Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Endo/Repro > Ovaries > Flashcards

Ovaries Flashcards

1
Q

What may patients present with that suggest ovarian causes?

A
  • Asymptomatic
  • Vaginal bleeding
  • Infertility
  • Hirsutism/virilization
  • Pain
  • Mass
  • Increasing abdominal girth
  • Weight loss or gain
  • History of recurrence or other medical condition
  • Systemic disease or syndrome
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the most common lesions encountered in the ovary?

A
  • Functional or benign cysts or tumors
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Where do cystic follicles originate?

A
  • Originate from unruptured Graafian follicles or in follicles that have ruptured and immediately sealed
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What do cystic follicles look like?

A
  • Usually multiple
  • Range in size up to 2 cm
  • Filled with clear serous fluid and are lined by a gray, glistening membrane
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is a follicle cyst?

A
  • Cysts greater than 2cm can be felt on palpation or during ultrasound (follicle cyst)
  • May cause pelvic pain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is a luteal cyst?

A
  • Present in normal ovaries of women of reproductive age
  • Lined by a rim of bright yellow tissue containing luteinized granulosa cells and are prone to rupture (cause peritoneal reaction)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is polycystic ovarian syndrome (PCOS)?

A
  • Multiple cysts (cystic follicles that don’t mature) combined with:
  • Hyperandrogenism
  • Menstrual irregularities
  • Chronic anovulation
  • Decreased fertility
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is PCOS associated with?

A
  • Obesity
  • T2DM
  • Premature atherosclerosis
  • Increased free serum estrone (E1)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is E1? What does it do?

A
  • Estrone
  • Menopausal estrogen produced by aromatization of androstenedione in peripheral fatty tissue
  • Less potent than E2
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is E2? What does it do?

A
  • Estradiol
  • Predominates in reproductive years
  • Most potent estrogen produced by aromatization of testosterone in Graafian follicle
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is E3? What does it do?

A
  • Estriol
  • Placental estrogen that originates in fetal adrenal gland and DHEA and converted in placenta
  • Least potent
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are some symptoms of PCOS?

A
  • Menstrual disorder/amenorrhea
  • Infertility
  • Hirsutism/male pattern baldness/acne
  • Obesity/metabolic syndrome
  • Diabetes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What ages are benign ovarian tumors seen in?

A
  • Women 20-45

- 80% of ovarian tumors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What age are malignant ovarian tumors seen in?

A
  • Women 45-65
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How are benign ovarian tumors found?

A
  • Unexpectedly on abdominal or pelvic exam

- Maybe during a different surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

When do benign ovarian tumors start to produce symptoms?

A
  • When they are large in size
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are the most common symptoms of ovarian tumors?

A
  • Abdominal pain and distention
  • Urinary and GI tract symptoms due to compression by the tumor or cancer invasion
  • Vaginal bleeding
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How are primary ovarian neoplasms grouped?

A
  1. Surface (müllerian) epithelium
  2. Germ cells
  3. Sex cord-stromal cells
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are some epithelial ovarian tumors?

A
  • Serous
  • Mucinous
  • Endometrioid
  • Clear cell
  • Brenner
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are some germ cell ovarian tumors?

A
  • Teratoma
  • Dysgerminoma
  • Yolk sac tumor
  • Mixed GC tumors
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are some sex cord-stromal ovarian tumors?

A
  • Granulosa tumors
  • Fibromas/Thecomas
  • Sertoli-Leydig cell tumors
  • Hilus (leydig) cell tumor
  • Gonadoblastoma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are some metastatic (non ovarian) tumors?

A
  • Appendiceal
  • Gastric
  • Breast
  • Pancreaticobiliary
  • Colonic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Where do most primary ovarian neoplasms of the ovary come from?

A
  • Müllerian epithelium
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is the classification based off of for tumors?

A
  • Differentiation and extent of proliferation of the epithelium
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What are the three major histologic types of tumors based on differentiation of the neoplastic epithelium?

A
  1. Serous
  2. Mucinous
  3. Endometrioid
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

How are the epithelial proliferations classified?

A
  • Benign
  • Borderline
  • Malignant
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What are the subclassifications of benign tumors?

A
  • Cystadenoma (includes cystic areas)
  • Cystadenofibroma (has cystic and fibrous areas)
  • Adenofibroma (predominantly fibrous areas
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What are borderline and malignant tumors called when they have a cystic component?

A
  • Cystadenocarcinoma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Which tumor has the highest incidence of being bilateral?

A
  • Malignant

- Metastatic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What are some high risk features of malignant serous ovarian tumors?

A
  • Women with low parity

- Inherited germline mutations of the BRCA1 and BRCA2 gene

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What are some features that decrease risk of malignant serous ovarian tumors?

A
  • Women 40-59 who have taken oral contraceptives or undergone tubal ligation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What does the biologic behavior of serous tumors depend on?

A
  • Degree of differentiation and the distribution

- Characteristics of the disease in the peritoneum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

How do low grade (type 1) carcinomas progress?

A
  • Even after spread outside ovary, they progress slowly

- Patients survive for relatively long periods before dying of disease

34
Q

What mutations are present in low grade tumors arising in serous borderline tumors?

A
  • KRAS, BRAF, or ERBB2 oncogenes

- Usually have wild type TP53

35
Q

How do high grade (type 2) carcinomas progress?

A
  • Often widely metastatic throughout abdomen at the time of presentation
  • Associated with rapid clinical deterioration
36
Q

What mutations are present in high grade tumors?

A
  • High frequency of TP53 mutations

- Lack of mutation in KRAS or BRAF

37
Q

What are all ovarian carcinomas in women with BRCA1 or BRCA2 mutations?

A
  • High grade serous carcinomas with TP53 mutations
38
Q

How do mucinous tumors differ from serous tumors?

A
  • Surface of the ovary is rarely involved

- Only 5% of primary mucinous cystadenomas and mucinous carcinomas are bilateral

39
Q

What is a consistent genetic alteration in mucinous tumors of the ovary?

A
  • Mutation of the KRAS proto-oncogene
40
Q

What is seen with endometrioid carcinoma?

A
  • In about 15%-20% of cases, there is endometriosis as well

- Peak incidence of tumors is a decade earlier than those without endometriosis

41
Q

What other carcinoma is seen with endometrioid carcinoma?

A
  • Carcinoma of the endometrium

- The relatively good prognosis in such cases suggests that the two arise independently

42
Q

What is the presentation of most ovarian tumors?

A
  • Weakness, weight loss –> cachexia
  • Peritoneal disease –> ascites/omental cake
  • With mets –> Liver, lungs, GI, opposite ovary
43
Q

How is the diagnosis of an ovarian tumor made?

A
  • Be clinically suspicious
  • Imaging
  • Tissue/cytology
  • Staging by surgery or imaging
  • Serum tumor markers +/-
44
Q

What are the three categories of tertomas?

A
  1. Mature (benign)
  2. Immature (malignant)
  3. Monodermal or highly specialized
45
Q

How are most benign teratomas?

A
  • Cystic and referred to as dermoid cysts because they are almost always lined by skin-like structures
46
Q

Who are cystic teratomas usually found?

A
  • In young women during the active reproductive years
47
Q

How are cystic teratomas usually found?

A
  • Incidentally but are occasionally associated with clinically important paraneoplastic syndromes like inflammatory limbic encephalitis (may remit upon removal of tumor)
48
Q

What are some specialized teratomas?

A
  • Struma ovarii and carcinoid ovarian tumor

- Almost always unilateral

49
Q

What is struma ovarii composed of?

A
  • Mature thyroid tissue, which may be functional and cause hyperthyroidism
50
Q

What do carcinoid tumors arise from?

A
  • Intestinal tissue found in teratomas may also be functional
51
Q

What can carcinoid tumors produce if large enough?

A
  • 5HT to cause the carcinoid syndrome even in the absence of hepatic metastases because ovarian veins connect directly to the systemic circulation
52
Q

How do immature malignant teratomas differ from benign teratomas?

A
  • Components resemble embryonal and immature fetal tissue
53
Q

Who is most likely to have an immature malignant teratoma?

A
  • Prepubertal adolescents and young women (mean age is 18)
54
Q

How is grading done for immature malignant teratomas?

A
  • Based on the proportion of the tumor that is comprised of immature epithelium
55
Q

What is a dysgerminoma?

A
  • Ovarian counterpart of testicular seminoma
56
Q

When does a dysgerminoma occur?

A
  • May occur in childhood but 75% occur in the second and third decade
57
Q

Who is most affected by dysgerminomas?

A
  • Patients with gonadal dysgenesis like pseudohermaphroditism
58
Q

What can dysgerminomas produce?

A
  • Elevated levels of chorionic gonadotropin which correlates with the presence of syncytiotrophoblastic giant cells
59
Q

What is a yolk sac tumor (endodermal sinus tumor)?

A
  • Second most common malignant ovarian tumor of germ cell origin
  • Though to be derived from malignant germ cells that are differentiating along the extraembryonic yolk sac lineage
60
Q

What do the tumor cells in yolk sac tumors elaborate?

A
  • a-fetoprotein
61
Q

What do yolk sac tumors look like histologically?

A
  • Glomerulus like structure composed of a central blood vessel enveloped by tumor cells within a space that is also lined by tumor cells (the Schiller-Duval body)
62
Q

What are granulosa cell tumors comprised of?

A
  • Cells that resemble granulosa cells of a developing ovarian follicle
  • Broadly divided into adult and juvenile granulosa cell tumors based on age of patient
63
Q

What age is most affected with granulosa cell tumors?

A
  • May be discovered at any age, most occur in postmenopausal women
64
Q

How would a adult granulosa cell tumor present?

A
  • Dysfunctional Uterine Bleeding
  • Endometrial hyperplasia
  • Endometrial carcinoma
  • Proliferative breast disease
65
Q

How would a juvenile granulosa cell tumor present?

A
  • Early breast development
  • Early menarche
  • Pubic or underarm hair
66
Q

What do granulosa cell tumors look like?

A
  • Usually unilateral and vary from microscopic foci to lare, solid, and cystic encapsulated masses
  • Tumors that are hormonally active have a yellow coloration to their cut surfaces, due to intracellular lipids
67
Q

What is histological diagnostic feature of granulosa cell tumors?

A
  • Small, distinctive, glandlike structures filled with an acidophilic material that resemble immature follicles
  • Called Call-Exnar bodies
68
Q

What are fibromas?

A
  • Unilateral tumors that are usually solid, spherical, or slightly lobulated, encapsulated, hard, gray-white masses covered by glistening, intact ovarian serosa
69
Q

How do fibromas come to attention?

A
  • As pelvic masses, sometimes associated by pain and two decidedly curious associations (ascites and basal cell nevus syndrome)
70
Q

What is Meigs syndrome?

A
  • Combination of ovarian tumor, hydrothorax, and ascites
71
Q

What are sertoli-leydig cell tumors?

A
  • Often functional
  • Produce masculinization or defeminization but a few have estrogenic effects
  • Recapitulate testicular sertoli or leydig cells at various stages of development
72
Q

When is the peak incidence of sertoli-leydig cell tumors?

A
  • Second and third decades
73
Q

What do sertoli-leydig cell tumors cause?

A
  • They block normal female sexual development in children
  • May cause defeminization of women manifested by atrophy of breasts, amenorrhea, sterility, and loss of hair
  • May progress to striking virilization associated with male hair distribution, hypertrophy of clitoris, and voice changes
74
Q

What are hilus cell tumors?

A
  • Rare, unilateral tumors comprised of large lipid-laden leydig cells with distinct borders and characteristic cytoplasmic structures called Reinke crystalloids
75
Q

How do women with hilus cell tumors present?

A
  • Evidence of masculinization (hirsutism, voice changes, and clitoral enlargement) but changes are milder than those seen in sertoli-leydig cell tumors
76
Q

What is a gonadoblastoma?

A
  • Uncommon tumor composed of germ cells and sex cord stromal derivatives resembling immature sertoli and granulosa cells
77
Q

Who is affected by gonadoblastomas?

A
  • Individuals with abnormal sexual development and in gonads of indeterminate nature (80% in phenotypic females and 20% in phenotypic males with undescended testes)
  • Turner syndrome and Denys-Drash syndrome
78
Q

What is the most common locations of tumors that metastasize to the ovaries?

A
  • Lungs and GI
79
Q

What is a tumor in the ovaries called that originated somewhere else?

A
  • Krukenberg tumor
80
Q

What is a histological appearance in some Krukenberg tumors?

A
  • Signet ring appearance, most often from gastric mucosa
81
Q

What is an ovarian torsion?

A
  • Infrequent but significant cause of acute lower abdominal pain
  • Peak median age of 28 and second peak of postmenopausal
  • Fallopian tube is often involved
82
Q

What can happen if ovarian torsion is not diagnosed and treated?

A
  • Can lead to vascular compromise of adnexa and subsequent infarction

Endo/Repro (31 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions