?
A
Includes inflammation and discharge, often associated with specific organisms.
Common organisms are Candida, Gardnerella, and Trichomonas.
3
Q
What is the morphology associated with HPV in cervical lesions?
A
Characterized by koilocytic (coil-low-sit-ick) atypia (perinuclear halo) and cytopathic effects in mature squamous cells.
HPV types 16 and 18 are particularly associated with cervical cancer.
4
Q
What are the recommendations for HPV vaccination?
A
Routine vaccination is recommended at age 11 or 12, with catch-up vaccinations up to age 26.
Vaccination can start as early as age 9.
5
Q
What are the common non-neoplastic uterine diseases?
A
Includes dysfunctional uterine bleeding, Asherman’s syndrome, acute and chronic endometritis, endometriosis, adenomyosis, and endometrial polyps.
These conditions can affect uterine health significantly.
6
Q
What distinguishes atypical from nonatypical endometrial hyperplasia?
A
Atypical hyperplasia has a higher risk of progressing to endometrial carcinoma.
Nonatypical hyperplasia has a lower risk.
7
Q
What types of endometrial carcinoma are there?
A
Type 1 (endometrioid) and Type 2 (serous) endometrial carcinoma.
These types have different histological features and prognoses.
8
Q
What are the histological features of Chlamydia trachomatis cervicitis?
A
Characterized by lymphoid germinal centers and prominent plasmacytic infiltrate.
Inflammation may lead to mucoid discharge and bleeding.
9
Q
What are the symptoms associated with Trichomonas vaginalis infection?
A
Presents with frothy green discharge and a ‘strawberry red cervix’.
Inflammation causes punctate hemorrhages on the cervix.
10
Q
What is the appearance of Candida albicans under microscopy?
A
Shows pseudohyphae and budding yeasts, resembling ‘cottage cheese’ discharge.
This appearance is associated with yeast infections.
11
Q
What is the significance of endocervical polyps?
A
Benign inflammatory lesions that may cause irregular bleeding, usually located in the endocervical canal.
Treatment may involve curettage or excision.
12
Q
What are the risk factors for cervical dysplasia?
A
Includes HPV infection, early age of coitus, low socioeconomic status, and multiple sexual partners.
Other factors include cigarette smoking and altered immune status.
13
Q
What is the role of E6 and E7 proteins in HPV-related carcinogenesis?
A
E6 promotes degradation of p53 and up-regulates telomerase expression, and E7 binds RB, disrupting cell cycle regulation.
This leads to increased cell proliferation and mutations.
14
Q
What are the characteristics of squamous cell carcinoma of the cervix?
A
Can be keratinizing or non-keratinizing and is the third most common cancer in women.
Peak incidence occurs between ages 40 and 45.
15
Q
What is the typical presentation of bacterial vaginosis?
A
Characterized by thin, gray, homogeneous discharge and a fishy odor.
Clue cells are typically observed under microscopy.
16
Q
What is the typical vaginal pH in bacterial vaginosis?
A
> 4.5.
This is higher than normal due to the decrease in lactobacilli.
17
Q
What type of carcinoma is associated with DES exposure?
A
Clear cell adenocarcinoma of the cervix.
Women exposed to DES in utero have a significantly increased risk.
18
Q
What is the histological feature of endometrial polyps?
A
Loose fibromyxomatous stroma with dilated mucus-secreting endocervical glands.
These may also show inflammation and squamous metaplasia.
19
Q
What is the duration of HPV types found with Gardasil?
A
At least 10 years
Gardasil is a vaccine for HPV that provides long-term protection against certain types of the virus.
20
Q
What is the most common cause of dysfunctional uterine bleeding?
A
Anovulatory cycle which leads to excessive endometrial estrogen stimulation w/o progesterone mediated glandular secretory changes
Anovulatory cycles occur when ovulation does not happen, leading to hormonal imbalance.
21
Q
What are the three types of endometriosis?
A
- Superficial peritoneal endometriosis
- Ovarian endometriosis
- Deep infiltrating endometriosis
These types differ in location and severity of the endometrial tissue outside the uterus.
22
Q
True or False: Endometrial hyperplasia can be a precursor to endometrial carcinoma.
A
True
Endometrial hyperplasia is characterized by the abnormal proliferation of endometrial glands and can lead to cancer.
23
Q
What are the key histologic findings in chronic endometritis?
A
Plasma cells in the endometrial stroma
Chronic endometritis is often associated with retained gestational tissue or chronic infections.
24
Q
What is Asherman Syndrome?
A
Secondary amenorrhea due to loss of stratum basalis
most commonly caused by D & Cs
It is often caused by surgical procedures like dilation and curettage.
25
What is the primary clinical symptom of endometriosis?
Pelvic pain
## Footnote
Other symptoms include severe dysmenorrhea, dyspareunia, and infertility.
26
Fill in the blank: The _______ is the thick muscular layer of the uterus.
Myometrium
## Footnote
The myometrium is responsible for uterine contractions.
27
What is the most common invasive carcinoma of the female genital tract?
Endometrial carcinoma
## Footnote
This carcinoma can be classified into Type I (endometrioid) and Type II (serous) based on various factors.
28
What are the two categories of endometrial hyperplasia according to the World Health Organization classification?
* Simple without atypia
* Complex with atypia
## Footnote
Atypical hyperplasia has a higher risk of progressing to carcinoma.
29
What is the typical age range for women affected by endometriosis?
3rd – 4th decades
## Footnote
Endometriosis affects approximately 10% of women during their reproductive years.
30
What is a 'Chocolate Cyst'?
A cyst filled with old blood that appears brown to black
## Footnote
It forms due to hemorrhage and breakdown of blood within an endometriotic cyst.
31
What is the role of aromatase in endometriosis?
Increased production of estrogen
## Footnote
Aromatase is an enzyme that converts androgens to estrogens, promoting the growth of endometriotic tissue.
32
What is the hallmark of atypical hyperplasia?
Complex patterns of proliferating glands showing nuclear atypia
## Footnote
Atypical hyperplasia is also known as endometrial intraepithelial neoplasia.
33
What is the peak occurrence age for cervical masses?
> 65 years
## Footnote
Cervical masses are more commonly seen in older women, often associated with adenocarcinoma.
34
What causes acute endometritis?
Bacterial infections after delivery or miscarriage
2 most common pathogens: Step A, staph.
## Footnote
Group A Streptococcus and Staphylococcus are common pathogens.
35
What is the main characteristic of endometrial polyps?
Exophytic masses that project into the endometrial cavity
## Footnote
Polyps can vary in size and may be asymptomatic or cause bleeding.
36
What is the relationship between estrogen and endometrial hyperplasia?
Prolonged estrogen stimulation leads to hyperplasia
## Footnote
Conditions like obesity and anovulation can contribute to excess estrogen.
37
What are the common clinical features of adenomyosis?
* Menorrhagia
* Colicky dysmenorrhea
* Pelvic pain
## Footnote
Adenomyosis involves the down-growth of endometrial tissue into the myometrium.
38
What is the significance of PTEN in endometrial hyperplasia?
Inactivation is seen in >20% of cases
## Footnote
PTEN is a tumor suppressor gene, and its loss can lead to increased proliferation.
39
What percentage of endometrioid carcinomas have activating mutations in PIK3CA?
Approximately 40%
## Footnote
PIK3CA is a gene that encodes a subunit of phosphoinositide 3-kinase, which is involved in cellular growth and proliferation.
40
In what percentage of endometrioid carcinomas are mutations that activate KRAS found?
Approximately 25%
## Footnote
KRAS mutations stimulate PI3K/AKT signaling.
41
What type of mutations occur in approximately one-third of endometrioid carcinomas?
Loss-of-function mutations in ARID1A
## Footnote
ARID1A is a regulator of chromatin structure.
42
What percentage of sporadic endometrial carcinomas have defects in DNA mismatch repair genes?
About 20%
## Footnote
Especially in tumors arising in women with hereditary nonpolyposis colorectal carcinoma syndrome.
43
What type of mutations disrupt the proofreading function of DNA polymerase ε?
Mutations in the POLE gene
## Footnote
Found in a small subset of less than 10% of cases.
44
What is the prevalence of loss-of-function mutations in TP53 in poorly differentiated endometrial carcinomas?
Approximately 50%
## Footnote
TP53 is a critical tumor suppressor gene.
45
What are the three grades in the grading system for endometrial adenocarcinoma?
* Grade I: well differentiated, easily recognizable glands
* Grade II: moderately differentiated, well-formed glands mixed with solid sheets of malignant cells
* Grade III: poorly differentiated, solid sheets of cells
## Footnote
Type II endometrial carcinoma is always grade 3 by definition.
46
What characterizes Grade I endometrial adenocarcinoma?
Well differentiated with easily recognizable glands
47
What characterizes Grade II endometrial adenocarcinoma?
Moderately differentiated with well-formed glands mixed with solid sheets of malignant cells
48
What characterizes Grade III endometrial adenocarcinoma?
Poorly differentiated with solid sheets of cells and more nuclear atypia
49
What is the typical age range for women diagnosed with Type II endometrial carcinoma?
About 10 years older than those with endometrioid carcinomas
## Footnote
Type II tumors generally arise in the setting of endometrial atrophy.
50
What percentage of Type II endometrial carcinomas have mutations in the TP53 gene?
Greater than 90%
## Footnote
TP53 mutations are also found in about 75% of endometrial intraepithelial carcinomas.
51
What is the overall 5-year survival rate for serous endometrial carcinoma?
18% to 27%
## Footnote
Even when confined to the uterus, the recurrence rate can be as high as 80%.
52
What are the stages of endometrial adenocarcinoma?
* Stage I: confined to the corpus uteri
* Stage II: involves the corpus and cervix
* Stage III: extends outside uterus but not outside pelvis
* Stage IV: extends outside pelvis or involves mucosa of bladder or rectum
53
What percentage of endometrial tumors are stage I well-differentiated or moderately differentiated endometrioid carcinomas in the US?
About 80%
## Footnote
Surgery combined with irradiation gives approximately 90% 5-year survival in stage I (grade 1 or 2) disease.
54
What is the 5-year survival rate for stage I/grade 3 endometrial carcinomas?
Approximately 75%
## Footnote
Survival rates drop significantly for stage II and III endometrial carcinomas.
55
What percentage of endometrial cancers do tumors of endometrial stroma represent?
Less than 5%
## Footnote
Includes adenosarcoma and stromal sarcomas.
56
What are the characteristics of adenosarcoma?
Well-circumscribed aggregates of endometrial stromal cells in myometrium that do not penetrate myometrium
57
What is the 5-year survival rate for low-grade stromal sarcomas?
Average 50%
## Footnote
Higher for low-grade tumors compared to high-grade.
58
What are carcinosarcomas also known as?
Malignant mixed Müllerian tumors
## Footnote
Composed of mixed epithelial and mesenchymal tumors.
59
What is a common clinical feature of leiomyomas?
Heavy or irregular vaginal bleeding
uterine enlargement
urinary incontinence
## Footnote
Leiomyomas are benign smooth muscle neoplasms.
60
What is the histological appearance of leiomyomas?
Whorled interlacing bundles of smooth muscle spindle-shaped cells with oval nuclei
61
What distinguishes leiomyosarcoma from leiomyomas?
Increased cellularity, nuclear atypia, mitotic rate, and areas of necrosis (distinguishes from leiomyoma)
62
What is the most likely diagnosis for a 55-year-old woman with a 10 cm uterine mass showing areas of necrosis and disorganized spindle cells?
Leiomyosarcoma
63
What are the histological features of acute cervicitis?
Neutrophils
64
What are the histological features of chronic cervicitis?
Plasma cells
65
What is the characteristic discharge associated with Candida infection?
Cottage cheese-like discharge
66
What are the key features of endometrial hyperplasia?
* Nonatypical hyperplasia
* Atypical hyperplasia (Endometrial intraepithelial neoplasia)
67
What characterizes Type I endometrial carcinoma?
Endometrioid, associated with obesity, estrogen, hyperplasia, and mutations in PTEN and KRAS
68
What characterizes Type II endometrial carcinoma?
Serous, often found in thinner women, associated with TP53 mutations and more aggressive behavior
69
What is the purpose of HPV Pap smear screening?
To detect cervical cancer risk factors and categorize low-grade vs high-grade lesions
70
T or F: at menarche, estrogen increases vaginal pH?
false
it decreases vaginal pH
71
what is the endocervix response to menarche
cell proliferation leading to squamous metaplasia
72
trauma and infections of the endocervix results in what type of metaplasia?
squamous
73
what is a buzz word for candida albicans vaginalis
"cottage cheese" discharge
74
what is the most common cause of bacterial vaginitis?
gardnerella vaginalis
75
describe the discharge characteristics of gardnerella vaginalis?
thin, green-gray & fishy
76
what are clue cells?
vaginal epithelial cells encompassed w/ a coat of bacteria
77
what are the characteristics of trichomonas vaginalis?
pear-shaped-flagellated protozoa
78
T or F: Chlamydia is considered and "obligate-intracellular" organism b/c it cannot make its own ATP
true
79
What factor makes chlamydia pathogenic?
elementary bodies - get released w/ infected cells rupture allowing the bacteria to spread
80
what is a cytopathologic hallmark of HSV-2?
Cowdry A bodies and multinucleated giant cells detected on Tzanck smear
81
Describe the characteristics of endocervical polyps
benign
inflammatory caused by dilated mucus secreting endocervical glands
82
T or F: HPV infect and replicate inside mature squamous epithelial cells.
false
HPV infect immature squamous cells and replicate in mature ones
83
what are the low-risk HPV subtypes?
6 & 11
low-risk = condylomata or genital warts
84
T or F: only CIN I & II are considered to be low-grade SIL
false
only CIN I (mild dysplasia) is considered to be LSIL
85
the cytoplasmic halos seen on pap smears assoc. w/ HPV are created by what?
HPV Protein E5 which localizes to the membranes of the ER
86
How are the endometrial glands during the follicular phase described histologically?
long & tubular
87
How are the endometrial glands during the luteal phase described histologically?
coiled
88
what would you susecpt to see histologically for acute endometritis?
microabscesses w/ neutrophil infiltration in the endometrial glands
89
what conditions are assoc. w/ chronic endometritis?
retained gestational tissue
chronic PID
ICDs
tuberculous salpingitis
90
which types of endometriosis are assoc. w/ increased risk for ovarian carcinoma?
endometrioid and clear cell types
superficial and ovarian forms
91
list the 4 theories of endometriosis etiology
regurgitation - backward flow menstruation
benign metastases - rough tissues travel through vessels
metaplastic theory - ectopic endometrial tissue is derived from the pelvic mesothelium that produces the endometrium during embryogenesis
extrauterine stem/progenitor cell theory - there are specific stem cells in the bone marrow that differentiate into endometrial tissue
92
What 2 things are required for ectopic endometrial tissue to successfully implant into the pelvic cavity?
survival - angiogenesis via VEFG
MMPs - remodeling
93
T or F: PG E2 can stimulate local synthesis of estrogen.
true
94
what epigenetic alterations have been linked to the pathogenesis of endometriosis?
increased responsiveness to estrogen and decreased response to progesterone
95
endometrial tissue in adenomyosis implants into what layer?
myometrium which can stimulate uterine enlargement
96
describe the gross characteristics of adenomyosis?
myometrial wall appears uniformly thickened w/ a spongy and ropey like appearance
97
endometrial hyperplasia is defined as what?
increased proliferative rate of endometrial glands relative to the stroma
98
How does obesity contribute to increased risk for endometrial hyperplasia?
increased peripheral conversion of androgens to estrogens
99
PTEN regulates what pathway?
PI3K/AKT growth-regulatory pathway
100
What is the main histologic difference b/t atypical and typical endometrial hyperplasia?
typical - looks much like a normal endometrium just higher # of glands
atypical - even higher # of glands w/ nuclear atypia: vesicular w/ prominent nucleoli
101
What are the key differences b/t type I & II endometrial carcinomas?
Type 1:
younger age
assoc. w/ metabolic syndrome (more sensitive to unopposed estrogen)
PTEN
well-differentiated
minimal aggression
Type 2:
older age
assoc. w/ atrophy & thin physique
TP53
poorly-differentiated
very aggressive
102
T or F: Type II endometrial carcinoma is always classified as grade III.
true
103
T or F: Type II endometrial carcinoma is more frequent in Caucasian populations?
false
occurs more frequently in women of African-american descent
104
what does the epithelial component of carcinosarcomas consist of?
usually resembles poorly differentiated endometrioid or serous carcinoma
105
what does the mesenchymal component of carcinosarcomas consist of?
varies - leiomyo, rhabdomyo, chondro
106
T or F: carcinosarcoma has an excellent prognosis
FALSE!!!!!!!
THIS IS A HORRIBLE CANCER
hospice care is the best option
107
T or F: Leiomyosarcomas are normally derived from leiomyomas.
false
more commonly arise from the myometrium and endometrial stromal precursor cells
108
what mutation is assoc. w/ leio neoplasms of the uterus
MED12
109
What are the non-neoplastic pathologies of the ovaries?
Follicular cysts, corpus luteal cysts, oophoritis, polycystic ovarian disease
## Footnote
Non-neoplastic pathologies include conditions that do not involve tumor formation.
110
What are the types of surface-epithelial-stromal neoplasms of the ovary?
Serous tumors, mucinous neoplasms, endometrioid carcinoma, Brenner tumor
## Footnote
These tumors can be benign, borderline, or malignant.
111
What are the morphological features of serous cystadenoma?
Benign, lined by tubal-like epithelium, cystic fluid
## Footnote
Serous cystadenomas are common benign tumors of the ovary.
112
What is the most common ovarian mass during pregnancy?
Corpus luteum cyst
## Footnote
It is also found in non-pregnant women.
113
What is polycystic ovarian syndrome characterized by?
Hyperandrogenism, menstrual abnormalities, polycystic ovaries, chronic anovulation, decreased fertility
## Footnote
It affects 6% to 10% of reproductive-age women.
114
What is the most common malignant tumor of the ovary?
Serous cystadenocarcinoma
## Footnote
It accounts for about 40% of ovarian cancers.
115
What are the three main ovarian cell types from which neoplastic diseases originate?
Müllerian epithelium, germ cells, sex cord–stromal cells
## Footnote
These cell types contribute to the classification of ovarian tumors.
116
What are the symptoms associated with large ovarian tumors?
Lower abdominal pain, distention, abdominal enlargement, urinary symptoms, GI bleeding
## Footnote
Symptoms may indicate progression of the disease.
117
True or False: Most ovarian cancers are diagnosed at an early stage.
False
## Footnote
Most ovarian cancers have spread beyond the ovary by the time of diagnosis.
118
What is the risk associated with BRCA1 and BRCA2 mutations?
Increased susceptibility to ovarian and breast cancer
## Footnote
Women with these mutations have a significant risk of developing ovarian cancer by age 70.
119
Fill in the blank: The most common lesions in the ovary are _______.
functional or benign cysts and tumors
## Footnote
These lesions are typically non-cancerous.
120
What are the two major groups of serous tumors?
Low-grade carcinoma and high-grade carcinoma
## Footnote
They are distinguished by the degree of nuclear atypia.
121
What is the clinicopathological feature of dysgerminomas?
Germ cell tumors that are solid and often unilateral
## Footnote
Dysgerminomas are the most common malignant germ cell tumors of the ovary.
122
What is the significance of CA-125 in ovarian cancer?
Tumor marker for progression and recurrence
## Footnote
Elevated CA-125 levels can indicate ovarian cancer.
123
What is oophoritis?
Primary inflammation of the ovary
## Footnote
It is an uncommon condition and can be autoimmune.
124
What characterizes granulosa-theca cell tumors?
Sex-cord stromal tumors that can produce estrogen
## Footnote
These tumors can lead to abnormal menstrual cycles.
125
What are the morphological features of polycystic ovarian disease?
Ovaries usually twice normal size, smooth outer cortex, multiple subcortical cysts
## Footnote
This condition can lead to fertility issues.
126
What is the primary origin of most ovarian neoplasms?
Müllerian epithelium
## Footnote
This epithelium is the source of many epithelial tumors.
127
What are the types of tumors that may progress from benign tumors?
Benign tumors progress to borderline tumors and then to low-grade carcinomas, including low-grade serous, endometrioid, and mucinous carcinomas.
128
What defines Type II tumors?
Type II tumors arise from inclusion cysts or fallopian tube epithelium and show high-grade features, most commonly of serous histology.
129
What is STIC?
Serous tubal intraepithelial carcinoma, lesions associated with high-grade serous ovarian cancers.
130
What observation led to the concept of fallopian tube origin for high-grade serous carcinomas?
Women with BRCA1/2 mutations often had areas of marked epithelial atypia in their fallopian tubes during prophylactic surgeries.
131
What are the micro features of benign serous cystadenomas?
Smooth glistening cyst wall lined by columnar epithelium, no epithelial thickening, abundant cilia on epithelial cells, and possible microscopic papillae.
132
What characterizes borderline serous tumors?
Increased number of papillary projections without invasion.
133
What percentage of serous carcinomas are bilateral?
Approximately 66%.
134
What are the characteristics of high-grade serous carcinoma?
Complex growth patterns, widespread infiltration, marked nuclear atypia, and atypical mitotic figures.
135
What is a common feature in serous tumors?
Concentric calcifications known as psammoma bodies.
136
What are common risk factors for ovarian tumors?
Nulliparity, family history, and heritable mutations.
137
What is the survival rate for borderline and malignant tumors confined to the ovary?
100% for borderline tumors and 70% for malignant tumors.
138
What are the characteristics of mucinous ovarian tumors?
Account for 20% to 25% of ovarian neoplasms, mostly benign or borderline, and primary ovarian mucinous carcinomas are uncommon.
139
What is the most consistent genetic alteration in mucinous tumors of the ovary?
Mutation of the KRAS proto-oncogene.
140
What distinguishes mucinous borderline tumors from benign mucinous cystadenomas?
Epithelial stratification, tufting, and/or papillary intraglandular growth.
141
What is pseudomyxoma peritonei?
Mucinous ascites, cystic epithelial implants on peritoneal surfaces, and frequent involvement of ovaries.
142
What is the peak incidence of endometrioid tumors of the ovary?
Occurs in the decade earlier than endometrioid carcinomas not associated with endometriosis.
143
What is the 5-year survival rate for patients with stage I endometrioid tumors?
Approximately 75%.
144
What is the typical presentation of clear cell carcinoma of the ovary?
May be predominantly solid or cystic, often resembles clear cell carcinoma of the endometrium.
145
What are transitional cell tumors of the ovary also known as?
Brenner tumors.
146
What is the typical behavior of Brenner tumors?
Mostly benign and often detected incidentally.
147
What are common clinical manifestations of epithelial ovarian carcinomas?
Lower abdominal pain, abdominal enlargement, GI complaints, urinary frequency, and pelvic pressure.
148
What is the function of serum marker CA-125?
Used to monitor disease recurrence/progression in patients with known ovarian cancer.
149
Fill in the blank: Mucinous tumors tend to produce larger cystic masses that are filled with _______.
sticky, gelatinous fluid rich in glycoproteins.
150
What is the significance of serum marker CA-125 in ovarian carcinoma?
Used in patients with known disease to monitor disease recurrence/progression
151
What is the current standard treatment for women at risk for ovarian cancer with BRCA mutations?
Risk-reducing salpingo-oophorectomy
152
What percentage of ovarian tumors are germ cell tumors?
15% to 20%
153
What are the subtypes of teratomas?
* Mature (benign) * Immature (malignant) * Monodermal or highly specialized
154
What are mature cystic teratomas also known as?
Dermoid cysts
155
What is a common microscopic feature of mature cystic teratomas?
Cyst wall made up of stratified squamous epithelium (basically skin) with underlying sebaceous glands, hair shafts, and other skin adnexal structures
156
What is the karyotype of almost all benign ovarian teratomas?
46,XX
most arise from after the first meiotic division
the rest arise before
157
What is a rare type of monodermal teratoma made entirely of mature thyroid tissue?
Struma ovarii
158
What is the typical age range for immature malignant teratomas?
Prepubertal adolescents and young women (mean age 18 years)
159
What is the histologic grading based on for immature teratomas?
Proportion of tumor that is comprised of immature neuroepithelium (can grossly resemble brain tissue)
160
What type of tumor is a dysgerminoma?
Ovarian counterpart of testicular seminoma
161
What is the prognosis for unilateral dysgerminomas that have not spread?
Excellent prognosis (up to 96% cure rate) after salpingo-oophorectomy
162
What are the characteristic histopathological features of dysgerminoma?
Large vesicular cells with clear cytoplasm, well-defined cell boundaries, grow in sheets or cords, stroma infiltrated by lymphocytes
may have noncaseating granulomas
163
What is the best serologic marker to monitor yolk sac tumors?
Alpha-fetoprotein (AFP)
164
What is the characteristic histological structure of yolk sac tumors?
Schiller-Duval body (glomerulus-like structure)
165
What are the common types of sex cord-stromal tumors of the ovary?
* Granulosa-theca cell tumors (in females)* Fibroma-thecoma tumors * Sertoli-Leydig cell tumors (in males)
166
What do granulosa cell tumors secrete?
Estrogens
167
What is the common driver mutation found in adult granulosa cell tumors?
Mutations in FOXL2 gene
168
What is the typical 10-year survival rate for granulosa cell tumors?
Approximately 85%
169
What can elevated levels of inhibin indicate in the context of ovarian tumors?
Useful in diagnosing granulosa cell tumors and monitoring treatment
170
Fill in the blank: Most mature cystic teratomas are usually _______.
Cystic
171
True or False: Immature teratomas tend to have a smooth external surface.
False
172
What is a granulosa cell tumor characterized by?
Call-Exner bodies: small, gland-like structures filled with acidophilic material
## Footnote
Granulosa cell tumors are a type of sex-cord stromal tumor found in the ovaries.
173
What is the typical clinical presentation of a granulosa cell tumor?
Intermittent vaginal bleeding and pelvic mass
## Footnote
These tumors can cause abnormal uterine bleeding due to estrogen production.
174
What is the most likely associated finding with a granulosa cell tumor?
Increased levels of inhibin
## Footnote
Inhibin is a hormone produced by granulosa cells that can be elevated in granulosa cell tumors.
175
What are the gross characteristics of fibromas?
Solid, spherical or slightly lobulated, encapsulated, hard, gray-white mass w/ intact ovarian serosa
## Footnote
Fibromas are benign ovarian tumors that arise from the stroma.
176
What is Meigs syndrome?
Combination of ovarian tumor, hydrothorax (usually on the right side), and ascites
## Footnote
Meigs syndrome is associated with benign ovarian tumors like fibromas.
177
What is the common histological finding in thecoma?
More yellow, softer tissue compared to fibromas
## Footnote
Thecoma is a type of sex-cord stromal tumor that can be hormonally active.
178
What is the peak incidence age for Sertoli-Leydig cell tumors?
Second and third decades of life
## Footnote
These tumors can cause masculinization in women due to androgen production.
179
What gene mutation is commonly found in Sertoli-Leydig cell tumors?
DICER1 gene mutation (encodes for an endonuclease essential for proper processing of micro-RNA)
## Footnote
This gene encodes an endonuclease essential for processing micro-RNAs.
180
Fill in the blank: The AJCC Stage I indicates that cancer is only in the _______.
[ovary or fallopian tube(s)]
181
In AJCC staging, what does Stage II indicate?
The cancer is in one or both ovaries or fallopian tubes and has spread to other pelvic organs
## Footnote
This stage includes invasion into nearby structures like the uterus or bladder.
182
What is a Krukenberg tumor?
Bilateral metastatic GI neoplasia to ovaries, characterized by mucin-producing signet ring cancer cells
## Footnote
It most commonly originates from gastric carcinoma.
183
What are the main types of surface-epithelial-stromal ovarian neoplasms?
* Serous cystadenoma
* Serous borderline tumor
* Serous papillary cystadenocarcinoma
* Mucinous tumors
* Endometrioid carcinoma
* Brenner’s tumor
## Footnote
These tumors vary in their behavior from benign to malignant.
184
True or False: Most fibromas, fibrothecomas, and thecomas are malignant.
False
## Footnote
The majority of these tumors are benign.
185
What is the histological appearance of well-differentiated Sertoli-Leydig cell tumors?
Tubules composed of Sertoli or Leydig cells interspersed with stroma
## Footnote
The degree of differentiation varies among tumors.
186
What is the prognosis for gonadoblastoma if completely excised?
Excellent
## Footnote
Gonadoblastomas are often associated with dysgerminomas and occur in patients with abnormal sexual development.
187
What are the common symptoms of polycystic ovarian disease?
* Hyperandrogenism
* Menstrual abnormalities
* Polycystic ovaries
* Chronic anovulation
* Decreased fertility
## Footnote
This condition is associated with obesity and insulin resistance.
188
What is the typical treatment for Hilus cell tumors?
Surgical excision
## Footnote
These tumors are almost always benign but can cause clinical masculinization.
189
Fill in the blank: Small cell carcinoma of the ovary is _______.
[rare and malignant]
190
What is the relationship between ovarian tumors and ascites?
Ovarian tumors may cause ascites in about 40% of cases when tumors > 6 cm
## Footnote
Ascites can occur due to tumor burden or irritation of the peritoneal lining.
191
What is the most common malignant ovarian carcinoma?
Serous papillary cystadenocarcinoma
## Footnote
It can be classified as low grade or high grade and is associated with BRCA mutations.
192
What are psammoma bodies associated with?
Serous papillary cystadenocarcinoma
## Footnote
Psammoma bodies are small calcified structures commonly found in certain tumors.
193
What types of mucinous tumors exist?
Benign, borderline, malignant
## Footnote
Mucinous tumors can vary in their behavior and prognosis.
194
What is the incidence of concurrent endometrial carcinoma with endometrioid carcinoma of the ovary?
15-30%
## Footnote
There is also a 15-20% chance of co-existing endometriosis.
195
What type of tumor is Brenner’s tumor?
Solid or cystic, transitional-cell type nests in fibrotic stroma resembling epithelium of the urinary tract
mucinous glands found in the center
## Footnote
Most cases of Brenner's tumor are benign.
196
What is a mature cystic teratoma also known as?
Dermoid cyst
## Footnote
It is characterized by containing various tissues, including hair and skin.
197
What is the chromosomal pattern of mature cystic teratoma?
46 XX
## Footnote
This indicates the typical female chromosomal pattern.
198
What is unique about immature teratoma?
Graded by proportion of immature neuroepithelium
## Footnote
The grading reflects the aggressiveness of the tumor.
199
Dysgerminoma is the ovarian counterpart to which male tumor?
Seminoma
## Footnote
Dysgerminomas are radiosensitive tumors.
200
Which tumor is associated with alpha-fetoprotein (AFP) and Schiller-Duval bodies?
Yolk sac tumor
## Footnote
These tumors are germ cell tumors often found in young women.
201
What hormone is associated with Choriocarcinoma?
HCG
## Footnote
Choriocarcinoma contains syncytiotrophoblasts.
202
What effect does granulosa-theca cell tumor have on estrogen production?
May lead to endometrial hyperplasia (or carcinoma)
## Footnote
It also increases inhibin levels and features Call-Exner bodies.
203
What is Meig’s syndrome associated with?
Fibroma-Thecoma
## Footnote
Meig's syndrome includes a triad of ovarian tumor, ascites, and pleural effusion.
204
What type of tumor is Sertoli-Leydig cell tumor known for?
Masculinizing
## Footnote
This tumor can lead to the development of male characteristics in females.
205
What type of cells are found in a Hilus cell tumor?
Pure Leydig cells
## Footnote
These tumors can produce androgens.
206
What is a characteristic of gonadoblastoma?
It is a germ cell tumor resembling immature sertoli and granulosa cells
can cause undersexual develpment
## Footnote
Typically associated with dysgenetic gonads.
207
What is a significant feature of small cell carcinoma of the ovary?
Hypercalcemia
## Footnote
This carcinoma is aggressive and often presents with paraneoplastic syndromes.
208
What is a Krukenberg tumor?
Metastatic GI tumor to ovary, usually gastric signet ring cell
## Footnote
Krukenberg tumors are secondary malignancies that originate from the gastrointestinal tract.
209
Sterile peritonitis is commonly caused by what?
follicular cysts ruptures
210
describe the gross features of corpus luteum cysts.
rim of bright yellow luteal tissue containing luteinized granulosa cells
usually have hemorrhages
211
PCOS is assoc. w/ what comorbidities and why?
obesity
DM type II
premature atherosclerosis
all of the above are complications that arise from PCOS b/c of the dysregulation of enzymes involved in androgen synthesis
212
what kind of cysts are found in PCOS?
subcapsular cysts
213
what type of ovarian tumors are pts. w/ Turner's syndrome most at risk to develope?
dysgerminomas
214
what type of ovarian tumors are pts. w/ PJ syndrome most at risk to develope
sex cord tumors
214
T or F: Epithelial tumors of the ovary account for over 80% of ovarian tumors/
true
215
what types of ovarian epithelial tumors are considered Type 1 (low-grade tumors)
endometrioid
serous
mucinous
216
what types of epithelial tumors are considered Type 2 (high-grade tumors)
serous intraepithelial carcinoma-most common
217
what parts of the internal female genitalia does serous intraepithelial carcinoma arise from?
fallopian tube epithelium
218
compare and contrast the genetic profiles of high and low grade serous cystadenocarcinoma.
low-grade:
KRAS
BRAF
ERBB2
high-grade:
TP53
219
T or F: almost all ovarian carcinomas in women w/ BRCA mutations are high-grade serous carcinomas w/ TP53 mutations
true
220
serous ovarian tumors commonly spread to what other regions in the body?
peritoneal surfaces and the omentum
(causes ascites)
221
describe the micro-characteristics of benign mucinous tumors
tall, columnar epithelial cells w/ apical mucin that lack cilia
222
T or F: the vast majority of benign mucinous tumors show endocervical differentiation
false
majority show gastric and intestinal differentiation
223
endometrioid tumors are commonly assoc. w/ what chronic gynecological condition?
endometriosis
224
the genetic profile of endometrioid ovarian tumors is very similar to what other cancer?
endometrial endometrioid carcinoma
225
mature teratomas are assoc. w/ what paraneoplastic syndrome?
inflammatory limbic encephalitis- inflammation of temporal lobes causing seizures and memory loss
226
List the main components of the genetic profile for dysgerminoma?
KIT
OCT genes
227
describe the histological characteristics of a schiller-duval body
glomerulus-like structure
contains a central blood vessel enveloped by tumor cells that are also lined by another set of tumor cells
228
This rare ovarian carcinoma is very aggressive-usually has already metastasized hematogenously to the lungs, liver, & bone at time of Dx. It does not respond to chemotherapy
ovarian choriocarcinoma
229
sex cord ovarian tumors arise from what?
the ovarian stroma
230
the juvenile form of granulosa-theca cell tumors can result in what?
precocious puberty
231
ovarian fibromas can be derived from what?
all arise in ovarian stroma either through fibroblasts or plump spindle cells w/ lipid droplets (thecomas)
fibroatheromas have a mixture of both
232
ovarian fibromas are asso. w/ what syndrome?
basal cell nevus syndrome-skin cancer
233
what are the histologic characteristics of intermediate SL tumors?
only immature tubules and large eosinophilic leydig cells
234
describe the histologic characteristics of poorly differentiated SL tumors?
sarcomatous pattern w/ disorded epithelial cell cords and heterologous elements (such as mucinous glands, bone, or cartilage)
235
list the stages of ovarian cancer?
stage 1: confined to the ovaries
stage 2: spread to other parts of the internal female organs
stage 3: spreads to other parts of the abdomen
stage 4: spreads beyond the abdomen
236
what are the clinical presentations of pregnancy luteoma?
resembles corpus luteum that may produce virillzation in preggies and their female infants
237
metastatic cancers of which organ commonly travel to the ovaries?
breast carcinomas
GI - colon, stomach (most common: resembling gastric adenocarcinoma), biliary, pancreas
238
What are paratubal cysts?
Most common primary lesions of fallopian tubes, lined by benign serous epithelium
## Footnote
Clear, serous fluid; thought to arise in remnants of Mullerian duct; little clinical significance.
239
What is the primary cause of suppurative salpingitis?
60% caused by N. gonorrheae; Chlamydiae responsible for most of the rest
## Footnote
Tuberculous salpingitis caused by M. tuberculosis; rare in the US but important in areas where TB is prevalent.
240
What are the common symptoms of Pelvic Inflammatory Disease (PID)?
Pelvic pain, adnexal tenderness, fever, and vaginal discharge
## Footnote
Begins in vulva or vagina and spreads upward.
241
What are the common infecting organisms responsible for PID?
Neisseria gonorrhea, Chlamydia, polymicrobial infections (e.g., staphylococci, streptococci, coliforms, Clostridium perfringens)
## Footnote
Infections may follow spontaneous or induced abortions and deliveries.
242
What is acute suppurative salpingitis?
Develops with tubal mucosa congested and infiltrated by neutrophils, resulting in epithelial injury
## Footnote
Tubal lumen fills with purulent exudate, may lead to salpingo-oophoritis.
243
What is hydrosalpinx?
Accumulation of tubal secretions and tubal distention due to fusion of fimbriae
## Footnote
Can develop from chronic salpingitis.
244
What is ectopic pregnancy?
Implantation of fetus in a site other than the normal intrauterine location
## Footnote
Most commonly occurs in the fallopian tube.
245
What are the common sites for ectopic pregnancy?
Extrauterine fallopian tube, ovary, abdominal cavity, cornual pregnancy
## Footnote
Prior PID is a significant predisposing condition.
246
What is the most common cause of hematosalpinx?
Ectopic pregnancy; blood in fallopian tube
## Footnote
Rupture can lead to massive intraperitoneal hemorrhage.
247
What is the typical clinical presentation of a ruptured ectopic pregnancy?
Moderate to severe abdominal pain and vaginal bleeding 6 to 8 weeks after last menstrual period
## Footnote
Patient may rapidly develop hemorrhagic shock.
248
What diagnostic methods are used for ectopic pregnancy?
Determination of beta-HCG titers, pelvic sonography, endometrial biopsy w/o chorionic villi, laparoscopy
## Footnote
Diagnosis often involves seeing decidua without chorionic villi.
249
What are the key characteristics of hydatidiform moles?
Complete and partial moles, associated with abnormal placental development
## Footnote
Can lead to complications such as choriocarcinoma.
250
What are the functions of the placenta?
Gas and nutrient exchange between maternal and fetal blood
## Footnote
Made of chorionic villi that sprout from the chorion.
251
What is the role of trophoblasts in the placenta?
Embryonic-derived portion that forms chorionic villi
## Footnote
Provides a large contact area between fetal and maternal circulations.
252
How does maternal blood circulate in the placenta?
Enters the intervillous space through endometrial arteries and returns via endometrial veins
## Footnote
Oxygen exchange occurs across the epithelium of villi.
253
What is the significance of deoxygenated fetal blood in the placenta?
Enters placenta through two umbilical arteries and forms chorionic arteries
## Footnote
Blood is oxygenated in placenta and returns to fetus through the single umbilical vein.
254
What is the function of maternal arteries in the placenta?
Deliver oxygenated blood to intervillous space/maternal sinus
255
Where does oxygen exchange occur in the placenta?
Across epithelium of villi
256
What carries oxygenated blood from the placenta?
Umbilical vein
257
What carries deoxygenated blood from the fetus?
2 umbilical arteries
258
What are the two types of twin pregnancies?
* Dizygotic (fertilization of two ova)
* Monozygotic (division of one fertilized ovum)
259
What does monochorionic placenta imply?
Monozygotic (identical) twins
260
What is a complication of monochorionic twin pregnancy?
Twin-to-twin transfusion syndrome
261
What is a characteristic of monochorionic twin placentas?
Vascular anastomoses connecting circulations of the twins and cardiovascular shunts that will often times feed one at the expense of the other
262
What can occur if twin-to-twin transfusion syndrome is severe?
May result in death of one or both fetuses
263
What is placenta previa?
Placenta implants in lower uterine segment or cervix
264
What is a serious risk associated with complete placenta previa?
Third-trimester bleeding requiring C-section
265
What is placenta accreta?
Partial or complete absence of the decidua; placental villous tissue adheres directly to myometrium
266
What are the two pathways for placental infections?
* Ascending infection through birth canal (most common and usually bacterial)
* Hematogenous (transplacental) infection
267
What type of infections are TORCH infections?
Infections that can affect the placenta, causing chronic inflammatory infiltrates
268
What is a hydatidiform mole?
Rare mass forming inside the uterus at the beginning of a pregnancy; type of gestational trophoblastic disease
269
What is the average gestational age at which hydatidiform moles are diagnosed?
9 weeks
270
What is the risk of persistent trophoblastic disease associated with hydatidiform moles?
Increased risk of invasive mole or choriocarcinoma
271
What are the two types of benign, noninvasive moles?
* Complete mole
* Partial mole
272
What characterizes complete moles?
Greatly increased HCG serum levels compared to gestational age
273
What is the risk associated with complete moles?
2.5% risk of subsequent choriocarcinoma
274
What is the karyotype typically found in complete moles?
46, XX karyotype from duplication of paternal chromosomes; NO MATERNAL CHROMOSOMES
275
What is characteristic of partial moles?
Karyotype is usually triploid 69, XXY, with fetal tissue usually present
276
What is an invasive mole?
Penetrates or perforates uterine wall, invades myometrium
277
What is choriocarcinoma?
Malignant neoplasm of trophoblastic cells derived from a previous pregnancy
278
What are the common origins of choriocarcinoma?
* 50% arise in complete hydatidiform moles
* 25% in previous abortions
* 22% follow normal pregnancies
279
What is the prognosis for choriocarcinoma treatment?
Very responsive to chemotherapy with nearly 100% remission
280
What is the definition of Placental Site Trophoblastic Tumor (PSTT)?
Rare neoplasm of intermediate trophoblasts following normal pregnancy or molar pregnancy
281
What is the histological characteristic of PSTT?
Malignant trophoblast cells diffusely infiltrating endomyometrium
282
What is the prognosis for localized PSTT?
Excellent prognosis
283
What is the typical treatment for choriocarcinoma?
Surgical removal, possibly total hysterectomy, and chemotherapy
284
What is the genetic makeup of a complete mole?
46, XX
## Footnote
A complete mole has no fetal tissue and carries a 2.5% risk of choriocarcinoma.
285
What is the genetic makeup of a partial mole?
69, XXY
## Footnote
Partial moles are not associated with choriocarcinoma.
286
What is the risk of death from disseminated disease in trophoblastic disease?
10 – 15%
## Footnote
This statistic reflects the severity of disseminated disease.
287
What are the common causes of gestational trophoblastic disease?
50% follow normal pregnancy, spontaneous abortion, hydatidiform mole
## Footnote
These are the common antecedents to trophoblastic disease.
288
What is the prognosis for localized disease in gestational trophoblastic disease?
Excellent
## Footnote
Localized disease refers to involvement in the endometrium.
289
What is a characteristic feature of an invasive mole?
Persistent elevation in HCG, mole penetrates/perforates uterine wall
## Footnote
Invasive moles can invade the myometrium.
290
What does choriocarcinoma lack?
Chorionic villi
## Footnote
Choriocarcinoma is a malignant neoplasm characterized by trophoblastic cells.
291
What are the types of trophoblastic disease?
* Molar pregnancies
* Invasive mole
* Choriocarcinoma
* Placental Site Trophoblastic Tumor
## Footnote
Each type has distinct features and implications.
292
True or False: Acute salpingitis is commonly associated with N. gonorrhoeae.
True
## Footnote
Acute salpingitis occurs in 60% of cases due to N. gonorrhoeae.
293
What is elevated in cases of gestational trophoblastic disease?
HCG greater than gestational age
## Footnote
This elevation is a key indicator of molar pregnancies.
294
What type of cells are present in choriocarcinoma?
Syncytiotrophoblasts and cytotrophoblasts
## Footnote
These cells are indicative of the malignancy in choriocarcinoma.
295
What is a paratubal cyst?
Benign
## Footnote
A paratubal cyst is a non-cancerous growth associated with the fallopian tube.
296
Fill in the blank: A 24-year-old female with a large central mass and no fetus or amniotic fluid is likely experiencing a _______.
molar pregnancy
## Footnote
The ultrasound findings are characteristic of a molar pregnancy.
297
there is a subset of ovarian cancer that sometimes arises from the fallopian tubes and is typically assoc. w/ what?
serous subtype
commonly seen in women w/ BRCA1 mutations
298
what are paratubal cysts called if they are located near the fimbriated end or the broad ligament
hydatid cysts of morgagni
299
paratubal cysts are thought to arise from what?
remnants of the mullerian duct
300
gonococcus infects what parts of the female reproductive tract?
endocervical mucosa
301
chronic salpingitis increases the risk for what?
ectopic pregnancies
302
what is Fitz-Hughes-Curtis syndrome?
PID plus inflammation of liver capsule w/o involvement of the liver parenchyma
causes RUQ pain
grossly looks like violin-string like adhesions
303
T or F: syncytiotrophoblasts form the maternal blood vessels
false
cytotrophoblasts form these
syncytiotrophoblasts will form the villi which the fetal capillaries grow into
304
List out the components of the TORCH acroym.
TO: toxoplasmosis
R: rubella
C: CMV
H: HSV
305
describe the histologic characteristics of hydatidiform moles.
delicate, friable, thin-walled, translucent grapelike structures w swollen edematous (hydropic) villi
306
what are the signs and symptoms of a hydatidiform mole?
signs:
size-date discrepancies (may appear 5 months gestation but actually only 2 months)
grape-like masses in the vaginal canal
TV US - Snowstorm appearance
absent fetal heart tones
symptoms:
hyperemesis gravidarum
hyperthyroidism
1st trimester bleeding
307
describe the histologic characteristics of a complete mole
enlarged chorionic villi that are scalloped in shape w/ central cisterns covered by extensive trophoblastic proliferation around the entire circumference of the villi
308
T or F: there is no assoc. increased frequencies of moles in any one population.
false
most common at both extremes of the childbearing age range: teenagers and females > 45
309
compare and contrast the differences b/t how complete and partial moles form.
complete mole is a diploid that receives 2 copies of paternal chromosomes b/c the egg contained no genetic material and so the sperm compensates by duplicated its own genetic material
partial mole is a triploid that results from fertilization of an egg w/ two different sperms
310
T or F: only part of the villi are involved and enlarged w/ focal trophoblastic hyperplasia for partial moles.
true
311
PSTTs are most commonly found where?
at the site of implantation
312
PSTTs are derived from what?
extravillous (intermediate) trophoblasts
313
describe the histologic features of PSTT.
polygonal mononuclear cells w/ abundant cytoplasm that produce human placental lactogen
