L71 Flashcards
What are the 5 types of ovarian surface epithelial tumors? Which 2 can arise from endometriosis?
- Serous
- Mucinous
- Endometrioid - endometriosis
- Clear cell - endometriosis
- Brenner/transitional
Explain the differences between benign, borderline, and malignant serous ovarian tumors
- Benign = serous cystadenoma = simple, flat lining
- Borderline = velvety, implants in abdomen as independent tumors (not mets)
- Malignant = serous carcinoma, thick + shaggy
What is the name for a benign serous or mucinous ovarian tumor?
Serous or mucinous cystadenoma
What is the tumor progression pathway to get a low grade serous ovarian carcinoma?
Cystadenoma // endometriosis -> borderline -> low grade
What is the tumor progression pathway to get a high grade serous ovarian carcinoma? What are the genes involved?
Think BRCA 1/2 + p53
Inclusion cyst
High grade
Presentation of mucinous ovarian cancer
HUGE, most benign
“Bag jelly beans”
What is a pseudomyxoma peritonei
Bilat mucinous ovarian tumor as met from appendix mucinous tumor
For epithelial tumors, describe the role of: Age Cystic vs solid tumors Bi vs unilat tumors Those associated with endometrisois
OVARIAN SURFACE EPI TUMOR
- Older = more likely to be malig
- Benign - cystic, solid - malignant
- Bilat more likely to be mets except serous
- Endometrioid + clear cell associated with endometriosis
What is a Krukenberg tumor? Unil or bilat, histology
Diffuse gastric cancer - mets to the bilat ovaries
Histo: signet ring
Which type of ovarian tumor presents before 20 yo + unilateral
Ovaruan germ cell tumors
You can guess what a mature teratoma is - so what is an immature teratoma? Treat
Contains immature neuro tissue (brain)
High grade will need chemo regardless of resection b/c immature tissue indications malignant potential (vs mature teratoma = benign)
What is a dysgerminoma Benign vs malignant Uni or bilat Enzyme elevated Age Prognosis
Ovarian "seminoma" Malignancy of oocytes Unilat Young women: 20-30s High LDH Responds to treatment
Yolk sac tumor = endodermal sinus tumor
Age
Elevated in serum
Histo
Malignant tumor in GIRLS High AFP (normally secreted by yolk sac) Schiller Duval bodies = glomerulus-like
Name the 5 types of germ cell tumors
Teratoma (mature vs immature) Dysgerminoma (oocytes) Yolk sac tumor = endodermal sinus tumor Choriocarcinoma (placental tissue) Embryonal carcinoma = emybro like, large primitive cells
2 types of sex cord stromal tissues
Ganulosa-theca cell tumor
Sertoli-Leydig cell tumor
What is Meigs syndrome?
Ovarian tumor = fibroma
Hydrothorax
Ascities
Describe presentation of granulosa tumor
Makes E - signs of E excess 1. Early puberty 2. Bleeding out of cycle 3. Post-meno bleeding Excess E likely to cause endometrial HYPERPLASIA + CARCINOMA
Serum + histo findings granulosa tumor
Inhibin = serum tumor marker
Coffee bean nuclei = Call Exner bodies
What is the normal vascular architecture of the umbilical cord?
2 arteries
1 vein
: o
What is oligohydramnios? What syndrome/sequence may result from prolonged/severe oligo?
Too little amniotic fluid
POTTER’s sequence = no amniotic fluid to swallow = lung hypoplasia
- May be due to congenital lab of kidneys/UT
Characteristic facial appearance after being smooshed on placenta
What is meconium? How could this signal fetal insult?
Baby poop - should only happen around time of delivery
If green, distress that caused pooping is removed (umbilical cord spasm)
What is placenta previa + complication
Placenta implanted into lower segment of uterus - lies over cervix
Can’t deliver through obstructed cervix - C section
What is placenta accreta + complication
Placenta into the myometrium - too tight
Hemorrhage -> may need to remove uterus at birth
Same idea, deeper invasion = placenta increta + percreta
What is twin twin transfusion syndrome
Anastimosis of the arteries so that one baby under profused (cause of death) and the other is over (dies CHF)
Name for infection of placenta vs membranes vs cord. Source?
Placenta = villitis
Membranes = chorioamnionitis
Cord = funisitis
Ascending infection via birth canal (duh none of these things exist if not pregnant)
What are you worried about with maternal infection of the placenta/membranes/cord
ToRCHES infections Toxo Rubella CMV HSV Syphilis
Most common cause of rupture membranes
Infection
What is pre-eclampsia vs eclampsia?
Pre = HTN + proteinuria + edema
Defective formation in placental vasc bed -> less BF to placenta = hypoxia, premature birth
Eclampsia = + seizures, DIC
What disease did mom have if you see decidual vasculopathy aka fibrinoid necrosis and hemorrhagic infarct at delivery?
Pre/eclampsia
If mom comes in with pain + vaginal bleeding, what are you thinking? Biggest worry
Placental abruption!!! (b/c pain AND blood)
Worry still birth -> emergency delivery
How does a complete hydatidiform mole form?
2 sperm - no maternal chromosome in egg
How does partial hydatidiform mole form?
Maternal chromosome + 2 sperm fertilize
Triploid genetic material
Describe complete H mole Genetics Fetal tissue Vilious edema Trophoblastic prolif Risk for choriocarcinoma
COMPLETE
Egg completely devoid mom’s genes (incompat w/ life)
Complete absence fetal tissue
Completely edematous vili
Complete covering of those vili in blasts - secreted hCG
Completely at risk for choriocarcinoma
What does a complete H mole look like?
Bunch of grapes - may have some come out
What is choriocarcinoma? 2 ways you can get this tumor
Malignant
Tumor of blasts: syncytio + cytotropho = why high BhCG
From
1. Germ cell pathway - don’t respond well to chemo
2. Gestation pathway (complete H mole) - yes chemo
