Test 2 Flashcards
_________: a term used for endometrial tissue that forms __________ like nodules (Foci) outside the uterus. These foci are composed of endometrial _____ and _____. They respond to ________ stimulation and _________ with the normal endometrium.
Endometriosis tumor glands and stroma estrogenic proliferate
Common locations of endometriosis
ovary, fallopian tube, pelvic peritoneum
on occasion, outside pelvis -> umbilicus, appendix, colon, pouch of douglas, vulva, bladdder, abdomen
Common age to suffer from endometriosis
Reproductive years -> 20s-40s and women of a higher SES
What is the regurgitation theory?
Most probable pathogenesis of endometriosis -> instead of endometrial tissue exiting the body through the vagina during every menstruation, it is regurgitated upstream where it enters the abdominal cavity through the fallopian tubes. The glands of the endometrial tissue implant on the serosa of the ovary or the peritoneum forming red brown nodules or plaques. Most foci of endometriosis are located near the opening of the fallopian tubes which support this theory
Name for benign tumors originating from smooth muscle cells of the myometrium
Fibroids -> most common uterine tumors
Name for benign fibroid
Leiomyomas (98%)
Name for malignant fibroid
leiomyosarcoma (1-2%)
Fibroid embedded within the myometrium
Intramural
Fibroid that occurs beneath the covering serosa of the uterus
Subserosal
Fibroid that protrudes into the endometrial cavity * Associated with miscarriage/infertility bc decreases ability for egg to implant onto uterus
Submucosa
Risk factors for endometrial adenocarcinoma? (7)
What reduces the risk of this cancer? (1)
- Exogenous estrogen
- Have estrogen-producing tumors
- Obesity
- DM
- HTN
- Nulliparous
- Early Menarche/late menopause
Most affected women have excellent prognosis
Risk reduced by multiple pregnancies -> gives endometrium long breaks from proliferation
What is caused by excessive estrogenic stimulation of the endometrium leading to cystic expansion and thickening of the entire endometrium with multi-layering of the enometrial glands with scant endometrial stroma
Endometrial hyperplasia
What type of hyperplasia is seen with minimal glandular complexity and no cytologic atypia
Simple Hyperplasia (1% progression to adenocarcinoma)
What type of hyperplasia is seen with multilayering of the glands with crowding but still no cytologic atypia
Complex Hyperplasia (3% progression to adenocarcinoma)
What type of hyperplasia is seen with complexity of the glands with crowding and there is cytologic atypia, also the epithelial cells are enlarged and hyperchromic with high nucleus/cytoplasm ratio and prominent nucleoli?
Atypical Hyperplasia (25% progression to adenocarcinoma)
What is the most common malignant tumor of the female genital tract? (50% of all GYN malignancies and usually in women over 35 years)
Endometrial adenocarcinoma
Where does endometrial adenocarcinoma originate from?
epithelial cells lining the endometrial glands
The endometrial adenocarcinoma tumor appears as a ________ mass protruding into the ______ lumen.
The tissue is ______ and ______ bc it consists of atypical _______ with very little stroma.
fungating
uterine
friable and soft
glands
The most common symptom in endometrial cancers is?
Vaginal bleeding that may occur as spotting between 2 menstruations or as prolonged pronounced menstrual bleeding (menorrhagia)
Treatment for endometrial adenocarcinoma?
D&C (Dilation and Curettage) -> TAH-BSO ( hysterectomy w/ or w/o ovaries -> possible lymph node removal
(80% of all endometrial cancers are detected while the tumor is confined to the uterus and affected women have an excellent prognosis)
Most common site of implantation in an ectopic pregnancy?
95% in Fallopian tube -> ovary -> abdominal cavity
With an ectopic pregnancy, the ______zygote undergoes its normal development with the formation of _______ tissue and _______ sac.
The _________ is poorly attached to the wall of the tube and weakens it with the possibility of ________ and _________ hemorrhage
fertile placental amniotic placenta rupture intraperitoneal
Major sign/symptom of an ectopic pregnancy?
Severe abdominal pain with rupture and possibility of shock
T/F a pregnancy test will be positive even with an ectopic pregnancy
True
What denotes rupture during an ectopic pregnancy?
Aspiration of fresh blood from the pouch of Douglas (posterior fornix)
What is the most common pathologic condition leading to ectopics? Plus 3 other causes?
- CHRONIC SALPINGITIS (PID)
- Pertubal adhesions as from endometriosis
- Previous Surgeries
- leiomyomas
Diagnosis of an ectopic pregnancy involves what 3 things?
- Biopsy (endometrial - shows decidual reaction)
- Absence of chorionic villi bc the villi are in the tube
- Ultrasound -will show dilation of fallopian tube
If there is an ectopic pregnancy in the Fallopian tube, at how many weeks will rupture occur?
2-6 weeks
What are the 2 complications of chronic salpingitis from PID?
Also what are 2 more complications of PID?
- ectopic pregnancy
- Infertility- risk increases with GC infection, scars FT -> occludes lumen and prevents spem from reaching egg
- Abscesses
- Peritonitis
Name 8 types of adenocarcinomas (neoplasia of epithelial tissue of glandular origin)
- Endometrial Hyperperplasia (non-neo)
- Endometrial Polyps (non neo)
- Endometrial Adenocarcinoma (neo)
- Tumors of the Fallopian tubes (rare, epithelium doesnt shed or respond to estrogen)
- Tumors of surface epithelium (neo - ovaries)
- Serous Cystadenocarinoma
- Solid Serous Cystadenocarcinoma
- Mucinous Cystadenocarcinoma
What are benign localized overgrowths that project from the endometrial surface into the endometrial cavity?
Most arise in the fundus, usually solitary and vary in size.
Endometrial polyps
What is a squamous cell cancer of the female reproductive tract that deals with pus in the endometrial cavity (pyometria)
Pyometria (non neo)
Associated with any lesion that causes cervical stenosis such as a tumor or scarring from surgical tx of the cervix
Name 5 surface germinal epithelium tumors and whether they are benign or malignant
(These are the worst of the primary neoplastic ovarian masses)
- Serous (Benign - borderline Malignant)
- Mucinous (Benign - borderline Malignant)
- Brenner (Benign)
- Endometroid (Malignant)
- Transitional Cell (Malignant)
Name 5 germ cell tumors and whether they are benign or malignant
- Dermoid (Benign)
- Dysgerminoma (Malignant)
- yolk sac (Malignant)
- Choriocarcinoma (Malignant)
- Embryonal (Malignant)
Name 4 sex cord stromal tumors and whether they are benign or malignant
- Thecoma (Benign)
- Fibroma (Benign)
- Granulosa (Malignant)
- Sertoli- Leydig (Malignant)
Which tumor secretes HCG?
can be used as a diagnostic marker/monitoring tumor recurrence after chemo
Choriocarcinoma
Which sex cord tumor secretes estrogen, causes menstrual irregularities, and endometrial hyperplasia?
Thecoma
What sex cord tumor produces estrogen that can cause menstrual irregularities -> precocious puberty and in older women, lead to breast/endometrial cancer?
Granulosa Cell Tumor
Which sex cord tumor secretes androgens which causes virilization?
Sertoli-Leydig Cell Tumor
Which germ cell tumor is the “worst” and why?
Choriocarcinoma -> highly invasive/malignant
-at time of dx tumor has typically already spread throughout blood stream to the lungs and other organs (liver brain bones)
Because the ovary is homologue of testes, what is the male equivalent of a choriocarcinoma?
teratocarcinoma
Choriocarcinomas are an ______ germ cell tumor.
Made up of __________ cells.
Results in bulky hemorrhagic ________ in placental bed that invades through the wall of the _______ and often implants into the ________.
Can be solid or ______
ovarian trophoblastic nodules uterus vagina cystic
Where do choriocarcinomas arise from? (3)
pre existing complete hydatidiform mole (50%)
placental tissue from abortion (25%)
normal placenta after delivery (25)
Histologically, the choriocarcinoma is identical to what 3 lesions?
placenta
endometrial
testicular
What is the most common germ cell tumor? Hint it is the most common ovarian tumor in women less than 25 years of age
benign cystic teratoma aka dermoid cyst (95%)
rare but could lead to malignant teratocarcinoma
What is the homologue tumor of the female dysgerminoma found in males?
- Seminoma -> tumor is large, firm, with a fleshy cut surface
What female malignant tumor is uncommon but makes up half of all malignant germ cell tumors? Tx is surgical. Usually occurs in childhood. Only 1/3 are aggressive. Highly radiosensitive
Dysgerminoma
What is the counterpart of the yolk sac tumor of the testes and what does it produce?
Endodermal Sinus Tumor
produces alpha fetoprotein (AFP)
What GYN cancer is most deadly?
Ovarian - causes more deaths than all other tumors of the reproductive tract, but is second most common behind endometrial adenocarcinoma
Which type of surface epithelium tumor is most common, mimics fallopian tube epithelium, seen older in life, consists of several cysts lumped together within a common outer capsule, and is least serious of the group?
Serous tumor - commonly benign 7:1
T/F all malignant tumors are characterized by hemorrhage and necrosis both grossly and microscopically
True
What is the Ab to cancer Ag detected in the serum in about 1/2 of the epithelial tumors that are confined to the ovary but 90% have already spread
CA-125
Which surface epithelial tumor mimics endocervical epithelium?
Mucinous - cavity of tumor filled with thick yellowish or clear jelly substance
What can happen is a mucinous tumor is malignant and ruptures?
Pseudomyxoma peritonei
Which surface epithelium tumor mimics urinary system epithelium? Give 2 names
Brenner - AKA transitional cell carcinoma (if in stage III/IV, 8% 5 year survival)
What are characteristics of a Brenner tumor?
Solid by a dense fibrous stroma with nests of transitional epithelium
Which surface epithelium tumor mimics endometrial glands?
Endometrioid -> solid tumor
can harbor benign endometriosis
15-30% accompanied by carcinoma of the endomedtium
Tumor of the GI tract that metastasizes to the ovaries. The most common metastatic tumor being a stomach carcinoma that will tend to produce bilateral enlargement of the ovaries
Krukenberg tumor
__________ ______ is a placental abnormality marked by trophoblastic proliferation & hydropic degeneration of chorionic villi
Hydatidiform Mole
The most common form of hydatidiform mole is the ____________ ______
Where the ______ cannot be identified in the ________ ___
Complete Mole
Fetus
Amniotic Sac
Complete Mole is a result of what?
What is that process called?
abnormal fertilization -> all chromosomes are paternal
due to loss of maternal chromosomes from the zygote at the time of fertilization
ANDROGENESIS - Paternal 23 chromosomes re-duplicate to create 46 chromosomes
What happens to the embryo in a case of complete mole?
Without maternal chromosomes, the embryo cannot develop and the placenta undergoes hydropic degeneration
What happen with an incomplete hydatidiform mole?
Oocyte fertilized with 2 sperm -> 69 chromosomes
Lethal combination, but embryo doesnt die immediately so parts of the embryo are found encased among the hydropically altered placental villi & normal placental tissue
What are some signs or symptoms of a hydatidiform mole pregnancy?
- Enlarged uterus compared to the normal corresponding growth ( people think its twins!)
- No fetal movement/ heartbeat
- Snowstorm pattern on ultasound
- High serum/urine levels of HCG
- Aborted spontaneously mid pregnancy
Mucous CT in umbilical cord
Wharton’s Jelly -> provides insulation and protection, also site of umbilical cord stem cells
Fetal/newborn feces
Meconium - tar like
As the blastocyst implants into the endometrium, it stimulated the ________ _________
The cells of the endometrial ______ (fleshy endometrial tissue between the glands of the inner lining endometrium) accumulate ______ & _______, become plump and are transformed into _________ cells
The________ thickens & becomes more highly ___________, and the endometrium is now called _______ and is ready for blastocyst implantation.
Decidual Reaction stroma lipids & glycogen decidual stroma vascularized decidua
What is found in 18% of placentas in pregnancies that last longer than 42 weeks?
Meconium-stained placenta - green colored staining, easily rinses off - major complication of thick meconium is aspiration causing fetal chemical pneumonitis
The attachment of the placental villi to the level of the myometrium without further invasion causes?
Placenta Accreta
The placental villi invade into the underlying myometrium causes?
Placenta Increta
The placental villi penetrate into the full-thickness of the uterine wall causes?
Placenta Percreta
The usual term placenta is about ______ in diameter and ______ thick
In generally weighs ________
The maternal surface is dark _____ or _____ in color and should be divided into ______ or cotyledons.
The fetal surface should be ______, grey and translucent enough to see the color of the underlying cotyledons. Fetal membranes (__________) are usually shiny, wrinkled, and translucent.
22-24 cm in diameter and 2.5-3.0 cm thick 500grams (1lb) red or maroon lobules shiny amnio-chorion
The umbilical cord at birth is ______ _______ in color
_____ cm in diameter
_____ cm long
It is _________ positioned, and contains the right and left (2!) umbilical ________, the left umbilical ______(1), and ___________.
Pearly white 1-2 cm 50-60 cm eccentrically arteries vein Wharton's jelly
The right and left umbilical arteries carry _________ blood from the fetus to the placenta. The umbilical vein carries ___________ blood from the placenta to the fetus.
deoxygenated
oxygenated
The volume of amniotic fluid ________ through the 7th month and then _______ somewhat in the last 2 months.
At birth the vol. of amniotic fluid is around ___ L.
The rate of water exchange within the amniotic fluid is around _______ ml/hr
The term fetus swallows about _____ ml of amniotic fluid daily and excretes ____ml of urine daily
Maternally derived water that is similar to ____ _____ in composition, that is continually produced and constantly ________.
increases decreases 1 L 400-500 ml/hr 400ml 500ml blood plasma resorbed
What does amniotic fluid contain? (10 things)
- Electrolytes
- Carbs
- Amino Acids
- Lipids
- proteins (hormones, enzymes, alpha-fetoproteins)
- urea
- creatineine
- desquamated fetal cells
- fetal urine and feces
- fetal lung lipids (lecitchin and sphingomyelin -2:1)
What is found on the maternal side of the placenta, consists of main stem of chorionic villus, and split in 15-30 divisions of the placenta?
Cotyledons - if any remain after birth -> post-partum hemorrhaging
Which hormone secreted from the placenta is know as the growth hormone for the fetus?
Human Placental Lactogen (hPL) -> protein hormone that induces lipolysis thus elevating free FA content in mom
What term is used to describe a placenta with extra lobes, usually linked by thin chorionic tissue, and usually of no clinical importance unless a portion of the lobe is retained after birth -> postpartum bleeding
Succenturiate
What term is used to describe a placenta with a rolled and raised ring of fetal membrane, instead of staying at the edge of the placenta? (Chorionic plate < basal plate).
Circumvallate
What are 4 risks with a circumvallate placenta?
- Prematruity
- Prenatal bleeding
- Placental abruption
- Multiplarity
What is the name of a condition with numerous small, gray, or yellow nodules on the fetal surface of the placenta which may be associated with oligohydramnions
Amnion Nodosa
What is Oligohydramnions? What can it cause?
Low amount of amniotic fluid, can cause Potters Syndrome which is renal agenesis (kidneys fail to develop)
What is the most common complication of a baby being born with amniotic fluid thick with meconium?
Aspiration causing fetal chemical pneumonitis
What can cause acute chorioamnionitis? (3 groups)
- genital mycoplasm species (M. hominis/U. urealyticum
- anaerobic bacteroides group
- aerobe group B Strep, E. coli, and Gardnerella vaginalis
Commonly caused by premature rupture of amniochorionic membranes (PROM)
What is the name for inflammation of the umbilical cord typically caused by intrauterine infection (meconium exposure, spread of chorioamnionitis, Candida, Actinomyces, HSV, Syphilis) ?
Funisitis -acute fetal inflammatory respose - can be necrotizing (infiltration into Whartons Jelly) or peripheral (micro-abscesses on surface)
What are two signs of funisitis?
- Vasculitis of umbilical vessels
2. PNM inflitration after extension of Wharton’s Jelly
