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

Question 1

define endometritis and what causes it

Answer 1

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

Question 2

define endometriosis

Answer 2

non-neoplastic growth of endometrial tissue outside of the endometrium

Question 3

where in the body does endometriosis usually manifest

Answer 3

ovary, peritoneum, pelvis

Question 4

what is the classic pathologic structure that forms

Answer 4

chocolate cyst (large clot of coagulated blood)

Question 5

what is the treatment for endometriosis

Answer 5

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

Question 6

what is adenomyosis

Answer 6

growth of endometrial glandular tissue into the myometrium

Question 7

what are the symptoms of endometriosis

Answer 7

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

Question 8

what are the three main causes of endometriosis

Answer 8

retrograde flow, metaplasia, transport of endometrial cells via lymphatics

Question 9

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

Answer 9

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

Question 10

how do you treat adenomyosis

Answer 10

hysterectomy

Question 11

what is adenomyoma

Answer 11

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

Question 12

define endometrial hyperplasia and what causes it

Answer 12

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

Question 13

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

Answer 13

55-65 years; preceeded by endometrial hyperplasia

Question 14

what’s the common clinical presentation for endometrial carcinoma

Answer 14

vaginal bleeding

Question 15

what are the risk factors for endometrial carcinoma

Answer 15

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

Question 16

what is the most common female tumor and describe it

Answer 16

leiomyoma (fibroids); benign smooth muscle tumor

Question 17

what impacts the size of leiomyomas

Answer 17

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

Question 18

what’s the peak age for leiomyomas

Answer 18

20-40 years old

Question 19

do leiomyomas become malignant

Answer 19

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

Question 20

rate the three highest incidence GYN cancers

rate the three worst prognosis GYN cancers

Answer 20

endometrial > ovarian > cervical

ovarian > cervical > endometrial

Question 21

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

Answer 21

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

Question 22

list the most common causes of anovulation

Answer 22

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

Question 23

describe the physiology (hormones) of PCOS

Answer 23

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)

Question 24

what do PCOS patients present with

Answer 24

amenorrhea/oligomenorrhea, hirsutism, acne, infertility

Question 25

what conditions are associated with PCOS

Answer 25

associated with obesity and an increased risk of endometrial cancer

Question 26

how do you treat PCOS

Answer 26

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)

Question 27

name six types of follicular cysts

Answer 27

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

Question 28

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

Answer 28

``` benign= serous cystadenoma malignant= serous cystadenocarcinoma ```

Question 29

from what kind of tissue does an endometrioma arise

Answer 29

ectopic endometrial tissue

Question 30

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

Answer 30

dermoid cyst (mature teratoma)

Question 31

name the type of teratoma that causes hyperthyroidism

Answer 31

struma ovarii (tumor consists of functional thyroid tissue)

Question 32

describe a Brenner tumor

Answer 32

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

Question 33

what is Meigs syndrome

Answer 33

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

Question 34

what is the presentation of a thecoma

Answer 34

abnormal uterine bleeding in a postmenopausal woman

Question 35

name 8 malignant ovarian tumors

Answer 35

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

Question 36

what is the most common sex cord stromal tumor

Answer 36

granulosa cell tumor

Question 37

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

Answer 37

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

Question 38

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

Answer 38

granulosa cell tumor

Question 39

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

Answer 39

serous cystadenocarcinoma; psammoma bodies; frequently bilateral

Question 40

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

Answer 40

mucinous cystadenocarcinoma a.k.a. pseudomyxoma peritoneii | =intraperitoneal accumulation of mucinous material from ovarian or appendix tumor

Question 41

what population commonly gets dysgerminomas

Answer 41

adolescents

Question 42

tumor markers for dysgerminomas

Answer 42

hCG and LDH

Question 43

what kind of cell is recapitulated in dysgerminoma

Answer 43

dysgerminoma is a hyperproliferation of germ cells

Question 44

male equivalent of dysgerminoma

Answer 44

seminoma

Question 45

characteristic histology of dysgerminoma

Answer 45

uniform sheets of "fried egg" cells

Question 46

when does choriocarcinoma develop

Answer 46

during or after pregnancy (in mom or baby)

Question 47

what happens to the chorionic villi in choriocarcinoma

Answer 47

there is none

Question 48

describe follicular cysts

Answer 48

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

Question 49

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

Answer 49

hemorrhage into a persistent corpus luteum; | regresses spontaneously

Question 50

are theca-lutein cysts singular or multiple

Answer 50

bilateral, multiple

Question 51

what causes a theca-lutein cyst

Answer 51

gonadotropin (LH, FSH) stimulation

Question 52

what other conditions is theca-lutein cyst associated with

Answer 52

choriocarcinoma and moles due to increased gonadotropin stimulation

Question 53

what is a hemorrhagic cyst (how does it occur)

Answer 53

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

Question 54

what is a dermoid cyst

Answer 54

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

Question 55

what is an endometrioid cyst

Answer 55

endometriosis within an ovary causing cyst formation; | when filled with blood==> chocolate cyst

Question 56

what is a Krukenburg tumor

Answer 56

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

Question 57

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

Answer 57

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

Question 58

what causes clear cell adenocarcinoma of the vagina

Answer 58

DES (diethylstilbestrol) exposure in utero

Question 59

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

Answer 59

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

Question 60

what is the histology and stain used to identify sarcoma botryoides

Answer 60

spindle-shaped cells; desmin positive