MOD 2 Flashcards
benign follicular cyst
distended follicle, lined by granulosa cells and filled with clear fluid, can cause pain/rupture
Hemorrhagic corpus luteum cysts
from CL that fills with blood/fluid, can cause pain/bleeding, look like diffusely large ovary
Ectopic preg
path
what is elev?
usu in fallopian tube but CAN be in ovary, can have pain/bleeding, rupture is surgical emergency and inv hemorr
B-HCG elev!
which ovarian tumors are usu bilateral/ occur in women >45?
malig ovarian tumors
risk factors for ovarian tumors?
protective factors?
nullparity, older age, turners (ovarian dysgenesis) etc
-protective factors preg and OCP
genetics of ovarian tumors
BRCA, lynch syndrome (usu endometrial with MMR issue), HER-2, early p53 etc
what are the 3 major compartments where ovarian tumors can arise?
Surface epithelium
Stroma
Germ cells
Serous tumors type 1 and 2
type 1 progress from benign thru borderline to get to low grade carc
type 2 mostly due to p53 mut, high grade
Serous tumors
Benign
Borderline
Malig/ marker?
benign serious (cystadenoma)- singler layer of cil epith prod yellow/clear fluid, can bey cystic or papillary or solid
- borderline serious: fingerlike prolif, can have compl like bowel obstr, px good if stays in ovary, NO prolif/invazn
- malig serious: (cystadenocarcinoma), similar to borderline but have invasion, can spread to perit, usu bilateral, have marker CA125! (low grade is KRAS/BRAF/HER2 and high grade is p53/BRCA)
Mucinous tumor/ marker
Benign
Borderline
malig
Marker: CEA! kras mut assoc, ascites, etc
- benign: similar to serous but single layer of col mucin-secr epith (similar to intest epith), assoc with fcystic teratomas
- borderline: prolif of epith but no invazn
- malig: stromal invazn, likely bilateral, usu metastatic from GI/pancr/breast
Endometrioid tumor
malig carc, assoc with endometriosis thru PTEN mut
-cx by atypical hyperplasia, can diff into carc and sarc forming MMMT (malig mixed mullerian tumor)
Clear cell carc
aggro, postmeno women, assoc with endometr
-histo: hobnail cells (enlarged nucl bulges into cyto), and vacuolated clear cyto
Brenner tumor
microscopic calc, elongated nuclei (coffee bean nuclei aka grooved nuclei), usu benign but can invade
Germ cell tumor types
Mature cystic teratoma (dermoid cyst)
Immature teratoma
Dysgerminoma
Yolk sac / endodermal sinus tumor
Mature cystic teratoma (dermoid cyst)
tissue from all 3 gemr layers, ectoderm usu, cystic cavity filled with fat and hair (or tooth) and can have irreg calcs, can rupture or cause hemolytic anemia
Immature teratoma
infrequent but can be malig, immature neural tissue, primitive mesenchyma cells, maybe some cartilage etc
dysgerminoma px pop histo gross markers
radiosens, excellent px
- histo: pale clear cells, PAS + clear cyto with intervening stroma/lymphos/plasma cells
- appear in adolescence and assoc with gonadal dysgen like streak ovaries
- gross: solid, lobulated, gray-white
- PAS + and CD117+
Endodermal sinus tumor (yolk sac tumor) pop histo elev
v malig, young kids
schiller-duval bodies, necr/hem
AFP+
Sex cord-stroma tumors
Fibroma/thecoma, granulosa/theca cell tumor, sertoli-leydig cell tumor (androblastoma)
Metastatic tumor to ovaries example
Krukenberg tumor
fibroma/thecoma
gross, assoc
postmeno women, vaginal bleeding
- fibroma is white and thecoma is yellow//fatty
- assoc with Meig’s syndrome (ascites and pleural effusion and basal cell nevus skin/nerv/bone syndrome)
granulosa-theca cell tumor
-histo, elev
makes estrogens leading to precocious puberty, bleeding, carc etc
-histo has call-exner bodies (EMPTY CYTOPLASM), coffee bean nuclei, and inhibin A/B markers
Sertoli-Leydig (androblastoma)
histo
androgenic tumor with masc
-Reinke crystals (eosinophillic)
Krukenberg tumor
histo etc
metastatic from GI tract, has mucin and signet ring cells, usu bilat
What does the chorion do and what is it made of
transfers nutrients to fetus, has villi, has cytotrophoblast and syncytiotrophoblast (which secretes hcg from villi into maternal circulation, preg tests measure this)
chronic follicular salpingitis?
scarring of salping (fallopian tube) after PID, commonly causes ectopic preg
Cornual vs Tubal pregnancy (from chronic follicular salpingitis)
cornual- ectopic preg in intrauterine part of fall tube
tubul- tubal preg thru fimbriated end into abd cavity
Most common cause of hematosalpinx
-when does it occur?
Tubal pregnancy! causes blood in fall tube (know this!), gest sac thins tube and causes rupture causing intraperitoneal hemm
-severe abdominal pain at 6 weeks after period
If monochorionic and monoamniotic past day 13 may mean?
conjoined twins
Gestational Trophoblastic Disease examples
Hyatidform or invasive mole, or chiorcarcinoma, placental site trophoblastic tumors
Which tumors produce HpL (human placental lactogen)
Placental-site trophoblastic tumors
Molar pregancy types and what they are
- Complete hyatidiform mole- fert of empty ovum and have only paternal chrom (more common)
- Partial- triploid gestiations– 2 sperm 1 ovum 2:1 ration of chrom
- Early complete, and
- Invasive molar preg– penetrates musc water of uterus
Placenta previa
placenta overlies exit of cervical canal and req C section for delivery
Preeclampsia
and what is it assoc with
need both HTN and proteinuria (severe is this with one of other stuff like oliguria, CNS, pulm , RUQ pain, hepatocell, thrombo, growth restr, etc)
assoc with hypercoag state
What is NOT preecplamsia?
new onset HTN without proteinuria after 20 wk gestation (if before with new onset then is)
Eclampsia
new onset seizures during preg
abruptio placentae
- what is it
- what is it assoc with
- what must you watch out for
placenta separates from uterus, causing retroperiot hemorr, (hallmark is painful vaginal bleeding in 3rd trim), uterine issues, fetal distress
- assoc with maternal trauma or alc or coke or delv of 1st twin or amniocentesis needle
- underlying htn
- watch out for DIC
Kleihauer-Betke test
and what happens when its not done
acid elution test that measures amount of fetal hb in mothers blood
- impt for Rh- mothers bc determines amt of chemical to inhib Rh ab’s/Rh disease in future
- hydrops erythroblastosis if not done when needed
What indicates intrauterine growth retardation?
measured by large head circumference (head bigger than body is long)
Chrioamnionitis
amniotic fluid infxn, placental infxn is leading cause of premature delviery at <32 wk, nonfatal, usu ascending route
TORCH infections
Toxo, Other (syphilis and viruses), Rubella, CMV, HSV
-titers incl testing for IgG or IgM ab’s (more than one)
does amnion or chorion split first
Amnion! so can be diamnionic monochrionic monozygotic twins
most common time to find ectopic tubal preg
6 wks
When does preeclampsia commonly manifest?
34 weeks of gestation (but earlier in women who have hyatidform mole)
Gestational choriocarcinoma lacks…?
villi
