Placental Phys / Uterine Path / Ovary & Fall Tube Path Flashcards
1
Q
Ability for each of the following to cross the placental barrier:
- IgG & IgM
- EtOH
- Bacteria & Viruses
- Heparin
- Insulin
- Barbiturates
- Thyroid Hormone
- Anesthetic Gases
A
Can cross:
- IgG
- Viruses
- Barbiturates
- Anesthetic Gases
Cannot cross:
- IgM
- Bacteria
- Heparin
- Insulin
- Thyroid Hormone
2
Q
What is the function of Chorionic Somatomammotropin (CSM)?
A
Anti-insulin action—favors protein synthesis and hyperglycemia
3
Q
Pregnancy - increased or decreased lipolysis?
A
Increased (increases fatty acid levels)
4
Q
How do Estrogen & Progesterone in a pregnant woman compare to their levels in a non-pregnant woman?
A
Estrogen
• 1000x that of ovulatory woman
Progesterone
• 250x nonpregnant levels
5
Q
Endometrial Polyp - Pathology?
A
Localized overgrowth of endometrium covered by epithelium and containing gland, stroma and blood vessels
6
Q
T or F?
An endometrial polyp contains endometrium & stroma, but no glands.
A
False. It is a localized overgrowth of endometrium covered by epithelium and containing gland, stroma and blood vessels
7
Q
Endometrial Polyp - Incidence & Age group?
A
Occur in 20-25% of women usually between ages 30 to 50
8
Q
Endometrial Polyp - Symptoms?
A
– Usually no symptoms
– Intermenstrual bleeding
– Menometrorrhagia (heavy or frequent menses)
9
Q
Endometrial Polyp- Dx & Tx?
A
– Endometrial biopsy
– D&C +/- Hysteroscopy
10
Q
Most frequent pelvic tumors?
A
Leiomyoma
11
Q
Leiomyoma - Pathology?
A
– Benign neoplasm arising from monoclonal population of smooth muscle cells
– Growth stimulated by estrogen
also…
- They can arise in the myometrium (intramural), project into the endometrium (submucous), or project out along the serosa (subserosal).
- They can also be found in the cervix, round ligament, broad ligament or fallopian tube.
12
Q
Leiomyoma - Incidence in Caucasian vs. African-American women?
A
– 25% Caucasian women
– 50% African American women
13
Q
Leiomyoma - Symptoms?
A
– Most asymptomatic
– Dysmenorrhea, menorrhagia, intermenstrual bleeding
– Infertility, recurrent miscarriage
– Pelvic pressure; acute pain with degeneration
– Urinary frequency
– Dyspareunia
14
Q
What is “dyspareunia”?
A
Painful sexual intercourse
15
Q
Leiomyoma - Diagnosis?
A
– Physical examination
– Ultrasound
– CT scan or MRI
16
Q
Leiomyoma uteri - Tx?
A
• Observation
• Hormonal therapy
– Pseudomenopause with GnRH agonists (leuprolide acetate, goserelin acetate, nafarelin acetate)
• Surgery (myomectomy, hysterectomy)
• Uterine artery embolization (UAE) (causes pain, which is managed w/ NSAIDS)
• MR guided focused ultrasound
17
Q
Adeonmyosis - Pathology?
A
Endometrial stoma and glands within the myometrium
18
Q
Adenomyosis - Incidence & Age group?
A
– May be present in as many as 60% of uteri
– Usually in women over age 40
19
Q
Adenomyosis - Symptoms?
A
– Asymptomatic
– Dysmenorrhea
– Metrorrhagia, dyschezia, dyspareunia
20
Q
Adenomyosis - Dx?
A
– Physical exam
– Hysteroscopy; Hysterogram; MRI
– Hysterectomy
**Dx is made pathologically following hysterectomy
21
Q
Adenomyosis - Tx (management)?
A
– GnRH agonists, cyclic hormones, progesterone releasing IUD
– Hysterectomy
22
Q
Endometrial Hyperplasia - Symptoms?
A
– None
– Intermenstrual bleeding or spotting
– Metrorrhagia/Menorrhagia
– Postmenopausal bleeding or spotting
23
Q
Endometrial Hyperplasia - Dx?
A
– Endometrial biopsy D&C
– D&C/Hysteroscopy
24
Q
Endometrial Hyperplasia - Cause?
A
Unopposed estrogen stimulation causes excessive proliferation of the glandular portion of the endometrium
- Anovulatory cycle
- Inc’d aromatization of androgens in obese patients
(progesterone normally counteracts these proliferative effects, leading to stabilization and thinning of the endometrial lining)
25
Endometrial Hyperplasia - Tx?
• Hormonal Therapy:
– Medroxyprogesterone acetate (Provera)
– Hydroxyprogesterone (Delautin)
– Progesterone IUD (Mirena)
• Hysterectomy
26
Endometrial Carcinoma - Sx?
* Postmenopausal bleeding or spotting
* Clear or purulent vaginal discharge
* Intermenstrual spotting
* Menorrhagia/Metrorrhagia
27
Endometrial Carcinoma - Dx?
* Sampling the uterine lining:
* Endometrial biopsy
* Dilation and Curettage (D&C)
* Hysteroscopy
28
Endometrioid endometrial cancer is divided into Type 1 and Type 2.
What does the "Type" indicate?
Which type is more likely to recur?
Which type is more likely to have distant metastatic spread?
Type 1 is estrogen dependent.
Type 2 is not estrogen dependent & is more likely to have distant metastatic spread and to recur
29
Uterine Sarcoma vs. Endometrial Adenocarcinoma:
Which is more aggressive?
Which is more common?
Which are more common in blacks vs. whites?
Uterine Sarcoma:
- More aggressive
- Less common
- Women more likely to be African-American
Endometrial Adenocarcinoma:
- Less aggressive
- More common
- Black women have less risk of developing
30
Uterine Sarcoma - Tx?
* Total abdominal hysterectomy
* Radiation may be considered to reduce the incidence of pelvic recurrence
* Chemotherapy as adjuvant therapy is under clinical investigation
* Chemotherapy may be used as palliative therapy
31
List the following Ovarian Tumors in order of frequency:
- Metastasis
- Germ Cell Tumor
- Surface Epithelial Stromal Tumor
- Sex Cord Stromal Tumor
1. Surface Epithelial Stromal Tumor (65-70%)
2. Germ Cell Tumor (15-20%)
3. Sex Cord Stromal Tumor (5-10%)
4. Metastasis (5%)
32
Ovarian Serous Tumors exhibit what cellular histology on their surface?
Serous = tall columnar cells resembling fallopian tube epithelium
33
Most common malignant ovarian tumor?
Serous Carcinoma
34
Serous Borderline Tumor - 5-yr-survival if confined to ovary?
5 year survival is 100% if confined to ovary
| 90% if involving peritoneum
35
Serous Borderline Tumor - may spread where (usually)?
Potential to spread to pelvis, upper abdomen, and lymph nodes
36
1/3 of Serous Borderline Tumors are _____
bilateral
37
Ovarian Mucinous Tumor - cells of the cyst lining?
Columnar cells containing mucin (resembling intestinal or endocervical cells)
38
Ovarian Mucinous Tumor - age group?
Occurs in middle aged women, rarely before puberty or after menopause
39
Most common Ovarian Mucinous Tumor?
Mucinous Cystadenoma (80%)
Gross: large cyst filled with viscous fluid Microscopic: mucinous epithelial lining
40
Histologic description of Mucinous Borderline Tumor & Mucinous Carcinoma?
Mucinous Borderline Tumor = areas of papillary excresences
Mucinous Carcinoma = destructive invasion of stroma and expansile growth pattern
41
Gene mutations ass'd w/ Ovarian Endometrioid Adenocarcinoma?
PTEN, P53, KRAS
42
Genet mutations ass'd w/ Ovarian Clear Cell Carcinoma?
ARID1A
43
Diagnosis?
* Unilocular cyst containing mature tissues from three germ layers: hair, cheesy sebaceous material, bone, teeth, etc.
* 1% malignant transformation (thyroid carcinoma, most commonly, squamous cell carcinoma)
Mature Cystic Teratoma
44
Leiomyoma growth stimulated by _____.
estrogen
45
Leiomyomas are typically not treated right away, but are followed w/ observation.
But if you're going to start hormonal therapy, what could you use?
GnRH agonists → Pseudomenopause
| Leuprolide acetate, Goserelin acetate, Nafarelin acetate
46
Dx?
- Carcinoma along the fallopian tube lining
- Pecursor for a subset of serous carcinoma
- Positive for p53
Serous Tubal Intraepithelial Carcinoma
47
Dx?
Extensive mucinous ascites, cystic epithelial implants on the peritoneal surfaces, adhesions, and frequently mucinous tumor involving the ovaries
PseudoMyxoma Peritonei (PMP)
48
Dx?
| Most cases are appendiceal mucinous tumor with secondary ovarian and peritoneal spread
PseudoMyxoma Peritonei (PMP)
49
What is a Mature Cystic Teratoma (Dermoid Cyst)?
Unilocular cyst containing mature tissues from three germ layers: hair, cheesy sebaceous material, bone, teeth, etc.
50
Dx?
| Specialized (cystic) teratoma composed entirely of mature thyroid tissue
Struma Ovarii
51
* *Struma Ovarii refers to a cystic teratoma with which of the following?
- Hair
- Thyroid tissue
- Liver tissue
- Fetal neuroepithelium
Thyroid tissue
| it is a "specialized teratoma composed entirely of mature thyroid tissue"
52
Struma Ovarii may cause ___a___.
| Malignancies are usually ___b___.
a) Hyperthyroidism
| b) Papillary Thyroid Carcinoma
53
Immature Malignant Teratoma typically arises in what demographic?
Prepubertal adolescents & young women
| mean age: 18 years
54
Immature Malignant Teratoma - gross appearance?
Solid tumor: tissue resembles embryonal or fetal tissue
55
Dx?
• Prepubertal adolescents and young women (mean age: 18 years)
• Solid tumor: tissue resembles embryonal or fetal tissue
• Spread locally or distantly.
Immature Malignant Teratoma
56
**Which of the following factors predict the prognosis of a patient with immature teratoma?
Tumor size
Tumor necrosis
Proportion of immature neuroepithelium
Patient’s age
Grading based on proportion of immature neuroepithelium
- ↑ immature neuroepithelium = ↑ aggressive
57
**Which tissue component is diagnostic for immature teratoma?
Skin
Teeth
Bone
Fetal neuroepithelium
Fetal neuroepithelium
58
**T or F?
| Both mature and immature teratoma are benign.
False.
| Immature "Malignant" Teratoma
59
**Which tumors are associated with endometriosis?
```
Low grade serous carcinoma
Mucinous adenocarcinoma
Serous borderline tumor
Clear cell carcinoma
Endometrioid adenocarcinoma
```
1. Ovarian Endometrioid Adenocarcinoma
(PTEN, P53, KRAS)
2. Ovarian Clear Cell Carcinoma
(ARID1A)
60
Which type of ovarian cancer is commonly seen in patients with BRCA1 or 2 mutation?
```
Low grade serous carcinoma
High grade serous carcinoma
Granulosa cell tumor
Yolk sac tumor
Mucinous adenocarcinoma
```
High grade serous carcinoma
61
Dysgerminoma - gross appearance & demographic?
- Unilateral solid tumor of oocyte-like cells
| - usually 2nd and 3rd decades (80% under age 30)
62
Dysgerminoma - benign or malignant?
All malignant but only 1/3 aggressive (metastasizing to opposite ovary, retroperitoneal nodes, peritoneal cavity)
63
Dysgerminoma - sensitive to chemotherapy or not?
Sensitive to chemotherapy
64
** Which of the following is the counterpart of seminoma in females?
Adult granulosa cell tumor
Yolk sac tumor
Dysgerminoma
Embryonal carcinoma
Dysgerminoma
- Large “fried-egg” tumor cells in nests separated by lymphocytes and plasma cells
65
Dx?
Large “fried-egg” tumor cells in nests separated by lymphocytes and plasma cells
(in a woman)
Dysgerminoma
66
Yolk Sac Tumor - Demographics?
Children or young adults (median age: 19 years)
67
Yolk Sac Tumor - unilateral or bilateral? Rapid- or slow-growing?
- Unilateral
| - Growing rapidly & aggressively
68
** Which tumor produces high serum AFP?
Yolk sac tumor
Dysgerminoma
Embryonal carcinoma
Struma ovarii
Yolk Sac Tumor
69
Yolk Sac Tumor - what is its molecular tumor marker?
High serum AFP
70
** Which structure is diagnostic for Yolk sac tumor?
Call-Exner body
Psammoma body
Schiller-Duval body
Neuroepithelium
Schiller-Duval body
71
Dx?
| Pathognomonic - central blood vessel enveloped by germ cells. Resembles glomerulus.
Yolk Sac Tumor
72
** Which tumor produces high serum hCG?
Dysgerminoma
Embryonal carcinoma
Yolk sac tumor
Struma ovarii
Embryonal Carcinoma
73
Embryonal Carcinoma - demographics?
Median age = 15 yrs
74
Embryonal Carcinoma - Clinical presentation?
Present with precocious puberty as well as vaginal bleeding, amenorrhea, hirsutism
75
Ovarian Sex Cord Stromal Tumors may be feminizing or masculinizing --- describe each.
– Feminizing = Granulosa-theca cells that secrete estrogen
–Masculinizing = Leydig cells producing androgen
76
Ovarian Fibroma - gross appearance & demographics?
| Benign or malignant?
Solid, unilateral tumors of women usually >40 yr. All are benign.
77
Ovarian Fibroma - Microscopic characterization?
Spindle cell tumors with collagenous background
78
What is Meigs syndrome?
Ovarian fibroma w/ pleural effusion (hydrothorax) & ascites
79
** How does one monitor the recurrence of granulosa cell tumors?
```
HCG
Inhibin
AFP
CA125
CA19.9
```
Inhibin level
80
Granulosa Cell Tumor (Adult Type) - benign or malignant?
“potentially malignant”= most are benign, but rare cases may recur or metastasize even years later (5-25% risk of malignancy)
81
Granulosa Cell Tumor (Adult Type) - high serum _____ level
inhibin
82
A 40-year-old patient undergoes surgery for large right ovarian mass. Frozen section reveals a granulosa cell tumor. The following procedure should be performed:
- Cervical biopsy for HPV
- Endometrium biopsy to rule out hyperplasia & carcinoma
- Colonoscopy for GI polyp
- Endocervical curettage to rule out endocervical adenocarcinoma
Endometrium biopsy to rule out hyperplasia & carcinoma
83
Juvenile Type Granulosa Cell Tumor (prepubertal patients) - estrogenic effects lead to ______
precocious puberty
84
Adult Type Granulosa Cell Tumor (postmenopausal patients) - estrogenic effects may lead to ______
Estrogenic effects may lead to abnormal uterine bleeding, endometrial hyperplasia, and in rare cases, endometrial adenocarcinoma.
85
Adult Type Granulosa Cell Tumors form _____ when the cells surround eosinophilic material in an attempt to recapitulate follicles.
Call-Exner bodies
86
T or F?
| Histology is used to predict prognosis in Adult Cell Granulosa Cell Tumor.
False.
Histology cannot predict prognosis
(note: histology shows sheets of granulosa cells)
87
Sertoli-Leydig Tumor - demographics?
Present in all ages with peak at 20-30 yrs
88
Sertoli-Leydig Tumor - Sx?
Virilization in 30-50% patients w/ oligo/amenorrhea, loss of secondary sex characteristics, breast atrophy, masculinization
- ↑ serum Testosterone
89
Metastatic tumor to Ovary - typical gross appearance?
Usually bilateral, small, multinodular surface tumors
90
Most common metastatic tumors to the Ovary are from where?
Uterus, contralateral ovary, peritoneum, appendix, breast, colon, pancreas, stomach
91
WHat is a Krukenberg Tumor?
Metastasis from gastric signet ring cell adenocarcinoma to the Ovary
92
Krukenberg tumors belong to:
- Ovarian surface epithelial tumor
- Metastatic tumor from stomach
- Metastatic appendiceal mucinous tumor
- Ovarian sex-cord stromal tumor
Metastatic tumor from stomach
93
The most common cause for enlargement of the ovary?
Follicular Ovarian Cyst
*Reproductive age women tend to have these and older women with and ovarian mass are more likely to have ovarian neoplasms.
94
______ should always be excluded in the workup of reproductive age women who present with bleeding, amenorrhea, syncope or near syncope and abdominal or pelvic pain, as it is the most common cause of maternal death in the first trimester.
Ectopic pregnancy
95
What is α-fetoprotein a tumor marker for?
- Endodermal sinus tumor (yolk sac tumor)
- Immature teratoma
- Mixed germ cell tumors
96
What is β-hCG a tumor marker for?
- Embryonal carcinoma
| - Choriocarcinoma
97
What is LDH a tumor marker for?
Dysgerminoma (female equivalent of a seminoma)
98
What is Inhibin a tumor marker for?
Granulosa cell tumors of the ovary – can cause ↑ estrogen – endometrial hyperplasia or CA
99
BRCA1 mutations increase risk for what types of cancer?
- Breast cancer
| - Serous (epithelial) carcinoma of the ovary & fallopian tube
100
Which ovarian tumor contains cells that resemble urothelium?
Transitional cell (Brenner) tumor
101
Prognosis of Surface Epithelial tumors of the ovary?
Poor
| b/c they present late & may have spread to peritoneum
102
Sx of Surface Epithelial tumors?
None until late, but when they do, Sx are vague…
- Pain
- Fullness
- ↑ Urinary frequency
103
Carcinomas like to spread via ______ (Pathoma)
lymphatics
104
Sarcomas like to spread via _____ (Pathoma)
hematogenously
105
Ovarian tumors like to spread via _____ (Pathoma)
locally into peritoneum (omental caking, etc.)
106
CA-125 can help monitor Tx response in what type of cancer?
Ovarian (& for recurrence)
107
What is CA-125?
- A glycoprotein antigen expressed by coelomic epithelium
- Elevated in 50% of women with early ovarian CA and in 80% of advanced CA
- Useful in monitoring progress/Tx/recurrence, NOT for screening
108
Name the 5 Germ Cell Tumors (of females)
1. Cystic Teratoma (fetal tissue)
2. Embryonal Carcinoma (fetal tissue)
3. Endodermal Sinus Tumor (Yolk Sac)
4. Dysgerminoma
5. Choriocarcinoma (placental tissue)
109
Cystic Teratomas are usually benign, however what 2 things must be excluded to ensure that it absolutely is benign?
Teratoma could be malignant if it has:
- immature tissue (potentially malignant neuroectoderm)
- Malignant tissue w/in teratoma (i.e. squamous cell carcinoma in the skin formed by teratoma)
110
Describe the histology of a Dysgerminoma (pathoma)
Large cells w/ clear cytoplasm & central nuclei (oocyte-like cells)
111
Dysgerminoma responses well to _____ (pathoma)
radiation
112
Ovarian mass in a 5-yr old girl (child) --- Dx?
Endodermal Sinus Tumor (Yolk Sac tumor)
113
Dx?
| Ovarian tumor w/ glomeruloid-like histology? (pathoma)
Endodermal Sinus Tumor
| Schiller-Duval bodies
114
Which of the germ cell tumors is most likely to spread early?
Choriocarcinoma (spreads hematogenously)
- composed of trophoblasts & syncytiotrophoblasts (villi are absent)
