Repro - Pathology (Ovarian pathology & Vaginal tumors) Flashcards
Pg. 581-583 in First Aid 2014 Pg. 529-532 in First Aid 2013 Sections include: -Premature ovarian failure -Most common causes of anovulation -Polycystic ovarian syndrome (Stein-Leventhal syndrome) -Ovarian cysts -Ovarian neoplasms
What is premature ovarian failure? What is the presentation that defines this?
Premature atresia of ovarian follicles in women of reproductive age; Patients present with signs of menopause after puberty but before age 40
What hormone changes are associated with premature ovarian failure?
Decreased estrogen, Increased LH, FSH
What are the 11 most common causes of anovulation?
(1) Pregnancy (2) Polycystic ovarian syndrome (3) Obesity (4) HPO axis abnormalities (5) Premature ovarian failure (6) Hyperprolactinemia (7) Thyroid disorders (8) Eating disorders (9) Female athletes (10) Cushing syndrome (11) Adrenal insufficiency
What is another name for polycystic ovarian syndrome? What is its definition?
Stein-Leventhal syndrome; Hyperandrogenism due to deranged steroid synthesis by theca cells, hyperinsulinemia.
What are 3 major hormone mechanisms associated with polycystic ovarian syndrome?
(1) Estrogen increases steroid hormone-binding globulin (SHBG) and decreases LH, ultimately resulting in decreased free testosterone; (2) insulin and testosterone decrease SHBG –> increased free testosterone; (3) Increased LH due to pituitary/hypothalamus dysfunction.
What imaging finding is associated with polycystic ovarian syndrome?
Results in enlarged, bilateral cystic ovaries
How does polycystic ovarian syndrome present?
Presents with amenorrhea/oligomenorrhea, hirsuitism, acne, infertility
What condition is associated with polycystic ovarian syndrome? For what other condition does PCOS increase the risk, and why?
Asociated with obesity. Increased risk of endometrial cancer secondary to increased estrogens from the aromatization of testosterone and absence of progesterone
What is the treatment for the different symptoms of polycystic ovarian syndrome?
TREATMENT FOR HIRSUITISM, ACNE: weight reduction, OCPs (estrogen increases SHBG and decreases LH –> decreased free testosterone), antiandrogens; FOR INFERTILITY: clomiphene citrate (blocks negative feedback of circulating estrogen, increasing FSH, LH), metformin (increase insulin sensitivity, decrease insulin levels, results in decreased testosterone; enables LH); FOR ENDOMETRIAL PROTECTION: cyclic progesterones (antagonizes endometrial proliferation)
What hormone changes are associated with polycystic ovarian syndrome?
Increased LH, Increased FSH (LH:FSH, 3:1), Increased testosterone, Increased estrogen (from aromatization)
What is the most common cause of infertility in women?
Polycystic ovarian syndrome
What defines/causes a follicular cyst?
Distension of unruptured graafian follicle
What are 2 conditions with which follicular cyst is associated?
May be associated with (1) hyperestrogenism and (2) endometrial hyperplasia.
What is the most common ovarian mass in young women?
Follicular cyst
What defines/causes a corpus luteum cyst?
Hemorrhage into persistent corpus luteum.
How is a corpus luteum cyst commonly resolved?
Commonly regresses spontaneously
What causes a theca-lutein cyst?
Due to gonadotropin stimulation
How does a theca-lutein cyst present in the body?
Often bilateral/multiple
What are 2 conditions with which theca-lutein cysts are associated?
Associated with choriocarcinoma and moles
What defines/causes a hemorrhagic cyst?
Blood vessel rupture in cyst wall.
What causes a hemorrhagic cyst to grow? How does it usually resolve?
Cyst grows with increased blood retention; usually self-resolves.
What is a dermoid cyst? What does it contain?
Mature teratoma. Cystic growths filled with various types of tissue such as fat, hair, teeth, bits of bone, and cartilage.
What defines/causes an endometrioid cyst?
Endometriosis within ovary with cyst formation
What produces variations in endometrioid cysts?
Varies with menstrual cycle.
What is a classical finding of endometrioid cysts in the ovaries?
When filled with dark, reddish-brown blood it is called a “chocolate cyst”
What is the most common adnexal mass in women > 55 years old? Is it benign, malignant, or both?
Ovarian neoplasms; Can be benign or malignant
From where can ovarian neoplasms arise? From where do the majority of malignant tumors arise?
Arise from surface epithelium, germ cells, and sex cord stromal tissue; Majority of malignant tumors arise from epithelial cells. Majority (95%) are epithelial (serous cystadenocarcinoma most common)
What are 5 factors/conditions that increase risk for ovarian neoplasms?
Risk increased with (1) advanced age, (2) infertility, (3) endometriosis, (4) PCOS, (5) genetic predisposition (BRCA-1 or BRCA-2 mutation, HNPCC, strong family history)
What are 4 factors/conditions that decrease risk for ovarian neoplasms?
Rick decreased with (1) previous pregnancy, (2) history of breastfeeding, (3) OCPs, and (4) tubal ligation
How do ovarian neoplasms present?
Presents with adnexal mass, abdominal distension, bowel obstruction, pleural effusion
How are ovarian neoplasms diagnosed? How are they monitored?
Diagnose surgically; Monitor progression by measuring CA-125 levels (not good for screening).
What are 7 examples of benign ovarian neoplasms?
(1) Serous cystadenoma (2) Mucinous cystadenoma (3) Endometrioma (4) Mature cystic teratoma (dermoid cyst) (5) Brenner tumor (6) Fibromas (7) Thecoma
What is the most common ovarian neoplasm?
Serous cystadenoma
What characteristics distinguish serous cystadenoma?
Thin-walled, uni- or multilocular. Lined with fallopian-like epithelium. Often bilateral.
What characteristics distinguish mucinous cystadenoma?
Multiloculated, large. Lined by mucus-secreting epithelium.
What is an endometrioma?
Mass arising from growth of ectopic endometrial tissue
What imaging finding characterizes endometrioma?
Complex mass on ultrasound
How does endometrioma present?
Presents with pelvic pain, dysmenorrhea, dyspareunia.
What is the most common ovarian tumor in women 20-30 years old?
Mature cystic teratoma (dermoid cyst)
What is a mature cystic teratoma (dermatoid cyst)? What can it contain? What are the most common components?
Germ cell tumor; Can contain elements from all 3 germ layers: teeth, hair, sebum are common components
What are ways in which a mature cystic teratoma (dermoid cyst) may present?
Can present with pain secondary to ovarian enlargement or torsion.; Can also contain functional thyroid tissue and present as hyperthyroidism (struma ovarii).
What is struma ovarii?
Mature cystic teratoma (dermoid cyst) that contains functional thyroid tissue and presents as hyperthyroidism
What is the defining characteristic of a Brenner tumor?
Benign ovarian neoplasm that looks like bladder; Think: “B for Brenner & bladder”
How does a Brenner tumor appear grossly? What characterizes it on H & E stain?
Solid tumor that is pale yellow-tan in color and appears encapsulated; “Coffee bean” nuclei on H & E stain; Think: “B for Brenner, Bladder, & coffee Bean”
How do fibromas appear on histology?
Bundles of spindle-shaped fibroblasts
What is Meigs syndrome?
Triad of ovarian fibroma, ascites, and hydrothorax.
What is a symptom associated with fibromas?
Pulling sensation in groin
What product comes from thecoma? What other tumor has the same product?
Like granulosa cell tumors, may produce estrogen
How does a thecoma usually present?
Usually present as abnormal uterine bleeding in a postmenopausal women.
What are 8 examples of malignant ovarian neoplasms?
(1) Immature teratoma (2) Granulosa cell tumor (3) Serous cystadenocarcinoma (4) Mucinous cystadenocarcinoma (5) Dysgerminoma (6) Choriocarcionma (7) Yolk sac (endodermal sinus) tumor (8) Krukenberg tumor
What are 3 defining features of an immature teratoma?
Aggressive, contains fetal tissue, neuroectoderm
What tissue is typically represented in immature teratoma versus mature teratoma?
Immature teratoma is most typically represented by immature/embryonic-like neural tissue. Mature teratoma are more likely to contain thyroid tissue.
What is the most common sex cord stromal tumor?
Granulosa cell tumor
In what patient population is granulosa cell tumor predominantly found?
Predominately women in their 50s.
What products come from granulosa cell tumors? How do granulosa cell tumors present?
Often produce estrogen and/or progesterone and present with abnormal uterine bleeding, sexual precocity (in pre-adolescents), breast tenderness.
What does histology of granulosa cell tumor show? What does this resemble?
Histology shows Call-Exner bodies (resemble primordial follicles)
What is the most common (malignant) ovarian neoplasm? How/Where is it typically found?
Serous cystadenocarcinoma; Frequently bilateral
What is a characteristic histological finding of serous cystadenocarcinoma?
Psammoma bodies.
What is another name to associate with mucinous cystadenocarcinoma? What defines it?
Pseudomyxomal peritonei - intraperitoneal accumulation of mucinous material from ovarian or appendiceal tumor
What is the most common neoplasm in adolescents?
Dysgerminoma
To what neoplasm is dysgerminoma equivalent? Which of these two is rarer?
Equivalent to male seminoma but rarer.
What percentage of all ovarian tumors are dysgerminomas? What percentage of germ cell tumors are dysgerminomas?
1% of all ovarian tumors; 30% of germ cell tumors.
What histological finding characterizes dysgerminoma?
Sheets of uniform “fried egg” cells
What are 2 tumor markers for dysgerminoma?
hCG, LDH = tumor markers
Is choriocarcinoma common or rare? When, and in what patient population(s) can it develop?
Rare; Can develop during or after pregnancy in mother or baby
What defines choriocarcinoma?
Malignancy of trophoblastic tissue (cytotrophoblasts, synctiotrophoblasts); no chorionic villi present.
What kind of cysts are increased in frequency with choriocarcinoma?
Increased frequency of theca-lutein cysts.
How does choriocarcinoma present? What can explain its symptoms?
Presents with abnormal Beta-hCG, shortness of breath, hemoptysis; Hematogenous spread to lungs.
How well does choriocarcinoma respond to chemotherapy?
Very responsive to chemotherapy
What is the most common tumor in male infants?
Yolk sac (endometrial sinus) tumor)?
Is yolk sac (endodermal sinus) tumor aggressive? Where is it found in the body, and in what patient population?
Aggressive, in ovaries or testes (boys) and sacrococcygeal area in young children
What are 3 features describing how yolk sac (endodermal sinus) tumor appear grossly?
Yellow, friable (hemorrhagic), solid mass
What histological finding do 50% of yolk sac (endodermal sinus) tumors have?
50% have Schiller-Duval bodies (resemble glomeruli)
What is a tumor marker for yolk sac (endodermal sinus) tumor?
AFP = tumor marker
What is the origin of a Krukenberg tumor? What are its defining features?
GI malignancy that metastasizes to the ovaries, causing a mucin-secreting signet cell adenocarcinoma
What are the 3 kinds of vaginal tumors?
(1) Squamous cell carcinoma (SCC) (2) Clear cell adenocarcinoma (3) Sarcoma botryoides (rhabdomyosarcoma variant)
In what context does squamous cell carcinoma (SCC) vaginal tumor usually occur? In what context is it rare?
Usually secondary to cervical SCC; Primary vaginal carcinoma rare
What patient population do clear cell adenocarcinoma vaginal tumors affect?
Affects women who had exposure to DES in utero
What patient population do sarcoma botryoides (rhadomyosarcoma variant) vaginal tumors affect?
Affects girls < 4 years old
What 2 histological/lab findings distinguish sarcoma botryoides (rhabdomyosarcoma variant) vaginal tumors?
Spindle-shaped tumor cells that are desmin +
