Tumors / Cysts Flashcards
Which tumor?
- Originate from specialized ovarian stromal cells
- 5% of ovarian tumors
- Has 3 variants
Sex Cord Stromal Tumors
What are the 3 Sex Cord Stromal Tumor Variants
- Thecomas
- Granulosa Cell Tumors
- Sertoli-Leydig Cell Tumors
Which tumor?
- Solid tumor
- Secretes estrogens
- Always benign
- Cause menstrual irregularities
- Causes endometrial hyperplasia
Thecomas
(Sex Cord Stromal Tumors)
Marshmellow man w/ detached penis beside him
Thecoma of Ovary
(Sex Cord Stromal Tumors)
Which tumor?
- Solid tumor
- Cells resemble granulosa cells of ovarian follicles
- Produce estrogens / menstrual irregularities
- Small ones are benign
- Large ones may be malignant
- Can cause precocious puberty in young girls
- Can lead to breast / endometrial cancer in older women
Granulosa Cell Tumors
(Sex Cord Stromal Tumors)
“Fish w/ a bloody side fin”
Granulosa Cell Tumor
(Sex Cord Stromal Tumors)
- Solid tumors
- Hormonally active cells which secrete Androgens –> cause virilization (deep voice, facial hair, male pattern baldness, hairy chest w/ hypertrophy of clitoris)
- May be benign or malignant
Sertoli-Leydig Cell Tumors
(Sex Cord Stromal Tumors)
Tomato w/ sun spots
Sertoli-Leydig Cell Tumor
Which tumor?
- Originate most often from carcinomas of endometrium and breast
- Have estrogen receptors (metastasize to ovaries)
- Tumors of GI tract metastasize to ovaries
- Most common is stomach carcinomas (produce bi enlargement of ovaries-Krukenberg tumors)
Metastatic Ovarian Tuors
Metastasis of GI tract to ovary
Krukenberg tumors
fortune cookie
Krukenberg Tumor
- Implantation of fetus in ANY other site other than the normal uterine location
- 1/150 pregnancies
- Chronic Salpingitis (adhesions) leads to this
- Peritubal adhesions from endometriosis, previous surgeries, and leiomyomas
- *Chronic complication of PID*
Ectopic Pregnancy
3 most common areas of ectopic
- fallopian tubes (95%)
- ovary
- Abdominal Cavity
How/why do ectopic pregnancies occur?
- Intratubal adhesions forms barrier to normal passage of zygote (so the zygote implants at site of obstruction)
- The entire fertile zygote undergoes its normal development w/ formation of placental tissue & amniotic sac
- Placenta is poorly attached to wall of tube
- This all leads to what 3 things?
- Weakening of tube
- Risk of rupture
- Risk of intraperitoneal hemorrhage
W/ ectopic pregnancy, when does rupture usually occur?
2-6 weeks after pregnancy
Describe the fallopian tube
Dilated
- Severe abdominal pain
- Possibility of shock (which type)?
- Signs/sxs of acute abdomen
Ruptured Ectopic Pregnancy
-Hypovolemic shock (Hemorrhagic Shock)
Ectopic Pregnancy
Are pregnancy tests positive or negative?
Positive
What procedure could you perform to detect a ruptured ectopic?
Aspiration of fresh blood from pouch of Douglas (posterior fornix)
What is helpful in dx of Ectopic Pregnancy?
Endometrial biopsy
How is dx of ectopic pregnancy made?
US of fallopian tube showing dilation
- Absence of ____ ____ is consistent w/ ectopic pregnancy
- What will biopsy show?
- US will show what?
- Chorionic villi
- Decidual reaction of endometrium
- Dilation of fallopian tube
- Rupture of ectopic is medical emergency
- How many die before hemorrhage can be controlled?
1/400
- Disease which involves trophoblastic epithelium and includes a spectrum of proliferative lesions
Gestational Trophoblastic Disease
3 types of Gestational Trophoblastic Disease (GTD)
- Benign: Hydatidiform
- Limited proliferation: trophoblast
- Highly malignant: Choriocarcinoma
- Has no fetal parts
- Only contains placental tissue inside the uterus w/ “snow storm patter” on US
- No heart, no baby, ONLY grapes of chorionic villi
Gestational Trophoblastic Disease (GTD)
- Placental abnormality marked by trophoblastic proliferation & hydropic degeneration of chorionic villi
Hydatidiform Mole
(Gestational Trophoblastic Disease) - benign
- Most common form of Hydatidiform Mole
- Fetus cannot be identified in amniotic sac
- Results from abnormal fertilization (all chromosomes are paternal due to loss of maternal chromosomes from zygote at time of fertilization)
- **Duplication of paternal haploid**
Complete Mole
(Gestational Trophoblastic Disease)
Alien baby
Complete Hydatidiform Mole
(Gestational Trophoblastic Disease)
Swollen Hydropic Villi
(of Hydatidiform Mole)
(Gestational Trophoblastic Disease)
Complete Hydatidiform Mole (of GTD)
- Has no fetal parts/no embryo development, bc it has no maternal chromosomes, so the placenta undergoes what?
- Paternal 23, X set of chromosomes reduplicates = 46 (this is called what?)
- Hydropic degeneration
- Androgenesis
- Evolves from oocytes fertilized w/ 2 spermatozoa.
- How many chromosomes?
- __ sets from mom
- ___ sets from dad
Incomplete Hydatidiform Mole (GTD)
- 69
- 1 from mom
- 2 from dad
- Lethal
- But, embryo doesn’t die immediately
- Parts of embryo found encased among hydropically altered placental villi & normal placental tissue
Incomplete Hyatidiform Mole (GTD)
In the US, Hydatidiform Moles of GTD are rare (1/2000)
- What is dx based on?
- enlarged uterus for corresponding / calculated duration of pregnancy
- No signs of fetal movement
Best method for dx Hydatidiform Mole (GTD)?
US will detect snow-storm patter w/ no fetal heart beat or movement
- W/ Hydatidiform Mole, high serum and urine levels of ____ are typically found.
- What is the malignant tumor called?
- Grossly, placenta is transformed into ______.
- HCG
- Chorio
- numerous grape-like clear vesciles filled w/ fluid / covered w/ hyperplastic trophoblastic epithelium
- Malignant tumors composed of trophoblastic cells
- 50% arise from preexisting complete mole
- 25% arise from placental tissue retained after abortion
- 25% arise from normal placenta after completion of normal pregnancy
Choriocarcinoma
Why is it important to remove all parts of abnormal placenta of Hydatidiform Mole?
Remaining trophoblastic cells could give rise to malignancy (chorio)
- Highly invasive tumors
- The tumor secretes ___ which is a good marker for the disease and monitors tumor recurrence after chemotherapy
Choriocarcinoma
HCG
- Forms bulky hemorrhagic nodules in placental bed
- Invades through wall of uterus & often invades through wall of uterus
- Often implants in vagina
Choriocarcinoma
By invading ____, metastasizes to lung, liver, and brain.
veins
Tumor responds well to chemo w/ _____ and cure rates of 80-100% have been achieved (but only in those w/o metastases.
Methotrexate
(Choriocarcinoma)
C shaped
Choriocarcinoma
