Uterine and Ovarian Pathology (580-583 and top of 584) Flashcards
define endometritis and what causes it
inflammation of the endometrium caused by retained products of conception, miscarriage, abortion, and foreign bodies such as IUDs
define endometriosis
non-neoplastic growth of endometrial tissue outside of the endometrium
where in the body does endometriosis usually manifest
ovary, peritoneum, pelvis
what is the classic pathologic structure that forms
chocolate cyst (large clot of coagulated blood)
what is the treatment for endometriosis
NSAIDs, OCP’s, progestins, GnRH agonists (Luprorelin and Triptorellin), surgery
what is adenomyosis
growth of endometrial glandular tissue into the myometrium
what are the symptoms of endometriosis
dysmenorrhea, dyspareunia (painful sex), dyschesia (painful #2), infertility with a normal sized uterus
what are the three main causes of endometriosis
retrograde flow, metaplasia, transport of endometrial cells via lymphatics
from H&P (and imaging) how do you differentiate endometriosis from adenomyosis
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
how do you treat adenomyosis
hysterectomy
what is adenomyoma
mass of endometrial tissue in uterine wall (endometrial or muscle tissue can grow into the endometrial cavity to form a polyp)
define endometrial hyperplasia and what causes it
abnormal proliferation of endometrial glands; due to excess estrogen stimulation (high estrogen can be from anovulatory cycles, hormone replacement, PCOS, granulosa cell tumor)
what’s the peak age for endometrial carcinoma and what condition is it preceeded by
55-65 years; preceeded by endometrial hyperplasia
what’s the common clinical presentation for endometrial carcinoma
vaginal bleeding
what are the risk factors for endometrial carcinoma
prolonged use of estrogen without progestins, obesity, diabetes, hypertension, nulliparity, late menopause
what is the most common female tumor and describe it
leiomyoma (fibroids); benign smooth muscle tumor
what impacts the size of leiomyomas
leiomyomas are estrogen sensitive, their sizes increases during pregnancy and decrease during menopause
what’s the peak age for leiomyomas
20-40 years old
do leiomyomas become malignant
only in very rare cases; leiomyomas generally do not progress to leiomyosarcoma
rate the three highest incidence GYN cancers
rate the three worst prognosis GYN cancers
endometrial > ovarian > cervical
ovarian > cervical > endometrial
what’s the age at which premature ovarian failure can be diagnosed
menopause before age 40 (same process: atresia of ovarian follicles lead to low estrogen and high LH/FSH)
list the most common causes of anovulation
pregnancy, PCOS, obesity, HPO axis abnormalities, premature ovarian failure, hyperprolactinemia, thyroid dysfunction, anorexia, exercise, Cushing’s, adrenal insufficiency
describe the physiology (hormones) of PCOS
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)
what do PCOS patients present with
amenorrhea/oligomenorrhea, hirsutism, acne, infertility
what conditions are associated with PCOS
associated with obesity and an increased risk of endometrial cancer
how do you treat PCOS
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)
name six types of follicular cysts
follicular cyst, corpus luteum cyst, theca-lutein cyst, hemorrhagic cyst, dermoid cyst (mature teratoma), endometrioid cyst
what is the most common benign ovarian neoplasm and malignant ovarian neoplasm?
benign= serous cystadenoma malignant= serous cystadenocarcinoma
from what kind of tissue does an endometrioma arise
ectopic endometrial tissue
what is the most common ovarian tumor in women 20-30 years old
dermoid cyst (mature teratoma)
name the type of teratoma that causes hyperthyroidism
struma ovarii (tumor consists of functional thyroid tissue)
describe a Brenner tumor
ovarian tumor consisting of urothelium (looks like a coffee bean on histology)
what is Meigs syndrome
pleural effusion (hydrothorax) and ascites on the backdrop of ovarian fibroma
what is the presentation of a thecoma
abnormal uterine bleeding in a postmenopausal woman
name 8 malignant ovarian tumors
immature teratoma, yolk sac carcinoma, embryonal carcinoma, dysgerminoma, choriocarcinoma, serous cystadenocarcinoma, mucinous cystadenocarcinoma, granulosa cell tumor, Krukenberg tumor
what is the most common sex cord stromal tumor
granulosa cell tumor
what are the symptoms for granulosa cell tumor and what is the pathognomonic finding on histology?
usually seen in women 50-60, abnormal uterine bleeding, precocious puberty in adolescents, breast tenderness
Call-Exner bodies (resemble primordial follicles) is representative of what ovarian neoplasm
granulosa cell tumor
most common malignant ovarian neoplasm and characteristic histology;
unilateral or bilateral
serous cystadenocarcinoma;
psammoma bodies;
frequently bilateral
what is the other name for mucinous cystadenocarcinoma and explain mucinous cystadenocarcinoma
mucinous cystadenocarcinoma a.k.a. pseudomyxoma peritoneii
=intraperitoneal accumulation of mucinous material from ovarian or appendix tumor
what population commonly gets dysgerminomas
adolescents
tumor markers for dysgerminomas
hCG and LDH
what kind of cell is recapitulated in dysgerminoma
dysgerminoma is a hyperproliferation of germ cells
male equivalent of dysgerminoma
seminoma
characteristic histology of dysgerminoma
uniform sheets of “fried egg” cells
when does choriocarcinoma develop
during or after pregnancy (in mom or baby)
what happens to the chorionic villi in choriocarcinoma
there is none
describe follicular cysts
distension of unruptured graafian follicle (associated with hyperestrogenism and endometrial hyperplasia); most common ovarian mass in women
what causes a corpus luteum cyst and what’s the course of disease
hemorrhage into a persistent corpus luteum;
regresses spontaneously
are theca-lutein cysts singular or multiple
bilateral, multiple
what causes a theca-lutein cyst
gonadotropin (LH, FSH) stimulation
what other conditions is theca-lutein cyst associated with
choriocarcinoma and moles due to increased gonadotropin stimulation
what is a hemorrhagic cyst (how does it occur)
rupture of blood vessel in follicular cyst wall; the cyst grows with blood retention and usually self-resolves
what is a dermoid cyst
mature teratoma (ovarian growth arising/ recapitulating multiple germ layers)
what is an endometrioid cyst
endometriosis within an ovary causing cyst formation;
when filled with blood==> chocolate cyst
what is a Krukenburg tumor
metastasis (usually from diffuse type gastric carcinoma) to ovary causing mucin-secreting signet cell adenocarcinoma
how does squamous cell carcinoma of the vagina usually arise (where does it come from)
secondary to squamous cell carcinoma of the cervix; primary vaginal carcinoma is rare
what causes clear cell adenocarcinoma of the vagina
DES (diethylstilbestrol) exposure in utero
what kind of vaginal tumor do young girls <4 years old typically get
sarcoma botryoides (a variant of rhabdomyosarcoma) note: botryoid="grape-like" in Greek
what is the histology and stain used to identify sarcoma botryoides
spindle-shaped cells; desmin positive
