Reproduction II Flashcards
What is defined as the abnormal presence of neutrophils in the endometrium?
Acute Endometritis
What are 3 causes of Acute Endometritis?
Ascending Infection due to Abortion
Delivery
Medical Instrumentation
**specific cause rare
What must Acute Endometritis be distinguished from?
Normal PMN’s due to menstruation
The presence of plasma cells, lymphocytes, and the occasional lymph nodule within normal Endometrium indicates what?
Chronic Endometritis
What is Chronic Endometritis often associated with?
3 things
IUD’s
PID
Abortion/Delivery substances (that have been retained)
Bleeding, Pelvic pain, IUD…
Chronic Endometritis
Pus in the Endometrial Cavity is defined as…
Pyometria
Anything that causes cervical stenosis (narrowing) will be associated with what condition?
*due to tumor, scarring, etc
Pyometria
Long standing pyometria may be associated with what?
How often does this occur?
Endometrial Squamous Cell Carcinoma
**Rare
Endometrial tissue that forms tumor-like nodules outside the uterus is known as…
Endometriosis
What are 3 places Endometriosis is often found?
Ovary
Fallopian tube
Pelvic peritoneum
Endometrial foci are composed of what?
Endometrial glands and stroma
***responds to estrogenic stimulation/cycle
Why can’t the blood be cyclically discharged in endometriosis?
Foci encased in CT/Peritoneum
Endometriosis primarily happens in the 3rd to 4th decade of life, and has a higher incidence in….
Higher socio-economic groups
*marry later
T/F
The most popular theory of Endometriosis pathogenesis is the Regurgitation Theory, but is not clearly understood
True
What color are the nodules/plaques in Endometriosis?
Red-Brown
Where are most foci in Endometriosis found?
Orifice of Fallopian Tubes
What percentage of women of reproductive age have Endometrial foci?
15-20%
T/F
Endometriosis does not progress to cancer
True
Where are Chocolate Cysts found?
How big are they?
Ovarian endometriosis
1-5 cms
*filled with brown red viscous fluid
If endometrial glands and stroma enter the myometrium, it can cause what?
Adenomyosis
T/F
The deeper the Adenomyosis penetration, the more likely symptomatic with dysmenorrhea (painful menstruation) or menorrhagia (heavy bleeding menstruation)
True
Adenomyosis is most often seen in what demographic?
Parous - have had children
Small, soft, tan, partially cystic masses in the myometrium is what?
*also mildly proliferative endometrial glands surrounded by stroma of varying fibrotic states
Adenomyosis
Adenomyosis is often asymptomatic, what percentage of removed uteri have some degree of this?
1/5
Benign tumors of the Myometrial smooth muscle are called what?
Leiomyomas
*Fibroids
Leiomyomas are ____ % benign and _____ % malignant and are then called ______
98%
1-2%
Leiomyosarcomas
What is the most common uterine tumor?
What % of reproductive-aged women have them?
Leiomyoma
20%
In connective tissue, ….oma is ______ and …sarcoma is ______.
Benign
Malignant
T/F
Leiomyomas aren’t seen before puberty or after menopause
True
Leiomyomas are more commonly seen in what ethnic group?
Blacks
Describe the histology of Leiomyoma:
Smooth muscle cells in fascicles
*unencapsulated, white-tan whorled masses
What are the 3 types of Leiomyoma fibroids?
Intramural - within myometrium
Subserosal - beneath uterine serosa
Submucosal - in endometrial cavity
**size and location determine symptoms
What type of Leiomyoma often compresses the rectum, and can cause abdominal heaviness, urinary urgency, and constipation?
Subserosal
What type of Leiomyoma can cause menstrual irregularities, bleeding, and Infertility?
Submucosal
*interfere with embryonic implantation
Submucosal fibroid (Leiomyoma) are treated how?
Surgically
small, myomectomy
large, hysterectomy
Excessive estrogen can cause what in the endometrium?
Endometrial Hyperplasia
Endometrial hyperplasia is mostly what type of tissue?
Glandular
*not much stroma
What are the 3 types of Endometrial Hyperplasia?
Simple - minimal glandular complexity, no cell atypia
Complex - multi-layered glandular complexity, no atypia
Atypical Hyperplasia - glandular complexity, cell atypia
What are the chances of progression to carcinoma/adenocarcinoma in the 3 types of Endometrial Hyperplasia?
Simple - 1% - carcinoma
Complex - 3% - adenocarcinoma
Atypical - 25% - adenocarcinoma
Estrogen -producing tumors, Polycystic Ovarian Syndrome, exogenous estrogen, an Obesity can all cause what?
Endometrial Hyperplasia
What is the treatment for Endometrial Hyperplasia?
Progestins (high dose)
*synthetic progesterone
What are the benign projections of the endometrial surface called?
Endometrial Polyps
What 2 things may cause endometrial foci to produce polyps?
Do polyps slough during menstruation?
Hypersensitive to Estrogen
Unresponsive to Progesterone
NO
Where are Endometrial Polyps usually found?
Fundus
What bleeds inter-menstually and has a high degree of endomentrial glands and stroma?
Endometrial Polyps
Endometrial Polyps aren’t considered neo-plastic, but _____ harbor Adenocarcinomas.
0.5%
What is the most common malignant tumor of the female genital tract?
It accounts for what % of GYN malignancies?
Endometrial Adenocarcinoma
50%
Endometrial Adenocarcinoma arises from what cells?
Associated with?
Epithelial cells lining endometrial glands
More estrogen exposure
What are 4 risk factors for Endometrial Adenocarcinoma?
Exogenous estrogen
Estrogen producing tumors
Obesity
Nulliparous (or early menarche/late menopause)
What gives the endometrium breaks from proliferation?
Progesterone
*Estrogens stimulate endometrium
What is the most important benefit to estrogen supplements?
Prevents bone loss
*but increases carcinoma
T/F
The risks outweigh the rewards for estrogen supplements
True
*bone loss more important to address, cancer can be detected early
**15,000 deaths/yr related to osteoporotic bone fractures
What is it about endometrial cancers (adenocarcinoma) that justifies estrogen supplementation?
80% confined to uterus.
Excellent prognosis
What 2 cancers, other than Endometrial Adenocarcinoma, are also estrogen dependent and have an increased risk for upon diagnosis?
Breast
Ovarian
How do most endometrial adenocarcinomas grow?
Exophytic - grow into endometrium
Describe the 4 Stages of Endometrial Carcinoma
I - Endometrium only
II - Endometrium, cervix, myometrium
III - Breaches uterus (but not outside pelvis)
IV - Bladder, rectum (outside pelvis)
T/F
Endometrial cancer is rare before 35, presents with inter-menstrual bleeding.
True
*mostly diagnosed through irregular bleeding
What is the treatment for Endometrial Cancer?
If advanced (or incomplete resection/undetected)?
If inoperable?
Hysterectomy
(with or without ovaries)
Radiation
Chemo
What are the most common primary lesions of the Fallopian Tubes?
Benign Paratubal Cysts
Describe Benign Paratubal Cysts?
0.1-2.0 cm
Translucent
Clear, serous fluid
Where are the largest Benign Paratubal Cysts found?
Fimbrae
Broad Ligament
*little clinical significance
Where do Ectopic Pregnancies most often implant?
3 places
Ovary
Abdominal cavity
Fallopian tubes (95%)
Ectopic Pregnancy incidence?
1/150
What is the greatest risk factor for Ectopic Pregnancy?
3 additional factors?
Chronic Salpingitis
Endometrial peritubular adhesions, Previous surgery, Leiomyoma
What usually happens in Ectopic Pregnancy 2-6 weeks after fertilization?
Rupture/Intraperitoneal hemorrhage
T/F
Decidual reaction of endometrium and no chorionic villi are indicative of Ectopic Pregnancy
True
PID ascends due to a variety of microorganisms
True
The ascent of PID can result in what 3 acute conditions?
Salpingitis
Pyosalpinx
Tuboovarian abscess
List 5 species that cause PID starting with the most common.
Gonorrhea
Chlamydia
Staph, Strept, Mycoplasma
What procedure/conditions may cause PID?
2 things
Septic Abortion
Postpartum endometritis
Cervicitis is usually due to what 2 bugs and has what symptoms?
Chlamydia/Gonococcus
Cervix red/swollen - yellow mucopurulent discharge
What is the most common symptom in Cervicitis/PID?
Lower abdominal pain
T/F
Gonococcal urethritis is more painful in men, and often asymptomatic in women
True
T/F
Dyspareunia (painful intercourse) and purulent discharge is common in PID
True
PID caused by what organism can be especially consequential (leading to infertility) because of mild symptoms?
Trachomatis
Name 4 Complications of PID:
Sterility - scars fallopian tubes
Ectopic Pregancy
Abscesses- in Fallopian Tubes, ovaries, peritoneum
Peritonitis - bacterial spread out fallopian tubes/ovaries
Increase risk of PID due to IUD is due to what organism?
Actinomyces israelii
Actinomyces israelii is found in what % of genital tracts?
What does it produce?
How does it enter the Uterine Cavity?
4%
Sulfur Granules
IUD tail
**G+ Rod
Actinomyces israelii PID by IUD can result in what?
Extensive scarring
T/F
Tumors of the Fallopian Tubes are rare because epithelium does not shed cyclically and isn’t under estrogenic control
True
Of Fallopian Tube cancers, what is the most common?
Account for what % of GYN malignancies?
Adenocarcinomas
1%
Ovarian Neoplasms come in what 4 subtypes based on their cells of origin?
What % of ovarian tumors do each make up?
Surface tumors (70%)
Germ Cell tumors (20%)
Sex cord stromal tumors (10%)
Ovarian metastases
(1st 3 embryological)
T/F
The benign Ovarian tumors are more common than malignant ones.
True
What is the 2nd most common GYN cancer?
What does it rank 1st for?
Ovarian
Deaths
*causes more deaths than all other GYN tumors
How many patients die from Ovarian cancer/year?
12,000
*19k new cases
The most common Ovarian Neoplasms are derived from what?
How do they act cyclically?
Surface Epithelial Cells
Rupture every month
- proliferating cells heals each month - increases cancer risk
- *BCP’s suppress
What are the four types of Ovarian Surface Epithelial Tumors?
*comprises 70% ovarian tumors
Serous
Mucinous
Brenner
Endometroid
*1st 2 cystic, latter 2 solid
T/F
All surface tumors of the Ovary are Adenomas
False
Adenomas and Adenocarcinomas
How are the Serous and Mucinous Epithelial tumors of the Ovary classified?
Benign
Borderline
Malignant
What are the most common surface tumors of the Ovary?
Serous
Serous Tumors of the Ovary epithelium consist of what?
What do they mimic?
Several encapsulated cysts
Fallopian tube epithelium
In Serous Tumors of Ovarian epithelium, what % are benign?
% borderline?
% malignant?
60%
15%
25%
60% of malignant Serous Tumors of the Ovarian epithelium are bilateral. 30% benign as well. Suggest?
Genetic component
What do the malignant tumors of the Serous type of Ovarian epithelial cancers form?
Papillary projections
Mucinous - type Ovarian Epithelial tumors have what ratio of benign:malignant?
What % are bilateral?
7:1
10-30%
Describe a Mucinous-type Ovarian Epithelial tumor.
Thick yellowish or clear jelly-like material
If a Mucinous-type Ovarian Epithelial tumor invades the peritoneum, what happens and what is it called?
Entire belly filled with mucous
Pseudomyxoma peritonei
What type of tumor mimics Endocervical Epithelium?
Mucinous tumors (Ovarian epithelium)
Describe Endometroid Ovarian Surface Epithelial tumors.
Solid, glandular
*resembles endometrial glands
What % of Endometroid Ovarian Surface Epithelial tumors have carcinoma of endometrium?
What % have benign endometriosis?
15-30%
15%
What type of malignancies are Brenner Tumors?
Transitional Cell Carcinomas
*Ovarian surface epithelial tumor
What type of tumor is solid with dense fibrous stroma and scattered nests of Transitional epithelium?
Brenner Ovarian Surface Epithelial tumors
*2%
T/F
The vast majority of ovarian tumors are hormonally non-functional
True
What antibody is detected in 50% epithelial tumors confined to the Ovary, and 90% that have spread?
CA-125
What is the survival rate of the progression-types of Surface Epithelial Tumors?
Benign - 100% (5 yr)
Borderline - 80%
Malignant - 10-40% (depends on stage)
What type of tumor accounts for 20% of Ovarian cancers and is predominately seen in women before age 25?
Germ Cell Tumors
What is the most common type of Germ Cell Tumor?
most common ovarian tumor in women less than 25
Benign Cystic Teratoma
(Dermoid Cyst)
*95%
How does Benign Cystic Teratoma present?
Cyst, hairy skin, teeth, etc.
- potentially metastatic but benign in this form
- *needs removal
What is the ovarian counterpart to male Seminoma?
Dysgerminoma
Describe Dysgerminoma
Treatment?
When does it occur?
large and firm
Surgical
Childhood
Dysgerminomas are sensitive to what
Radiosensitive
Dysgerminoma is homologous to what male tumor?
Seminoma of testes
What is the ovarian counterpart to of the Yolk Sac Tumor of the male testes?
Endodermal Sinus Tumor
Endodermal Sinus Tumor is rich in what?
Predominantly seen in what age group?
Describe growth
AFP - alpha feto protein
Children/young adults
Agressive/rapid
What tumor is histologically identical to Placenta?
What does it excrete? (the Tumor Marker)
Choriocarcinoma
HCG
T/F
Choriocarcinomas usually exist in combo with teratocarcinomas (other germ cell tumors)
True
T/F
Choriocarcinomas are highly lethal because they get into the bloodstream/liver/lungs/bones at time of diagnosis
True
What accounts for 5% of all Ovarian tumors and originate from cells forming the Follicles?
Sex Cord Stromal Tumors
What are the 3 variants of Sex Cord Stromal Tumors?
Theocomas - solid/estrogen secreting/benign
Granulosa - solid/estrogen producing/small are benign/large malignant
Sertoli-Leydig Cell Tumors - solid/Androgen secreting
What can Granulosa Sex Cord Stromal tumors cause in the young?
Older?
Precocious puberty
Breast/endometrial cancer
What does Sertoli-Leydig tumors cause?
What type of tumor is it?
Deep voice, hypertrophy clitoris (micropenis), baldness, etc.
Sex Cord Stromal Tumor
*can be benign/malignant
Where do Metastatic Ovarian Tumors most often originate?
What explains this?
Carcinomas of Endometrium and Breast
Tumors have estrogen receptors
What is the most common tumor of the GI tract that metastasizes on the ovary?
Krukenberg tumors
***Stomach carcinoma
Describe the maternal surface of Normal Placenta
Describe the fetal surface of a Normal Placenta
Dark red, lobules (cotyledons)
Shiny, gray, translucent
Out of the syncytiotrophoblast, cytotrophoblast, connective tissue, and endothelium of fetal capillaries that make up the Placenta early in pregnancy, what degenerates in late pregnancy?
What is displaced?
What remains?
Cytotrophoblast
Connective tissue displaced by fetal capillaries
Syncytiotrophoblast/fetal capillary endothelium
How does the blastocyst stimulate the endometrium for implantation?
Decidual Reaction
*stimulates Stroma to thicken and vascularize
T/F
The placenta produces both steroid and protein hormones
True
Name 2 hormones secreted by the Placenta
Human chorionic gonadotropin (hCG)- stimulated progesterone production by corpus luteum
Human placental lactogen (hPL) - induces lypolysis
What hormone is considered the Growth Hormone for the fetus?
hPL - Human Placental Lactogen
T/F
Estrone, Etstradiol, and Estriol are all steroid hormone of unknown function secreted by the Placenta
True
What hormone is used by the fetal adrenal cortex as a precursor for other hormones?
Progesterone
“seeds” cortex
What placental variation presents as a thick ring that is over the fetus rather than around the placenta?
Circumvallate Placenta
T/F
Placenta can have accessory lobes and are usually of no clinical importance
True
What variation of Placenta has small gray or yellowish nodules on the fetal surface associated with oligohydramnios and Potters syndrome (renal agenesis)?
Amnion Nodosa
What are the contents of the Umbilical cord?
Right and Left arteries
Vein
Wharton’s Jelly
What blood is in the Right and Left umbilical arteries?
What blood is in the Umbilical vein?
Deoxygenated blood from fetus to placenta
Oxygenated blood from placenta to fetus
T/F
Presence of only on Umbilical artery suggests CV abnormalities
True
If the umbilical cord is inserted into the fetal membranes and not the placenta, this suggests what?
Velamentous Insertion
*longer cord - 1%
T/F
True knots are found more often in males
True
*false knot is Wharton’s jelly accumulation
What is it called if the umbilical cord becomes wrapped around the neck?
Nuchal cords
T/F
15-20% of pregnancies have one-loop nuchal cords
True
T/F
The amniotic fluid increases through the 7th month and decreases in last 2
True
What is the volume of amniotic fluid at birth?
What is the exchange rate?
1 liter
400-500mL/HOUR
How much amniotic fluid will the term fetus swallow daily?
How much urine excrete daily?
400 mL
500 mL
What is produced in fetal hepatocytes?
Elevated levels associated with what?
Reduced levels associated with what?
AFP - alpha fetoprotein
Neural tube defects (spina bifida) or Esophageal problems
Down syndrome
Fetal swallowing defects or absorption defects (duodenal) result in what?
What is this associated with?
Polyhydramnios
(too much amniotic fluid)
Diabetes
What is a low amount of amniotic fluid called?
Caused by?
Causes what congenital malformations?
Oligohydraminios
Inability to excrete urine
Potter’s syndrome/hypoplastic lungs
Placenta implanting over the cervix is called what?
It is often caused by?
Placenta previa
Decidua deficiency
**old cesarean scars also have difficulty implanting
5 contributing factors for Placenta Previa
C-section
Advanced maternal age
multiparity
Cocaine
Cigarettes
What placental condition is marked by the absence of decidua and inability to separate from wall?
Placenta Accreta
Placenta Accreta is subclassified according to what?
Depth of villous invasion to myometrium
What are the 3 types of Placenta Accreta?
Placenta Accreta - villi to myometrium
Placenta Increta - villi to underlying myometrium
Placenta Percreta - villi across uterine wall
**normal villi
What is the most common presentation of Placenta Accreta?
3rd trimester bleeding
T/F
Postpartem hemorrhage from Placenta Accreta requires emergency hysterectomy
True
Placenta accreta has a maternal death rate of what?
2%
Blood between the basal plate of the placenta and uterine wall is what?
Accounts for what % of perinatal deaths?
Retroplacental Hematoma
8%
T/F
smoking, advanced age, cocaine, and acute chorioamnionitis are all associated with Retroplacental Hemotama
True
What is the term for infection/inflammation of the placental amnion, chorion, and extraplacental membranes?
Chrioamnionitis
T/F
Chorioamnionitis can spread to the umbilical cord (funisitis)
True
5 Bacteria responsible for Chorioamnionitis starting with the most common
Mycoplasma
Bacteroides
B strep
E. coli
Gardnerella vaginalis
These bacteria responsible for chorioamnionitis are found in what % of placentas?
10%
Infection of the placental villi can come from what 2 sources?
Endometritis
Transplacental from maternal circulation
*syphilis, rubella, HSV, etc.
T/F
Meconium stained placentas occur 18% of the time and are usually in pregnancies that go longer than 42 weeks
True
Thick meconium aspiration causes what?
Fetal chemical pneumonitis
T/F
There are macrophage within fetal membranes of meconium stained placenta
True
What are the 3 most common sites of Ectopic pregnancy?
Tubal - 95%
Ovarian
Peritoneal
T/F
The aspiration of fresh blood from the Pouch of Douglas (posterior fornix) denotes ectopic rupture
True
What disease involves the trophoblastic epithelium?
Gestational Trophoblastic Disease
Trophoblastic proliferation and degeneration of chorionic villi suggest what placental abnormality?
Hydatidiform Mole
Complete Hydatidiform Mole is caused by what?
All chromos paternal
Androgenesis 23 X to 46
T/F
Without maternal chromos the embryo can’t develop and the placenta undergoes hydropic degeneration
True
2 Sperm fertilizing an ovum will result in what?
Incomplete Hydatidiform Mole
- 69 chromos
- *fatal but not immediate
What is the incidence of H. moles in the US?
Diagnosis based on what?
1/2000 pregnancies
Enlarged uterus - no fetus
What hormone is found in Hydatidiform Mole in high levels?
hCG
T/F
Hydatidiform Mole pregnancies are aborted spontaneously mid-pregnancy
True
Why is it important to remove Hydatidiform Mole completely upon miscarriage?
Grossly, what does H. Mole look like
Trophoblastic cells are potential malignancies (chorio)
Grape-like clear vesicles
The malignant tumor composed of trophoblastic cells is called what?
Choriocarcinoma
T/F
50% of Choriocarcinomas arise from a preexisting complete mole
25% retained abortive tissue
25% normal placenta
True
Describe the nature of choriocarcinoma and what its marker is
Highly invasive
hCG
T/F
Choriocarcinoma forms bulky hemorrhagic nodules in the placental bed
Invades through uterus, often implants in vagina
True
Where does Choriocarcinoma often metastasize to once it invades the veins?
Lung, liver, and brain
What does Choriocarcinoma respond well to if it hasn’t yet metastsized?
Chemo with Methotrexate
80-100% cure rates
