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Reproductive System- First Aid > Uterine and Ovarian Pathology (580-583 and top of 584) > Flashcards

Uterine and Ovarian Pathology (580-583 and top of 584) Flashcards

1
Q

define endometritis and what causes it

A

inflammation of the endometrium caused by retained products of conception, miscarriage, abortion, and foreign bodies such as IUDs

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2
Q

define endometriosis

A

non-neoplastic growth of endometrial tissue outside of the endometrium

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3
Q

where in the body does endometriosis usually manifest

A

ovary, peritoneum, pelvis

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4
Q

what is the classic pathologic structure that forms

A

chocolate cyst (large clot of coagulated blood)

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5
Q

what is the treatment for endometriosis

A

NSAIDs, OCP’s, progestins, GnRH agonists (Luprorelin and Triptorellin), surgery

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6
Q

what is adenomyosis

A

growth of endometrial glandular tissue into the myometrium

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7
Q

what are the symptoms of endometriosis

A

dysmenorrhea, dyspareunia (painful sex), dyschesia (painful #2), infertility with a normal sized uterus

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8
Q

what are the three main causes of endometriosis

A

retrograde flow, metaplasia, transport of endometrial cells via lymphatics

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9
Q

from H&P (and imaging) how do you differentiate endometriosis from adenomyosis

A

adenomyosis causes a large, soft, globular uterus while endometriosis patients have normal sized uteruses; pain is not much of a problem for adenomyosis patients while it is for endometriosis

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10
Q

how do you treat adenomyosis

A

hysterectomy

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11
Q

what is adenomyoma

A

mass of endometrial tissue in uterine wall (endometrial or muscle tissue can grow into the endometrial cavity to form a polyp)

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12
Q

define endometrial hyperplasia and what causes it

A

abnormal proliferation of endometrial glands; due to excess estrogen stimulation (high estrogen can be from anovulatory cycles, hormone replacement, PCOS, granulosa cell tumor)

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13
Q

what’s the peak age for endometrial carcinoma and what condition is it preceeded by

A

55-65 years; preceeded by endometrial hyperplasia

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14
Q

what’s the common clinical presentation for endometrial carcinoma

A

vaginal bleeding

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15
Q

what are the risk factors for endometrial carcinoma

A

prolonged use of estrogen without progestins, obesity, diabetes, hypertension, nulliparity, late menopause

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16
Q

what is the most common female tumor and describe it

A

leiomyoma (fibroids); benign smooth muscle tumor

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17
Q

what impacts the size of leiomyomas

A

leiomyomas are estrogen sensitive, their sizes increases during pregnancy and decrease during menopause

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18
Q

what’s the peak age for leiomyomas

A

20-40 years old

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19
Q

do leiomyomas become malignant

A

only in very rare cases; leiomyomas generally do not progress to leiomyosarcoma

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20
Q

rate the three highest incidence GYN cancers

rate the three worst prognosis GYN cancers

A

endometrial > ovarian > cervical

ovarian > cervical > endometrial

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21
Q

what’s the age at which premature ovarian failure can be diagnosed

A

menopause before age 40 (same process: atresia of ovarian follicles lead to low estrogen and high LH/FSH)

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22
Q

list the most common causes of anovulation

A

pregnancy, PCOS, obesity, HPO axis abnormalities, premature ovarian failure, hyperprolactinemia, thyroid dysfunction, anorexia, exercise, Cushing’s, adrenal insufficiency

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23
Q

describe the physiology (hormones) of PCOS

A

there is increased LH due to pituitary dysfunction –> increased theca cell activity –> hyperandrogenism; hyperinsulinemia; insulin and T lead to decreased SHBG leading to increased free T; (pathoma also says androgens in periphery get converted to estrone –> negative feedback on FSH –> anovulation –> degeneration of follicles –> cystic follicles)

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24
Q

what do PCOS patients present with

A

amenorrhea/oligomenorrhea, hirsutism, acne, infertility

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25
Q

what conditions are associated with PCOS

A

associated with obesity and an increased risk of endometrial cancer

26
Q

how do you treat PCOS

A

treat the symptoms (acne, hirsutism); weight loss; OCPs (estrogen increases SHBG and decreases LH resulting in lower free T); antiandrogens; clomiphene citrate for infertility (blocks estrogen negative feedback); metformin (lowers insulin, which lowers T, which allows for LH surge); cyclic progesterones (to antagonize endometrial proliferation)

27
Q

name six types of follicular cysts

A

follicular cyst, corpus luteum cyst, theca-lutein cyst, hemorrhagic cyst, dermoid cyst (mature teratoma), endometrioid cyst

28
Q

what is the most common benign ovarian neoplasm and malignant ovarian neoplasm?

A 
benign= serous cystadenoma
malignant= serous cystadenocarcinoma
29
Q

from what kind of tissue does an endometrioma arise

A

ectopic endometrial tissue

30
Q

what is the most common ovarian tumor in women 20-30 years old

A

dermoid cyst (mature teratoma)

31
Q

name the type of teratoma that causes hyperthyroidism

A

struma ovarii (tumor consists of functional thyroid tissue)

32
Q

describe a Brenner tumor

A

ovarian tumor consisting of urothelium (looks like a coffee bean on histology)

33
Q

what is Meigs syndrome

A

pleural effusion (hydrothorax) and ascites on the backdrop of ovarian fibroma

34
Q

what is the presentation of a thecoma

A

abnormal uterine bleeding in a postmenopausal woman

35
Q

name 8 malignant ovarian tumors

A

immature teratoma, yolk sac carcinoma, embryonal carcinoma, dysgerminoma, choriocarcinoma, serous cystadenocarcinoma, mucinous cystadenocarcinoma, granulosa cell tumor, Krukenberg tumor

36
Q

what is the most common sex cord stromal tumor

A

granulosa cell tumor

37
Q

what are the symptoms for granulosa cell tumor and what is the pathognomonic finding on histology?

A

usually seen in women 50-60, abnormal uterine bleeding, precocious puberty in adolescents, breast tenderness

38
Q

Call-Exner bodies (resemble primordial follicles) is representative of what ovarian neoplasm

A

granulosa cell tumor

39
Q

most common malignant ovarian neoplasm and characteristic histology;
unilateral or bilateral

A

serous cystadenocarcinoma;
psammoma bodies;
frequently bilateral

40
Q

what is the other name for mucinous cystadenocarcinoma and explain mucinous cystadenocarcinoma

A

mucinous cystadenocarcinoma a.k.a. pseudomyxoma peritoneii

=intraperitoneal accumulation of mucinous material from ovarian or appendix tumor

41
Q

what population commonly gets dysgerminomas

A

adolescents

42
Q

tumor markers for dysgerminomas

A

hCG and LDH

43
Q

what kind of cell is recapitulated in dysgerminoma

A

dysgerminoma is a hyperproliferation of germ cells

44
Q

male equivalent of dysgerminoma

A

seminoma

45
Q

characteristic histology of dysgerminoma

A

uniform sheets of “fried egg” cells

46
Q

when does choriocarcinoma develop

A

during or after pregnancy (in mom or baby)

47
Q

what happens to the chorionic villi in choriocarcinoma

A

there is none

48
Q

describe follicular cysts

A

distension of unruptured graafian follicle (associated with hyperestrogenism and endometrial hyperplasia); most common ovarian mass in women

49
Q

what causes a corpus luteum cyst and what’s the course of disease

A

hemorrhage into a persistent corpus luteum;

regresses spontaneously

50
Q

are theca-lutein cysts singular or multiple

A

bilateral, multiple

51
Q

what causes a theca-lutein cyst

A

gonadotropin (LH, FSH) stimulation

52
Q

what other conditions is theca-lutein cyst associated with

A

choriocarcinoma and moles due to increased gonadotropin stimulation

53
Q

what is a hemorrhagic cyst (how does it occur)

A

rupture of blood vessel in follicular cyst wall; the cyst grows with blood retention and usually self-resolves

54
Q

what is a dermoid cyst

A

mature teratoma (ovarian growth arising/ recapitulating multiple germ layers)

55
Q

what is an endometrioid cyst

A

endometriosis within an ovary causing cyst formation;

when filled with blood==> chocolate cyst

56
Q

what is a Krukenburg tumor

A

metastasis (usually from diffuse type gastric carcinoma) to ovary causing mucin-secreting signet cell adenocarcinoma

57
Q

how does squamous cell carcinoma of the vagina usually arise (where does it come from)

A

secondary to squamous cell carcinoma of the cervix; primary vaginal carcinoma is rare

58
Q

what causes clear cell adenocarcinoma of the vagina

A

DES (diethylstilbestrol) exposure in utero

59
Q

what kind of vaginal tumor do young girls <4 years old typically get

A 
sarcoma botryoides (a variant of rhabdomyosarcoma)
note:  botryoid="grape-like" in Greek
60
Q

what is the histology and stain used to identify sarcoma botryoides

A

spindle-shaped cells; desmin positive

Reproductive System- First Aid (3 decks)

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