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Endo/Repro II Test 1 > Robbins: Fallopian Tubes and Ovaries > Flashcards

Robbins: Fallopian Tubes and Ovaries Flashcards

1
Q

What is adnexa?

A

Fallopian tubes + ovaries = the parts adjoining an organ

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2
Q

Fallopian tubes are most commonly affected by what?

A

Infections + inflammatory conditions

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3
Q

Most common etiologies underlying suppurative salpingitis?

A
  • N. gonorrhea = 60% of cases
  • C. trachomatis = remainder
  • More than one organism can be involved; any pyogenic organism
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4
Q

Tuberculosis salpingitis is an important cause of what in endemic countries; what are the main histo features of this disorder?

A
  • Infertility
  • Caseating granulomas + multinucleated giant cells + epitheliod macrophages
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5
Q

What are the most common primary lesions of the fallopian tubes (excluding endometriosis)?

A
    • Paratubal Cysts = small translucent cysts filled w/ clear, serous fluid
    • Hydatids of Morgagni = larger cysts found near the fimbriae of the tube or in the broad ligaments formed remnants of müllerian duct.
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6
Q

Which uncommon benign tumor may arise in the fallopian tube?

A

Adenomatoid tumor (mesotheliomas)

- Sub-serosal/mesosalpinx

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7
Q

Which rare tumor of the fallopian tube may present as dominant tubal mass on pelvic examination or due to abnormal discharge, bleeding, and occasionally abnormal cells on Pap smear?

A

Primary Adenocarcinoma of the Fallopian Tubes

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8
Q

At diagnosis, what is the prognosis of Primary Adenocarcinoma of the Fallopian Tube?

Treatment?

A

- 50% = stage I at diagnosis, but 40% of pts die in 5-years

- Chemotherapy used for ovarian cancers bc a subset of serous ovarian cancers arise from epithelium of fallopian tube.

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9
Q

In terms of the fallopian tubes what are the most common disorders you must consider?

A
  • Ectopic pregnancy
  • Endometriosis
  • Inflammatory disorders –> Salpingitis
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10
Q

What are the most common lesions in the ovary?

A

Functional or benign cysts/tumors.

  • Inflammation (oophoritis) is NOT common, but if occurs => AI component.
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11
Q

How can neoplastic disorders of the ovaries be divided?

A
  1. Mullerian epithelium
  2. Germ cell
  3. Sex cord-stromal cells
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12
Q

What is the most common cause of an ovarian mass in a reproductive age female?

A

Cystic follicle –> NL, mulitiple benign cysts with clear/serous fluid in a glistening membrane originating from unrutured graafian follicles or follicles that ruptured and sealed.

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13
Q

34 year old female with pelvic pain, fever, and adnexal mass. Imaging and surgery c/w tubo-ovarian abscess. Most likely organism?

A

Cystic ovarian follicle

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14
Q

What are the growth characteristics of cystic follicles and how does size dictate their classification?

A
  • Usually multiple < 2cm in diameter.
  • If >2cm, called follcle cyst and can cause pelvic pain
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15
Q

How common are luteal cysts (corpora lutea) and what is their gross appearance that distinguishes them from cystic follicles?

A
  • Present in the normal ovaries of reproductive age females
  • Lined w/ rim of bright yellow tissue containing luteinized granulosa cells. If it ruptures => peritoneal reaction.
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16
Q

Polycystic ovarian syndrome (PCOS) is a complex endocrine disorder characterized by what findings clinically?

A
    • Hyperandrogenism - hirsutism, acne, deep voice, male pattern baldness
    • Menstrual irregularities - amenorrhea
    • Chronic anovulation => ↓ fertility
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17
Q

What underlying metabolic disorders are common in women with PCOS?

A
  1. Obesity due to altered adipose tissue metabolism
  2. T2DM due to insulin resistance
  3. Premature atherosclerosis
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18
Q

Due to increase in free estrone levels (due to aromatization of androgens in fat), women with PCOS are at an increased risk for what?

A

Endometrial hyperplasia and cancer

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19
Q

What form of estrogen:

  1. Predominates in reproductive years and is the most potent, made by aromatization of testosterone?
  2. Least potent and made in placenta, originating in fetal adrenal gland from DHEA.
A
  1. Estradiol (E2)
  2. Estriol (E3)
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20
Q

What is stromal hyperthecosis?

MC?

A

Bilateral, uniform enlargment of ovary due to hypercellular stroma and leutinzation of stromal cells.

MC = post-menopausal F and overlaps with PCOS in younger F.

21
Q

What does stromal hyperthecosis look like? What is seen?

Similar presentation to PCOS, except?

A
  • white-tan looking
  • Nests of cells with cavuolated cytoplasm
  • Viriluzation is more stiking
22
Q

What is theca-lutein hyperplasia of pregnany>

Looks like?

A
  • Proliferation of concentric theca cells and expansion of perifollicular zone due to increase gonadtropins in PG.
  • When follicles regress => nodular appearance
23
Q

Majority of ovarian tumors are (benign/malignant) and how does age play a role in this?

A

- 80% are benign, typically occur in younger women (20-45YO)

  • Malignant tumors often older women (45-65YO)
24
Q

what is unique about malignant ovarian tumors by the time they have been diagnosed?

A

most have spread BEYOND ovaries

25
Q

What type of tissues can ovarian tumors arise from?

A
  • 1. Epithelial tissue from fallopian tubes/endomerial
  • 2. Pluripotent germ cells that migrated from yolk sac => ovary.
  • 3. Stromal cells (sex-cords)
26
Q

Sx of ovarian tumors

A
  1. Abdominal pain / distention
  2. Urinary/ GI tract symptoms due to compression or invasion
  3. Vaginal bleeding
27
Q

Most primary ovarian neoplasms arise from?

What are the types?

A
  • Mullerian epithelium
  • 1. Serous
  • 2. Mucinous
  • 3. Endometroid
28
Q

How are epithelial tumors of the ovary classified?

A
  • ​1. Benign
    • ​Cystic (cystadenomas), cystic and fibrous (cystadenfibromas) and fibrous (adenofibromas)
  • 2. Borderline
  • 3. Malignant (cystadenocarcinomas)
29
Q

How can we classify ovarian carcinomas?

A

Type I: Low-grade that arise from with borderline tumors or endometriosis

  • Low-grade serous/endometroid/mucinous

Type II: High-grade serous carinomas that arise from serous intraepithelial carcinoma (percursor lesion)

30
Q

What is the most common malignant ovarian tymor (40% of all cancers of ovary)?

A

Malignant Serous Carcinoma of the ovary

31
Q
  • Serious tumors of the ovary have what kind of epithelium?
  • All serous tumors have _________
  • Are most benign/malignant?
A

Tubal-like epithelium, all have psammoma bodies (concentric calficification)

70% = benign or borderline

32
Q

What are the risk factors associated with malignant serous carcinomas of the ovary?

A
  1. Nulliparity (low parity) = never given birth
  2. Family hx
  3. Heritable mutations: BRCA1 and BRCA2
33
Q

The distinction between low-grade (well-differentiated) and high-grade (moderate to poor differentiated) serous ovarian carcinoma is based on what and correlates with?

A

Degree of nuclear atypia; correlates with patient survival

34
Q

How do the genetic mutations observed in low- vs. high-grade serous ovarian carcinomas differ?

A
  • Low-grade = arise from serous borderline tumors and have mutations in KRAS, BRAF, or ERBB2; with wild-type TP53
  • High-grade = high frequency of TP53 mutations and lack mutations in either KRAS or BRAF.
35
Q

ALL ovarian and endometrial serous tumors have what characteristic morphologic finding?

A

Psammoma bodies (concentric calcificaitons)

36
Q

What are the morphological features of benign serous ovarian tumors both grossly and microscopically?

Bilateral?

A
  • Smooth, glistening cyst wall w/ NO epithelial thickening or have small papillary projections
  • Lined by columnar epithelium + abundant cilia
  • 20% = bilateral
37
Q

Morphology of borderline serous tumor

A
  1. Increase in papillary projections, often involving surface of voary
  2. Mild nuclear atypia
  3. No stromal invasion
38
Q

What gross morphological features of malignant serous ovarian carcinomas?

A
  1. Solid or papillary tumor mass with watery fluid
  2. Irregular
  3. Fixation or nodularity of the capsule
39
Q
  1. Which cystic lesions of the ovary may be the origin of a vast majority of serous ovarian carcinomas?
  2. Which precursor lesion associated with sporadic high-grade serous ovarian cancer has been described as originating in the fallopian tube?
A
  1. Cortical inclusion cysts
  2. Serous tubal intraepithelial carcinoma (STIC)
40
Q

What epithelial proliferation pattern is thought to be the precursor to low-grade serous carcinomas?

A

Growth in a delicate, papillary pattern known as “micropapillary carcinoma”

41
Q

Serous tubal intraepithelial carcinomas consist of cells morphologically identical to high-grade serous ovarian carcinomas, but are distinguished how?

A

LACK of invasion of stroma

42
Q

Both low- and high-grade serous ovarian tumors have a propensity to spread where; assoc. w/ what common presenting sign?

A
  • Spread to peritoneal surface and omentum
  • BL = extend to peritoneum and remain fixed or spread => intestinal obstruction
  • Low grade = same but survival is better
  • High-grade = highly metastic throughout abdomen and cause ascites
43
Q

What determines staging of serous carcinoma?

A

Spread outside ovaries

44
Q

What is the 5-year survival rate for borderline and malignant serous ovarian carcinomas confined to the ovaries; what is prognosis for same tumor involving the peritoneum?

A

- Confined to ovary = 100% (borderline) and 70% (malignant)

- Peritoneum = 90% (borderline) and 25 %(malignant)

45
Q

What is the prognosis of serous ovarian carcinomas dependent on?

A

Pathologic classification of the tumor and growth pattern on the peritoneum

46
Q

Describe a serous cystadenoma.

MC in who?

A
  • Serous Cystadenoma = benign
    • Cysts filled with water fluid lined of single cells, often bilateral.
    • W 30-40
47
Q

Type 1: low grade serous cystadenocarcinoma arises from _________

Type 2: high grade serous cystadenocarcinoma arises from _________

A

- borderline tumors

  • in-situ lesions in fallopian tubes or serious inclusion cysts
48
Q

M

A

Endo/Repro II Test 1 (23 decks)

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