Test 2 Flashcards
Defined as the abnormal presence of neutrophils
in the endometrium
Acute Endometritis
Most cases of Acute Endometritis result from an
ascending infection from the cervix as a result of abortion, delivery, or medical instrumentation
The presence of plasma cells within a normal
endometrium, along with lymphocytes and an
occasional lymphoid nodule
Chronic Endometritis
The disorder is associated with intrauterine
devices (IUD’s), PID, and retained products of
conception after an abortion or delivery
Chronic Endometritis
in Chronic Endometritis Patients usually complain of…
bleeding, pelvic pain,
or a combination of both
Defined as pus in the endometrial cavity
Pyometria
Associated with any lesion that causes cervical
stenosis, such as a tumor or scarring from
surgical treatment of the cervix (conization of
cervix)
Pyometria
may be associated with a rare chance of developing an endometrial squamous cell carcinoma
Long-standing pyometria
A term used for endometrial tissue that forms
tumor-like nodules outside the uterus.
Endometriosis
Endometrial tissue that forms tumor-like nodules outside the uterus can be most often found on…
Most often located on the ovary, fallopian
tube or on the pelvic peritoneum,
Less common Sites of Endometriosis can be found…
anything in the abdominal cavity
_____% of all women
of reproductive age are affected by Endometriosis
15-20%
alleviates the symptoms of Endometriosis
Suppression of menstruation with BCP’s
What is a Chocolate Cyst?
Ovarian endometriosis may present with large
cystic lesions measuring 1-5 cms. in diameter.
Typically, the endometriotic cysts are filled with
brown-red viscous fluid derived from
decomposed blood.
The presence of endometrial glands and stroma
within the underlying myometrium.
Adenomyosis
• Many patients are asymptomatic.
• One-fifth of all uteri removed at surgery reveal
some degree of this disorder.
Adenomyosis
Benign tumors originating from the smooth
muscle cells of the myometrium. (Fibroids)
Leiomyomas
___% of Leiomyomas are benign whereas ___% are
malignant (leiomyosarcomas).
98%
1-2%
Grossly describe Leiomyomas
they are sharply circumscribed,
unencapsulated white-tan whorled masses on
cut section. Histologically, they consists of
smooth muscle cells arranged in fascicles.
Leiomyomas are most common in the 3rd and 4th
decades and more common in…
blacks
Leiomyomas embedded within the
myometrium
Intramural
Leiomyomas occurs beneath the covering serosa of the uterus.
Subserosal
Leiomyomas protrude into the endometrial cavity
Submucosa
Leiomyomas symptoms
related to the compression of
the rectum and urinary bladder, especially the
subserosal type.
Abdominal heaviness, urinary urgency, and
constipation are commonly encountered.
Leiomyomas located beneath the mucosa tend to
grow into the endometrial cavity, causing menstral
irregularities and endometrial bleeding.
Caused by excessive estrogenic stimulation of the
endometrium leading to cystic expansion of the
entire endometrium with focal branching of the
glands with scant endometrial stroma.
Endometrial Hyperplasia
When there is complexity to the glands with crowding and there is cytologic atypia. The epithelial cells are enlarged and hyperchromatic with high N/C ratios and prominent nucleoli.
About 25% of these cases progress to adenocarcinoma.
Atypical Hyperplasia
Benign, localized overgrowths that project
from the endometrial surface into the
endometrial cavity. • Thought to arise from endometrial foci that are
hypersensitive to estrogen stimulation or
unresponsive to progesterone that, in either
case, would not slough during menstruation
and would continue to grow.
Endometrial Polyps
Most Endometrial Polyps arise in the______, usually solitary, and vary in size.
fundus
When there is minimal glandular complexity and no cytologic atypia, the term _____________ is used. (1% progression to carcinoma)
When there is multilayering of the glands (complexity) with crowding, but still no cytologic atypia, the term _____________ is used. (3% may develop adenocarcinoma)
simple hyperplasia
complex hyperplasia
• The most common malignant tumor of the
female genital tract, accounting for approx.
50% of all GYN malignancies.
• Arises from the epithelial cells lining the
endometrial glands.
• Clinical studies have found an association
between hyperestrinism and endometrial
cancer, regardless of the source of the estrogens
Endometrial Adenocarcinoma
Endometrial Adenocarcinoma
• More common in women who:
Have elevated estrogen for any reason
_____% of all endometrial cancers are detected
while the tumor is confined to the uterus, and
affected women have an excellent prognosis.
80%
Women with endometrial carcinoma also at an
increased risk of developing carcinoma of the…
ovaries and breasts
Carcinoma confined to the endometrium
Stage I
Carcinoma extending into the cervix
and invading into the myometrium.
Stage II
Carcinoma extending through the wall
of the uterus, but not outside the pelvis.
Stage III
Carcinoma infiltrating the bladder or
the rectum, or extending outside the pelvis.
Stage IV
The most common primary lesions of the
fallopian tubes, and its characteristics
Benign Paratubal Cysts
Small
Larger cysts may be found near the fimbrae or
in the broad ligament and are of little clinical
significance
Endometriosis is most common in?
Higher incidence in women in higher socio-
economic groups who tend to marry latter in life.
The most common place for an ectopic pregnancy
places are the ovary, abdominal cavity, and the fallopian tubes (95%).
The most common pathologic condition leading
to ectopics is…
chronic salpingitis
Other factors
include peritubal adhesions as from endo-
metriosis, previous surgeries, and leiomyomas.
An infection of the female pelvic organs that
begins in the vulva and ascends upwards, and
follows the extension of any of a variety of
microorganisms.
Pelvic Inflammatory Disease
Pelvic Inflammatory Disease may result in acute accesses called?
salpingitis, pyosalpinx, and tuboovarian abscess.
The 2 principal single organism
causing PID in order
N. gonorrhea followed by Chlamydia, but Staph,
Strept, and Mycoplasma species may also be a
cause of PID
It infects the columnar epithelium of the
cervix, which becomes reddened and friable,
with a purulent exudate.
Gonococcal Disease
pain with sexual intercourse
dyspareunia
This organism often causes asymptomatic or
mild symptoms of PID that may go undiagnosed or
untreated, yet can still lead to infertility.
C trachomatis
Some users of IUD’s are at an increased risk for
PID, usually due to
Actinomyces israelii.
Why is it uncommon to get cancer of the fallopian tubes?
attributable to the fact that the epithelium of the fallopian tubes does not shed cyclically
are the most common lesions, and these tumors account for 1% of all GYN malignancies.
Adenocarcinomas
The absence of chorionic villi is consistent with
an…
ectopic pregnancy, because the villi are in the
tube.
is a disease that involves the trophoblastic epithelium and includes a spectrum of proliferative lesions, from the benign Incomplete and Complete Hydatidiform Mole, with limited and full proliferation of the trophoblast, respectively, to the highly malignant Choriocarcinoma.
Gestational Trophoblastic Disease
A placental abnormality marked by trophoblastic
proliferation and hydropic degeneration of the
chorionic villi.
Hydatidiform Mole
Results from abnormal fertilization, where all of the chromosomes are paternal in origin due to a loss of maternal chromosomes from the zygote at the time of
fertilization.
Complete Hydatidiform Mole
the fetus cannot be identified in the
amniotic sac
Evolve from oocytes fertilized with two
spermatozoa, therefore, the cells have 69
chromosomes, one set from the mother, and
two sets from the father. This combination is
also lethal, but the embryo does not die
immediately, so parts of the embryo are found
encased among the hydropically altered
placental villi and normal placental tissue.
Incomplete Hydatidiform Mole
It is important to remove all parts of the Hydatidiform Mole placenta because the remaining trophoblastic cells could give rise to…
Chorio malignant tumors (Choriocarcinoma)
A malignant tumors composed of trophoblstic
cells. In 50% of cases it arises from a
preexisting complete mole
Choriocarcinoma
A_______ arises in in 25% of placental tissue retained after abortion, and in the last 25%, it arises from normal placenta after completion of a normal pregnancy.
Choriocarcinoma
Highly invasive tumors and secrete hCG which
is a good marker for the disease and monitors
tumor recurrence after chemotherapy.
Choriocarcinoma
Choriocarcinoma invading veins, it metastasizes to the.
lung, liver, and the brain.
Choriocarcinoma tumors responds well to _____________, and cure rates of ______% have
been achieved, but only in those patients who
do not have metastases.
chemo with Methotrexate
80-100%
is the second most common GYN cancer, but ranks first for deaths caused by GYN cancer
Ovarian cancer
suppress ovulation and reduces
the risk of ovarian cancer.
BCP’s
Birth control pills
most common group of ovarian tumors are
derived from surface epithelial cells of the ovary
which rupture each month at ovulation.
Cystic Tumors of the ovaries Surface Epithelium
Serous and Mucinous
• Are the most common form of surface tumors.
• They consists of several cysts lumped together
within a common outer capsule.
• The tumors mimic the fallopian tube epithelium
Serous Tumors
Ovarian Serous and Mucinous tumors are either
classified as…
benign, borderline (potential), or malignant.
malignant Serous Tumors tumors form…
bilateral
The more solid ovarian surface epithelium tumors…
Endometroid and Brenner are more
solid.
• These are Ovarian surface epithelial Tumors
• Are more often benign (7:1 ratio) and less
commonly bilateral (10-30%)
• The cavity of these tumors is filled with thick,
yellowish or clear jelly-like material.
Mucinous Tumors
When the entire belly is filled with mucus this is called.
Pseudomyxoma peritonei
This tumor mimics endocervical epithelium.
Mucinous Tumors of ovarian surface epithelium
_______are solid ovarian tumors composed
of glands that resemble endometrial glands.
-15-30% are accompanied by a carcinoma of the endometrium and 15% harbor benign endometriosis.
Endometroid tumors
_________are also tumors of surface
epithelia which is essentially solid and char. by a
dense fibrous stroma with scattered nests of
Transitional epithelium (2% of all neoplasms)
Brenner Tumors
There is an antibody to a cancer antigen when detected in the serum in about half of the epithelial tumors that are confined to the ovary, but about 90% that have already spread.
CA-125
Benign surface epithelium ovarian tumors have an excellent prognosis, and the 5 year survival rate is…
100%.
surface epithelium ovarian tumors of borderline potential also have a good prognosis, but their five year survival rate is….
around 80%.
The overall five year survival rate for malignant
epithelial ovarian tumors is…
10-40%, depending
on the stage of the tumor.
Account for 20% of all ovarian tumors.
• Occur predominantly in women younger than
25 years of age.
Germ Cell ovarian tumors
The most common Germ Cell ovarian tumor are \_\_\_\_\_\_\_\_\_\_\_, which accounts for \_\_\_% of all of these tumors (Dermoid Cyst); it is the
benign cystic teratoma
95%
most common ovarian tumor in women less than 25
years of age.
benign cystic teratoma (Germ Cell Tumor)
The ovarian counterpart of the male Seminoma
Dysgerminoma
Germ Cell ovarian tumors that Usually occurs in childhood, all are malignant, but only one-third are aggressive. Highly radiosensitive like Seminomas.
Dysgerminoma
The ovarian counterpart of the Yolk Sac
Tumor of the male testes
Endodermal Sinus Tumor
• It too is rich in AFP.
• It is a rare tumor that grows aggressively and
rapidly. Nodular tan-white firm masses
• Predominantly seen in children and young
adults.
Endodermal Sinus Tumor
• Usually exists in combination with other germ
cell tumors of the ovaries (teratocarcinomas)
• Histologically, identical to placenta, endometrial,
or testicular lesions and elaborates HCG to help
with the diagnosis
• Macroscopically, they are ugly, bulky tumors
that usually mets widely through the bloodstream
to the liver, lungs, and bones at the time of
diagnosis. They are highly lethal tumors.
Choriocarcinoma
• Originate from the specialized, ovarian stromal
cells forming the follicles.
• Accounts for about 5% of all ovarian tumors.
• Three variants are recognized:
Sex Cord Stromal Tumors
solid Sex Cord Stromal Tumors that secrete Estrogens. They are always benign and often cause menstrual irregularities and endometrial hyperplasia.
Thecomas
solid Sex Cord Stromal Tumors composed of cells resembling granulosa cells of the ovarian follicles. These also produce estrogens that can cause menstral irregularities. The small tumors are benign, whereas the larger tumors may be malignant. These can cause
precocious puberty in young girls and in older
women can lead to breast or endometrial cancer.
Granulosa Cell Tumors
are solid Sex Cord Stromal Tumors composed of hormonally-active cells that secrete Androgens and cause virilization (deep voice, facial hair, male pattern baldness, hairy chest with hypertrophy of the clitoris)
Sertoli-Leydig Cell Tumors
These tumors may be benign or malignant.
Tumors of the GI tract metastasize to the
ovaries, the most common being stomach
carcinomas which tend to produce bilateral
enlargment of the ovaries
Krukenberg tumors.
• Originate most often from carcinomas of the
endometrium and breast.
• These tumors often have estrogen receptors,
which explains their predilection for
metastasizing to the ovaries.
Metastatic Ovarian Tumors
The usual term placenta is about____ cm in
diameter, and 2.5-3.0 cm thick.
22-24
The Normal Placenta maternal surface is dark red or maroon in color and should be divided into_____ or_________.
lobules or cotyledons
It is important that The Normal Placenta structure be complete with no missing….
cotyledons.
As the blastocyst implants, it stimulates this
reaction in the uterine endometrium.
Decidual Reaction
It is considered to be the “growth hormone” for the fetus.
Human Placental Lactogen (hPL) is a protein
hormone that induces lipolysis, thus elevating
the levels of free fatty acid in the mother.
steroid hormones produced by the placenta, but their function is unknown in the fetus and mother.
Estrone, Estradiol (the most potent), and Estriol
used by the fetal adrenal cortex as a
precursor for glucocorticoid, testosterone
(males), and mineralocorticoid synthesis.
Progesterone
The fetal membranes present as a thick ring, rolled and raised over the fetal surface instead of at the edge of the placenta. (the chorionic plate is smaller than the basal plate of the placenta). The blood vessels at the chorionic plate stop at the raised membranes and continue to run deeper under the membranes.
Circumvallate Placenta
The presence of one or many extra lobes of placental tissue near the main placenta, usually linked by thin chorionic tissue. (about 1 in 600 placentas)
Accessory (Succenturiate) Lobes
Numerous small, gray or yellow nodules on the fetal surface which may be associated with Oligohydramnios and renal agenesis (Potters Syndrome)
Anmion Nodosa
This finding within the umbilical cord is an abnormal
finding that suggests cardiovascular
abnormalities.
The presence of one umbilical artery
The Umbilical Cord is inserted into the fetal membranes and not the placenta, hence the unprotected umbilical vessels run for some distance between the amnion and chorion before passing on to the placental surface. (found in about 1% of deliveries)
Velamentous Insertion of Umbilical Cord
The umbilical cord becomes
coiled around the neck, again caused by
movement of the fetus through a loop of cord.
Nuchal Cords
Elevated levels are associated with Neural Tube
Defects (Spina Bifida, Anencephaly, etc.) and
esophageal and duodenal atresias (these interfere
with fetal swallowing). Reduced levels are
associated with Down Syndrome (Trisomy 21).
Alpha-Fetoprotein or AFP produced by the
fetal hepatocytes.
Excess amniotic fluid is removed via the
placenta and passed into maternal blood. Swallowing defects (esophageal atresia) or absorption defects (duodenal atresia) results in
Polyhydramnios
A low amount of amniotic fluid (<400ml in late pregnancy). It may be associated with the inability of the fetus to excrete urine into the amniotic sac due to
renal agenesis or an obstructive uropathy.
OLIGOHYDRAMNIOS
a lack of amniotic fluid can cause the amniotic cavity to be too small, can cramp the growth of the fetus, and can cause various congenital malformations such as
Potter’s Syndrome or hypoplastic lungs
due to increased pressure on the fetal lungs.
Occurs when there is a large amount of amniotic fluid (>2000 ml in late pregnancy). It may be associated with the inability of the fetus to swallow due to various
conditions
POLYHYDRAMNIOS
A partially or wholly implanted placenta in the
lower uterine segment overlying the internal
cervical os in its most severe form (Grade IV).
Placenta Previa
Owing to the absence of decidua, the placenta
does not separate normally from the
underlying uterine wall following delivery, an
event that can be associated with life-
threatening hemorrhage.
Placenta Accreta
Type of Placenta Accreta
the attachment of villi to the level of the myometrium without further invasion.
Placenta Accreta
Types of Placenta Accreta
The villi invade into the underlying myometrium.
Placenta Increta
Types of Placenta Accreta
The villi penetrate into the full-thickness of the uterine wall.
Placenta Percreta
• Defined as blood between the basal plate of the
placenta and the uterine wall.
• One of the most common causes of perinatal
mortality, accounting for 8% of perinatal deaths.
Retroplacental Hematoma
With more extensive spread, the umbilical cord,
may also become infected (funisitis), and can
exhibit vasculitis of the umbilical vessels with
neutrophilic infiltration after extension of
Wharton’s Jelly.
Chorioamnionitis
Infection of the villi results from endometritis
or transplacental passage of organisms
delivered by way of the maternal circulation.
(hematogenic spread)
Chorionic Villitis
Green-colored staining of the fetal membranes
that easily rinses off is meconium.
-Thought to be related to acute fetal hypoxia and distress, but this recently has been challenged
Meconium-Stained Placentas
bacteria that cause chorioamnionitis?
-Most to least
- Mycoplasm species (M. hominis, U. urealyticum)
- Anaerobic Bacterioides
- Aerobes Group B Streptococcus
- E. Coli
- Gardnerella Vaginalis
What is the most common cause of acute chorioamnionitis?
- Inflammation of the fetal membranes due to bacterial infection (placental amnion, chorion, and extraplacental membranes)
Define amnion nodosum
Nodosa-Numerous small, gray or yellow nodules on the fetal surface which may be associated with Oligohydramnios ( too little amniotic fluid) and renal agenesis (Potters Syndrome-Renal Agenesis)
Right and left umbilical arteries carry (deoxygenated or oxygenated?) blood from the fetus to the placenta
Umbilical vein carries (deoxygenated or oxygenated?) blood from the placenta to the fetus
deoxygenated blood
Oxygenated blood
the normal volume of the embryonic fluid at term.
o At birth volume = 1L, rate of exchange within amniotic sac = 400-500ml/hr
o Fetus swallows 400ml of amniotic fluid daily and excretes 500ml or urine at term
Ultra sound is the best method for early detection of Hydatidiform Moles with no fetal heartbeat or
movement. The presence of a mole relays a…
Snowstorm pattern
What are schiller duval bodies and where would you find them in the male/female?
Schiller duval bodies is seen in the endodermal sinus pattern of yolk sac tumors
Consists of a central vessel surrounded by tumor cells, and the whole thing is contained in a cystic space and lined with flattened tumor cells. It represents an attempt of the tumor to form a yolk sac.
Also most common testicular cancer in children
yolk sac tumors which are homologous too…
endodermal sinus tumors
