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Module 6: Repro/Endocrine > Pathology: Female Genital System Continued > Flashcards

Pathology: Female Genital System Continued Flashcards

1
Q

What is the result of hormones on endometrium?

A

Estrogen: Growth of endometrium
(Proliferative phase)

Progesterone: Preparation of endometrium for implantation
(Secretory phase)

Remove progesterone and shedding occurs

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2
Q

What is Asherman Syndrome?

A

Secondary amenorrhea due to loss of basalis (regenerative layer of endometrium) and scarring

  • Results from overaggressive dilation and curettage
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3
Q

What is anovulatory cycle?

A

Lack of ovulation

  • Results in estrogen-driven proliferative phase without progesterone-driven secretory phase
  • Common cause of dysfunction uterine bleeding, especially during menarche and menopause
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4
Q

What is acute endometritis? Common causes?

A

Bacterial infection of endometrium

  • Presents as:
    Fever
    Abnormal Uterine Bleeding
    Pelvic Pain
  • Usually due to retained products of conception
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5
Q

What is chronic endometritis?

A

Chronic inflammation of endometrium

  • Characterized by plasma cells
  • Common causes include:
    retained products of conception
    chronic PID
    IUD
    TB (would also see granulomas)
  • Presents with:
    Abnormal uterine bleeding
    pelvid pain
    infertility
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6
Q

What is an endometrial polyp?

A

Hyperplastic protrusion of endometrium

  • Presents as abnormal uterine bleeding
  • can arise as side effect of tamoxifen
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7
Q

What is endometriosis?

A

Endometrial glands AND stroma outside the uterine endometrial lining

  • Presents with dysmenorrhea and pelvic pain; may cause infertility
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8
Q

What are the current theories on how endometriosis develops?

A

1. Retrograde Theory: products of menstruation go backward through uterus out the fallopian tubes into the abdominal cavity (prevailing theory)

  1. Metaplastic Theory: Endometrial metaplasia is cause of endometriosis
  2. Lymphatic Dissemination theory: endometrium spreads into lymphatics and into the rest of the body
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9
Q

What are the most common sites of endometriosis involvement?

A

Ovary - Chocolate cysts

Uterine ligaments - pelvic pain

Pouch of Douglas - pain with defecation

Bladder wall - pain with urination

Bowel serosa - abdominal pain and adhesions

Fallopian tube mucosa - scarring –> infertility and ectopic pregnancy

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10
Q

What is adenomyosis?

A

Presence of endometriosis in the uterine myometrium

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11
Q

Where does endometriosis have an increased risk of carcinoma?

A

At the site of endometriosis

  • Especially when the ovary is involved
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12
Q

What is endometrial hyperplasia? What drives this process?

A

Hyperplasia of endometrial glands relative to stroma

  • Consequence of unopposed estrogen
  • Presents as postmenopausal (no longer has a progesterone phase) uterine bleeding
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13
Q

How is endometrial hyperplasia classified?

A

Based on architectural growth and cellular atypia

  • Most important predictor for progession to carcinoma is cellular atypia
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14
Q

What is the clinical presentation of endometrial carcinoma?

A

Malignant proliferation of endometrial glands

  • Presents as postmenopausal bleeding
  • arises via two distinct pathways: hyperplasia due to unopposed estrogen (endometrioid) and sporadic production of cancer from atrophic endometrium (serous with papillary structures)
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15
Q

What ages area associated with endometrial cancer?

A

Sporadic pathway: woman >70yrs old

Hyperplastic pathway: woman ~50-60yrs old

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16
Q

What are characteristics of the hyperplastic pathway of endometrial carcinoma?

A

Carcinioma arises from endometrial hyperplasia

  • Risk factors are related to estrogen exposure (unopposed estrogen leads to endometrial hyperplasia)
  • Average age is 60yrs old
  • Histology is endometrioid
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17
Q

What are characteristics of the sporadic pathway of endometrial carcinoma?

A

Carcinoma arises in atrophic endometrium

  • No evident precursor lesion
  • Average age is 70yrs old
  • Histology is usually serous and papillary
    Psammomma bodies may be evident
  • Driven by p53 mutations
  • Very aggressive behavior
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18
Q

Where are psammoma bodies seen?

A

Papillary serous carcinoma of the endometrium

Papillary carcinoma of Thyroid

Meningioma

Mesothelioma

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19
Q

What is Leiomyoma?

A

Benign proliferation of smooth muscle arising from myometriium

  • Related to estrogen exposure
  • Multiple, well-defined white whorled masses
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20
Q

What are the symptoms of a leiomyoma?

A

Most common symptom: Asymptomatic

Any presentation otherwise is a derivative of the leiomyoma:

Stretching uterine lining = abnormal uterine bleeding
Block the ability of the ovum to implant = infertility
Pelvic mass detected

21
Q

What are characteristics of leiomyosarcoma?

A

Malignant mesenchymal proliferation of smooth muscle arising from the myometrium

- Arises de novo (leiomyoma DOES NOT become leiomyosarcoma)

  • Usually seen in postmenopausal women
  • Single lesion with necrosis and hemorrhage
  • Necrosis, mitotic activity, and cellular atypia
22
Q

What are the three cell types of the ovary, where do they come from, and what type of tumor arises from them?

A

Surface epithelium: lines the surface of the ovar, derive surface epithelial tumors

Germ cells: from the oocyte, creates germ cell tumors

Sex cord stroma: from granuloma, theca, and fibroblast cells that support the oocyte, creates sex cord stromal tumor

23
Q

What are surface epithelial tumors? What are the two most common subtypes?

A

Most common type of ovarian tumor

  • Derived from coelomic epithelium that lines the ovary
  • Two most common subtypes of surface epithelial tumors are serous and mucinous (both usually cystic)
24
Q

What is a cystadenoma?

A

Benign tumor composed of single cyst with simple, flat lining

  • Most common in premenopausal women (30-40)

(can be serous or mucinous, depending on epithelium)

25
Q

What is a cystadenocarcinoma?

A

Malignant, epithelial tumor composed of complex cysts with thick, shaggy lining

–> clear invasion of cells into the connective tissue

  • Most commonly arises in post menopausal women (60-70yrs old)
  • Can be serous or mucinous, depending on epithelium
26
Q

What are borderline tumors?

A

Tumors with features between benign and malignant

–> better prognosis than clearly malignant tumors, but still carry metastatic potential

27
Q

What does BRCA1 mutation increase risk for?

A

Increased risk of breast cancer as well as serous carcinoma of the ovary and fallopian tube

28
Q

What are the four types of surface epithelial ovarian tumors?

A

Serous - can be benign, borderline, or malignant

Mucinoid - can be benign, borderline, or malignant

Endometrioid - usually malignant

Brenner

29
Q

What are characteristics of endometrioid tumors?

A
  • Usually malignant, surface epithelial tumor of the ovary that resembles endometrium
  • May be associated with endometriosis
  • 15% of patients have separate endometrioid carcinoma in uterus
30
Q

What type of cells make up a Brenner tumor?

A

Usually contains urothelium

31
Q

What is the presentation of surface epithelial tumors?

A

Present late, leading to poor prognosis

  • Vague abdominal symptoms; pain, fullness
  • Epithelial carcinomas tend to spread locally, especially to peritoneum
  • Useful serum marker to monitor treatment: CA-125
32
Q

What are characteristics of Germ cell tumors?

A

2nd most common ovarian tumor

  • Usually occur in women of reproductive age
  • Subtypes mimic tissues normally produced by germ cells
33
Q

What ovarian tumor would I suspect for a woman of:

15-30yrs old

35-40yrs old

60-70yrs old

A

15-30 yrs old: Germ cell tumor

35-40 yrs old: Benign surface epithelial tumor

60-70 yrs old: Malignant surface epithelial cell tumor

34
Q

What are the types of germ cell tumors?

A
  • Cystic teratoma
  • Embryonal Carcinoma
  • Yolk Sac Tumor
  • Dysgerminoma (mass of germ cells)
  • Choriocarcinoma
35
Q

What is a cycstic teratoma?

A

Benign, cystic tumor composed of fetal tissue derived from two or three embryological layers

  • Most common germ cell tumor in females
  • bilateral in 10% of cases
36
Q

What could lead to a potential malignancy with a cystic teratoma?

A

Presence of immature tissue (most commonly neural ectoderm) or somatic malignancy in the mature tissue of the teratoma

37
Q

What is the most common somatic malignancy of teratomas?

A

Sqamous cell carcinoma of the epithelium in the teratoma

38
Q

What is struma ovarii?

A

Cystic teratoma composed primarily of thyroid tissue

  • Can lead to hyperthyroidism because teratoma has hyperfunctioning thyroid tissue
39
Q

What is Dysgerminoma?

A

Compoosed of large cells with clear cytoplasm and central nuclei (look like an oocyte/germ cell)

  • Most common malignant germ cell tumor
  • Testicular counterpart is seminoma
  • Good prognosis, responds to radiotherapy
  • Serum LDH may be elevated
40
Q

What is an endodermal sinus tumor?

A

Malignant tumor that mimics yolk sac

  • Most common germ cell tumor in children
  • Serum AFP is often elevated
  • Schiller-duval bodies are seen in histology (same as testicular yolk sac tumors)
41
Q

What is choriocarcinoma?

A

Malignant proliiferation of placental-like tissue

  • Composed of trophoblasts (syncytiotrophoblasts and cytotrophoblasts) –> villi are absent
  • Small, hemorrhagic tumor with early hematogneous spread (due to syncytiotrophoblasts ability to infiltrate vasculature)
  • High ß-HCG
  • Poor response to chemotherapy
42
Q

What is an embryonal carcinoma?

A

Composed of large, primitive cells

  • Aggressive with early metastasis
43
Q

What are characteristics of granulosa-theca cell tumor?

A

Neoplasm of granulosa and theca cells

  • often produces estrogen
  • presents with signs of estrogen excess (symptoms vary with age)
44
Q

What is a sertoli-leydig cell tumor?

A

Tumor that mimics sex cord-stromal cells of testicle

  • Sertoli cells form tubules
  • Leydig cells contain characteristic Reinke crystals
  • May produce androgen; associated with hirsutism or virilization
45
Q

What are characteristics of fibromas?

A

Benign tumor of fibroblasts

  • Associated with pleural effusion and ascites (Meigs syndrome)
46
Q

What is a Kruckenberg tumor?

A

Mucinous carcinoma from some site outside the ovary that metastasizes and spreads to both ovaries

  • primary site can arise from:
  • *gastric carcinoma** (diffuse subtype with signet ring cells where mucus has displaced the nucleus)
  • *breast tumor** (lobular carcinoma - also has signet ring cells)
  • *colon cancer**
47
Q

What is pseudomyxoma peritonei?

A

Classically known as “Jelly Belly”

  • Primary source of tumor is usally a tumor in appendix which produces abundant mucus in peritoneum
48
Q

How do you grossly determine if a mucinous tumor is primarily ovarian or kruckenberg?

A

Kruckenberg = bilateral

Surface epithelial mucinous tumor = unilateral

*Most likely

49
Q
A

Module 6: Repro/Endocrine (28 decks)

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