Pathoma CH. 13 Female Genital System and Gestational Pathology Flashcards
1
Q
What are the anatomical elements of the vulva?
A
Labia majora, labia minora, mons pubis, and vestibule
2
Q
35 y/o patient presents with left sided painful cystic lesion adjacent to the vaginal canal. What type of cyst is most likely causing this unilateral pain and what causes this type of cyst?
A
Bartholin cyst—caused by inflammation and obstruction of the bartholin gland
3
Q
What are the two most common causes of a bartholin cyst?
A
Infection and STDs
4
Q
What are the 2 most common HPV strains causes a condyloma?
A
HPV 6 and 11
5
Q
Warty neoplasm present in the vulvar skin…
A
Condyloma
6
Q
A condyloma can occur secondary to what type of STD other than HPV?
A
Syphilis—less common
7
Q
What histological characteristic does an HPV-associated condyloma have?
A
Koilocytes
8
Q
Raisin/crinkled cells present in HPV-associated condylomas…
A
Koilocytes
9
Q
Why are HPV strain 6 and 11 considered low risk HPV types?
A
The condylomas associated with these strains RARELY develop into carcinoma
10
Q
Name the 4 most common high risk HPV types that can lead to dysplasia and carcinoma…
A
HPV 16, 18, 31 and 33
11
Q
What disorder is associated with thinning of the epidermis and fibrosis of the dermis?
A
Lichen sclerosis
12
Q
A postmenopausal patient presents with leukoplakia (white patch) and parchment-like vulvar skin. What disorder is associated with these findings?
A
Lichen sclerosis
13
Q
Lichen sclerosis is a _____ tumor with an increased risk of ___________.
A
Benign
Squamous cell carcinoma
14
Q
Hyperplasia of the vulvar squamous epithelium…
A
Lichen Simplex Chronicus
15
Q
Patient presents with leukoplakia on thick, leathery vulvar skin and complains of constant irritation and scratching around the area. What is the most likely disorder this patient is presenting with?
A
Lichen Simplex Chronicus
16
Q
Is Lichen Simplex Chronicus benign or malignant? Is there an increased risk of developing a carcinoma from this abnormality?
A
Benign—no increased risk of squamous cell carcinoma
17
Q
Thinning of the vulvar skin is seen in what abnormality?
A
Lichen Sclerosis
18
Q
Thickening of the vulvar skin is seen in what abnormality?
A
Lichen Simplex Chronicus
19
Q
Squamous epithelium lining the vulva can develop into what type of cancer?
A
Vulcar carcinoma
20
Q
What three vulvar disorders present with leukoplakia and why is a biopsy performed?
A
Lichen sclerosis
Lichen simplex chronicus
Vulvar carcinoma
Biopsy performed to distinguish each from one another and to determine if carcinoma
21
Q
A 45 year old woman presents with leukoplakia of the vulvar and it was determined to be caused by vulvar carcinoma. Is the etiology HPV or non-HPV related? Why?
A
HPV— Seen primarily in premenopausal women btwn the ages of 40-50
22
Q
A postmenopausal woman presents with vulvar carcinoma and has a history of lichen sclerosis. Is the etiology HPV or non-HPV related? Why?
A
Non-HPV related—this is due to long standing lichen sclerosis
23
Q
HPV-related vulvar carcinoma is due to what HPV types?
A
High-risk—16,18,31, and 33
24
Q
What are the most common risk factors for HPV related vulvar carcinoma?
A
Multiple partners
Early intercourse
Women of reproductive age
25
What vulvar disease is characterized by koilocytic change, disordered cellular maturation, nuclear atypia and increased mitotic activity? What cancer can develop from this disease?
Vulvar intraepithelial neoplasia
Vulvar carcinoma
26
Malignant epithelial cells in the epidermis of the vulva indicate what?
Extramammary Paget Disease
27
A female patient presents with erythematous, pruritic(itchy), ulcerated vulvar skin. What disease is most likely associated with this presentation?
Extramammary Paget disease
28
Extramammary Paget Disease of the breast will present with or without surrounding cancer?
With—Malignant epithelial cells of the nipple within the epidermis of the nipple will almost always present with underlying carcinoma—Paget disease of the vulva will NOT
29
Extramammary Paget disease of the vulva usually represents carcinoma _______ and will have no underlying carcinoma.
In situ
30
Name the stains used to distinguish Extramammary paget disease of the vulva from melanoma of the vulva…
PAS
Keratin
S100
31
PAS+, keratin+ and S100- will represent Paget cell carcinoma or melanoma?
Paget cells---PAS marks mucous, which only glandular tissue produces mucous—involves the epidermis—so PAS + → Paget
32
PAS-, keratin – and S100+ will represent Paget cell carcinoma or melanoma?
Melanoma---S100+→ melanoma
33
The mucosa of the vagina is lined by what type of epithelium?
Non-keratinizing squamous epithelium
34
This abnormality is characterized by focal persistence of columnar epithelium in the upper vagina…
Adenosis
35
The squamous epithelium from the lower 1/3 of the vagina is derived from what embryological structure?
Urogenital sinus
36
The columnar epithelium from the upper 2/3 of the vagina is derived from what embryological structure?
Mullerian ducts
37
The columnar epithelium of the upper 2/3 of the vagina is normally replaced by the lower 1/3 squamous epithelium. Name the disease where this replacement doesn’t occur and the columnar epithelium remains…
Adenosis
38
A female patient who was previously exposed to diethylstilbestrol (DES) in utero (because it can easily cross the placenta) is at risk for what vaginal disease?
Adenosis—can progress to clear cell adenocarcinoma
39
Malignant proliferation of glands with clear cytoplasm…
Clear cell adenocarcinoma
40
What precursor disease can lead to clear cell adenocarcinoma?
Complication of DES-associated vaginal adenosis
41
Malignant mesenchymal proliferation of immature skeletal muscle…
Embryonal Rhabdomyosarcoma
42
A 4 year old female patient presents with a grape-like mass protruding from the vagina with associated bleeding. What vaginal disorder does this patient most likely have?
Embryonal Rhabdomyosarcoma—also known as sarcoma botryoides—can occur in males and usually in children
43
What are the three characteristic features of Rhabdomyoblast seen in embryonal rhabdomyosarcoma?
1)Cytoplasmic cross-striations
Positive immunohistochemical staining for 2)desmin and 3)myogenin
Desmin—intermediate filament found in skeletal muscle
Myogenin—found in immature skin
44
What carcinoma arises form the squamous epitheliual lining of the vaginal mucosa?
Vaginal carcinoma
45
What HPV types are usually related to vaginal carcinoma?
High-risk—16,18,31, and 33
46
What is the dysplastic precursor for vaginal carcinoma?
Vaginal intraepithelial neoplasia (VAIN)
47
When cancer occurs in the lower 1/3 of the vagina, what regional lymph nodes can it spread to?
Inguinal nodes
48
When cancer occurs in the upper 2/3 of the vagina, what regional lymph nodes can it spread to?
Iliac nodes
49
What are the two division of the Cervix?
Exocervix and endocervix
50
What epithelium lines the exocervix?
Nonkeratinizing squamous
51
What epithelium lines the endocervix?
Single later of columnar cells
52
What is the junction btwn the exo and the endocervix?
Transformation zone
53
Within the cervix, what area is most susceptible to HPV?
Transformation zone
54
Persistent infection of HPV can lead to an increased risk of __________.
Cervical dysplasia---cervical intraepithelial neoplasia (CIN)
55
What are the high-risk HPV types for the development of cervical intraepithelial neoplasia (CIN)?
16,18,31 and 33
56
What are the low-risk HPV types for the development of cervical intraepithelial neoplasia(CIN)?
6 and 11
57
What 2 proteins are produced by high-risk HPV types and what do these proteins cause?
E6 and E7 proteins---cause increased destruction of p53 and Rb, respectively ---loss of tumor suppressor proteins
58
The production of E6 from high-risk HPV types causes destruction of _____.
P53
59
The production of E7 from high-risk HPV types causes destruction of _____.
Rb
60
When high-risk HPV types produce E6 and E7, what cervical abnormality is the patient at an increased risk of developing?
Cervical intraepithelial neoplasia (CIN)
61
What is seen within the cervical epithelium when cervical intraepithelial neoplasia (CIN) occurs?
Koilocytic change
Disordered cellular maturation
Nuclear atypia
Increased mitotic activity
62
A grade of CIN I indicates involvement of…
63
A grade of CIN II indicates involvement of…
64
A grade of CIN III indicates involvement of…
Slightly less than the entire thickness of epithelium
65
Carcinoma in situ (CIS) of the cervical epithelium involves…
The entire thickness of the epithelium
66
What grades of CIN are reversible and which are not?
CIN I,II and III are all reversible---the higher the grade the less likely it is to regress. Carcinoma in situ (CIS) is NOT reversible and is considered metastatic
67
What is the average age range seen for women who develop cervical carcinoma?
40-50 years
68
A 44 y/o female patient presents with postcoital vaginal bleeding with associated discharge. What carcinoma should be considered in this patient based on her presentation?
Cervical carcinoma
69
What are the primary risk factors for cervical carcinoma?
Exposure to high-risk HPVs
70
What are the secondary risk factors for cervical carcinoma?
Smoking and immunodeficiency (AIDS-defining illness)
71
Name the two most common subtypes of cervical carcinoma…
Squamous cell carcinoma (80%) and adenocarcinoma (15%)
*** Both types related to HPV infections***
72
What is a common cause of death seen in advanced cervical carcinoma? Why?
Hydronephrosis with postrenal failure due to the advanced tumor invading the anterior uterine wall, entering the bladder, and blocking the ureters
73
The progression of CIN into carcinoma can take anywhere from _____ to _____ years.
10-20
74
What is the gold standard for screening of cervical carcinoma?
Pap smear
75
When performing a Pap smear, where are the cells scraped from?
Transformation zone of the cervix
76
List the low grade and high grade CINs…
Low grade—CIN I
| High grade---CIN II and CIN III
77
What are the two characteristics of high-grade dysplasia (CIN)?
Cells with hyperchromatic nuclei
| High nuclear to cytoplasmic ratios
78
What is indicated for confirmation after an abnormal Pap smear is discovered?
Confirmatory colposcopy and biopsy
79
What are the 2 major limitations to Pap smears?
Inadequate sampling of the transformation zone
Limited efficacy in screening for adenocarcinoma
80
What are the 4 HPV types that the vaccine covers?
6, 11, 16 and 18
81
What do antibodies against HPV type 6 and 11 protect against?
Condylomas
82
What do antibodies against HPV type 16 and 18 protect against?
CIN(cervical intraepithelial neoplasia) and Carcinoma
83
Why are Pap smears still necessary, even with the vaccine?
Because of the many different HPV subtypes that the vaccine does NOT cover
84
What hormone drives the proliferative phase/growth of the endometrium?
Estrogen
85
What hormone prepares the endometrium for implantation?
Progesterone
86
Loss of progesterone support causes what phase of the female cycle?
Menstrual (shedding) phase
87
Loss of the basalis and scarring causing amenorrhea…
Asherman syndrome
88
What is the cause of Asherman syndrome?
Overaggressive D&C—causing loss of basalis
89
How does an anovulartory cycle occur?
Estrogen-driven proliferative phase occurs WITHOUT a progesterone-driven secretory phase
Overgrowth occurs and the proliferative glands break down causing uterine bleeding
Common cause of dysfunctional uterine bleeding—during menarche and menopause
90
Bacterial infection of the endometrium…
Acute endometritis
91
A 25 year old 1 week post partum women presents with fever, abnormal uterine bleeding and pelvic pain. What is the most likely cause of her symptoms?
Acute Endometrities—due to retained products of conception
92
Chronic inflammation of the endometrium…
Chronic endometritis
93
What is necessary for the diagnosis of chronic endometritis?
Plasma cells—lymphocytes are also present, but are normally found in the endometrium
94
Retained products of conception, chronic pelvic inflammatory disease, IUDs and TB are all causes of chronic _________.
Endometritis
95
Chronic endometritis can present as…
Abnormal uterine bleeding, pain and infertility
96
Hyperplastic protrusion of the endometrium…
Endometrial Polyp
97
Endometrial polyp can arise as a side effect of what drug?
Tamoxifen---anti-estrogenic effects on the breast, BUT pro-estrogenic effects on the endometrium
98
Caused by retrograde menstruation and implantation at ectopic site…
Endometriosis
99
A 31 year old female patient presents with dysmenorrhea (pain during menstruation) pelvic pain and infertility. Upon ultrasound, fluid is found in the ovary and is describe as a ‘chocolate cyst’. What disorder does this patient most likely have?
Endometriosis
100
Where is the most common site of involvement with endometriosis?
Ovary---chocolate cyst
101
If a patient has endometriosis and presents with pelvic pain, what structure is most likely involved?
Uterine ligaments
102
If a patient has endometriosis and presents with pain with defecation, what structure is most likely involved?
Pouch of douglas
103
If a patient has endometriosis and presents with painful urination, what structure is most likely involved?
Bladder wall
104
If a patient has endometriosis and presents with abdominal pain and adhesions, what structure is most likely involved?
Bowel serosa
105
If a patient has endometriosis and presents with ectopic tubal pregnancy, what structure is most likely involved?
Fallopian tube mucosa---scarring increases risk
106
Endometriosis in which the uterine myometrium is involved…
Adenomyosis
107
Occurs as a consequence of unopposed estrogen…
Endometrial hyperplasia
108
Endometrial hyperplasia usually presents as__________ uterine bleeding.
Postmenopausal
109
What two classifications are used when determining the prognosis of endometrial hyperplasia?
Growth pattern—simple or complex
| Presence or absence of cellular atypia
110
What histological finding is the most important predictor for the progression of endometrial hyperplasia to carcinoma?
Presence of cellular atypia
111
Malignant proliferation of endometrial glands…
Endometrial carcinoma
112
Endometrial carcinoma most often presents in _____menopausal women.
Post---bleeding occurs
113
What are the two pathways in which endometrial carcinoma arises?
Hyperplasia (75%)
| Sporadic (25%)
114
What are the risk factors for the hyperplasia pathway of endometrial carcinoma?
```
Estrogen exposure
Early menarche/late menopause
Nulliparity
Infertility
Anovulartory cycles
Obesity
```
115
What is the average age for presentation of hyperplastic endometrial carcinoma?
Age 60
116
Describe the histological appearance of hyperplasia endometrial carcinoma…
Endometrioid→ normal endometrium-like
117
What is the mechanism for the sporadic pathway of endometrial carcinoma?
Carcinoma arises in an atrophic endometrium→ no precursor lesion
118
What is the average age for presentation of sporadic endometrial carcinoma?
Age 70
119
Describe the histological appearance of sporadic endometrial carcinoma…
Serous→ papillary structures with psammoma body formation
120
What is the common mutation that occurs in the sporadic pathway of endometrial carcinoma?
P53 mutation
121
Benign neoplastic proliferation of smooth muscle beginning in the myometrium…
Leiomyoma (fibroids)
122
Leiomyomas are related to ______ exposure.
Estrogen
Premenopausal women
Enlarge during pregnancy
Shrink after menopause
123
Multiple, well-defined, white, whorled masses found within the myometrium…
Leiomyoma (fibroids)
124
What are the symptoms associated with leiomyomas?
Usually asymptomatic, but when present→ abnormal uterin bleeding, infertility, and a pelvic mass
125
Malignant proliferation of smooth muscle beginning in the myometrium, usually present in postmenopausal women…
Leiomyosarcoma
126
Do leiomyosarcomas arise from leipmyomas?
NO—arise de novo
127
Single lesion in the myometrium with areas of necrosis and hemorrhage…
Leiomyosarcoma
128
What are the histological features of a leiomyosarcoma?
Necrosis
Mitotic activity
Cellular atypia
129
What acts on theca cells to induce androgen production?
LH
130
What cells act to convert androgen to estradiol and what induces this?
Granulosa cells stimulated by FSH
131
What two actions occur leading to ovulation?
Estradiol surge→ LH surge
132
After ovulation occurs what does the residual follicle become and what is secreted from this?
Corpus luteum→ secreting progesterone---driving the secretory phase (prep endometrium for possible pregnancy)
133
What occurs when there is degeneration of the follicles?
Follicular cysts
134
Multiple ovarian follicular cysts due to hormone imbalance…
Polycystic ovarian disease (PCOD)
135
What imbalance characterizes polycystic ovarian disease?
Increased LH and low FSH (LH:FSH >2)
136
Hirsutism (excess hair in a male distribution) occurs in women with polycystic ovarian disease. What causes this?
Increased LH inducing excess androgen production→ from the theca cells
137
What is androgen converted to in adipose tissue? What does this cause and what are woman at an increased risk of?
Estrone→ has feedback decreasing FSH→cystic degeneration of follicles
High levels of Estrone put women at increased risk of endometrial carcinoma
138
A 15 year old women presents with obesity, infertility, oligomenorrhea, insulin resistance and hirsutism. What is the most likely diagnosis and what is this patient at an increased risk of developing?
Polycystic ovarian disease
Increased risk of developing type 2 DM due to insulin resistance
139
What are the 3 cells types of the ovary that tumors can arise from?
```
Surface Epithelium (70%)
Germ cells (15%)
Sex cord-stroma
```
140
A surface epithelial tumor of the ovary is derived from what epithelium lining the ovary?
Coelomic epithelium
141
What does the coelomic epithelium produces embryologically?
Fallopian tube
Endometrium
Endocervix
142
What are the two most common subtypes of surface epithelial tumors?
Serous and mucinous
143
Benign surface epithelial tumors (cystadenomas) are most common in…
Premenopausal women age 30-40
144
Describe the histology of a benign surface epithelial tumor (cystadenoma)
Single cyst with a simple, flat lining
145
Malignant surface epithelial tumors (cystadenocarcinomas) are most common in…
Postmenopausal women age 60-70
146
Describe the histology of a malignant surface epithelial tumor (cystadenocarcinoma)
Complex cysts with a thick, shaggy lining
147
What mutation carries an increased risk for the development of serous carcinoma in the ovary and fallopian tube?
BRCA1 mutation
148
Name two subtypes of surface epithelial tumors that a uncommon…
Endometrioid—usually malignant
| Brenner tumor
149
What is an endometrioid surface epithelial tumor associated with?
Endometriosis
150
What type of surface epithelial tumor is composed of bladder-like epithelium and is usually benign?
Brenner tumor
151
What is CA-125 tumor marker useful for?
Useful serum marker used to monitor treatment response and screening for recurrence
152
What are the age ranges in which women are most likely to develop a germ cell tumor?
15-30 y/o-→ reproductive age
153
Name the 4 germ cell tumor subtypes…
Fetal tissue→ cystic teratoma and embryonal carcinoma
Oocytes→ dysgerminoma
Yolk sac→ endodermal sinus tumor
Placental tissue→ choriocarcinoma
154
Cystic tumor composed of fetal tissue derived from 2/3 embryologic layers…
Cystic teratoma
155
A cystic teratoma is most often benign, however the presence of what two aspects will indicate malignant potential?
Immature tissue
| Somatic malignancy→squamous cell carcinoma of the skin
156
Teratoma composed primarily of thyroid tissue…
Struma ovarii
157
A tumor composed of large cells with clear cytoplasm and a central nuclei and is the most common malignant germ cell tumor…
Dysgerminoma
158
What is the testicular counterpart to a dysgerminoma?
Seminoma
159
The serum level of what substance may be elevated due to a dysgerminoma?
LDH
160
A malignant tumor that mimics the yolk sac and is the most common germ cell tumor is young children…
Endodermal sinus tumor
161
The serum level of what substance is often elevated in the presence of an endodermal sinus tumor?
Serum AFP
162
What structures are classically seen on histology where an endodermal sinus tumor is present?
Schiller-Duval bodies (glomerulus-like structures
163
Malignant tumor composed of cytotrophoblasts and syncytiotrophoblasts mimicking placental tissue and does NOT response well to chemotherapy…
Choriocarcinoma→ small hemorrhagic tumor with early hematogenous spread
164
What substance is elevated in the presence of a Choriocarcinoma and what can this lead to?
Elevated B-hCG—produced by the syncytiotrophoblasts, which may lead to thecal cysts in the ovary
165
Sex cord-stromal granulosa-theca cell tumors will often present with signs of estrogen excess, why and what will this cause for pre-puberty, reproductive age, and postmenopausal women.
These tumors often produce estrogen
Pre-puberty→ precocious puberty
Reproductive age→ menorrhagia or metrorrhagia
Post menopausal (most common)→ endometrial hyperplasia with postmenopausal uterine bleeding
166
What sex cord-stromal tumor can produce androgen, which can lead to hirsutism and virilization in women?
Sertoli-Leydig cell tumor
167
What sex cord-stromal tumor is characterized by Reinke crystals?
Sertoli-Leydig cell tumor
168
A benign tumor of fibroblasts…
Fibroma
169
Meigs syndrome is associated with a fibroma. What is Meigs syndrome?
Pleural effusions and ascites
170
Metastatic mucinous tumor involving both ovaries→ commonly due to metastatic gastric carcinoma…
Krukenberg tumor→ usually seen bilaterally—which helps distinguish it from primary mucinous carcinoma of the ovary (seen unilaterally)
171
What helps distinguish a Krukenberg tumor of the ovaries from a primary mucinous carcinoma of the ovary?
Krukenberg tumor of the ovaries is bilateral
| Primary mucinous carcinoma of the ovary is unilateral
172
Large amount of mucus in the peritoneum caused by a mucinous tumor of the appendix…
Pseudomyxoma
173
Implantation of fertilized ovum at a site other than the uterine wall…
Ectopic Pregnancy
174
Where is the most common site for an ectopic pregnancy to occur?
Lumen of the fallopian tube
175
What is the classic presentation of an ectopic pregnancy?
Lower quadrant abdominal pain occurring a few weeks after a missed period
176
A miscarriage occurring before 20 weeks gestation…
Spontaneous abortion
177
A women who is 14 weeks pregnant presents to her OB/GYN with vaginal bleeding, crampy pain and spotting. What is the most likely complication that occurred?
Spontaneous abortion
178
What are some common causes of a spontaneous abortion?
Chromosomal anomalies (especially trisomy 16)
Hypercoagulable states
Congenital infection
Exposure to teratogens
179
Name the teratogen that is the most common cause of mental retardation…
Alcohol
180
Name the teratogen that can lead to facial abnormalities and microcephaly…
Alcohol
181
Name the teratogen that can lead to IUGR and placental abruption…
Cocaine
182
Name the teratogen that an lead to limb defects…
Thalidomide
183
Name the teratogen that can lead to IUGR…
Cigarette smoke
184
Name the teratogen that can lead to a spontaneous abortion…
Isotretinoin
185
Name the teratogen that can lead to hearing and visual impairment…
Isotretinoin
186
Name the teratogen that can lead to discolored teeth…
Tetracycline
187
Name the teratogen that can lead to fetal bleeding…
Warfarin
188
Name the teratogen that can lead to digit hypoplasia and cleft lip/palate…
Phenytoin
189
Implantation of the placenta in the lower uterine segment overlying the cervical os…
Placenta previa---presents as 3rd trimester bleeding and often requires c-section
190
Separation of the placenta form the decidua prior to delivery…
Placental abruption—3rd trimester bleeding and fetal insufficiency
191
Implantation of the placenta into the myometrium with little or no intervening decidua presenting with difficult delivery of the placenta…
Placenta accreta
192
Pregnancy-induced HTN, proteinuria and edema…
Preeclampsia
Fibrinoid necrosis occurs due to the HTN
193
What is the cause of preeclampsia?
Abnormality of the maternal-fetal vascular interface in the placenta
194
What signals the beginning of eclampsia?
Seizures
195
What is HELLP syndrome?
HELLP is preeclampsia with thrombotic microangiopathy involving the liver
Hemolysis/Elevated Liver enzymes/Low Platelets
196
Death of a healthy infant 1 month→1 year old…
Sudden Infant Death Syndrome
197
What are risk factors for SIDS (Sudden Infant Death Syndrome)?
Sleeping on stomach
Exposure to cigarette smoke
Prematurity
198
Swollen and edematous villi with proliferation of trophoblasts seen during an abnormal pregnancy…
Hydatidiform mole
199
A normal ovum fertilized by two sperm creates what type of molar pregnancy and how many chromosomes are present?
Partial—has 69 chromosomes
200
An empty ovum fertilized by two sperm creates what type of molar pregnancy and how many chromosomes are present?
Complete—has 46 chromosomes
201
In what type of molar pregnancy in fetal tissue present? Absent?
Partial→ present
| Complete→ absent
202
Describe the villous edema in a partial mole pregnancy…
Some villi are hydropic and some are normal
203
Describe the villous edema in a complete mole pregnancy…
Most villi are hydropic
204
What are the risks of developing choriocarcinoma from a partial mole pregnancy and a complete mole pregnancy?
Partial—minimal
| Complete—2-3%
205
What two aspects of a pregnancy are abnormal when a molar pregnancy occurs?
Uterus is much larger
| B-hCG is much higher than expected for date of gestation
206
A patient with a molar pregnancy who has had no prenatal care will usually present…
In second trimester after passage of a grape-like mass through the vaginal canal
207
A patient with a molar pregnancy who has had prenatal care will usually present…
In first trimester for routine ultrasound and fetal heart sounds will be absent and a snowstorm appearance will be seen on ultrasound
208
What is the treatment for a molar pregnancy?
Suction curettage
209
Why is B-hCG monitoring important after D&C of molar pregnancy?
Ensure adequate removal
| Screen for development of choriocarcinoma
210
When will choriocarcinomas respond well to chemotherapy and when will they NOT?
When they arise from gestational pathway (molar pregnancy) they respond well to chemo
When they arise from the germ cell pathway they do not respond well
