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Pathology Term 5 > Week 6 - DUB > Flashcards

Week 6 - DUB Flashcards

PCOS, Neoplasms, Gestational

1
Q

What is menopause that occurs before 45 and before 40?

A 
<45 = early menopause
<40 = ovarian failure
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2
Q

What is the commonest clinical ovarian disorder?

A

ovarian cysts (non-neoplastic - small)

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3
Q

What are the types of non-neoplastic ovarian cysts (small)?

A
  • follicular, epithelial, luteal, etc

- PCOS

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4
Q

What are the types of ovarian neoplastic cysts (large)?

A
  • benign (cystadenoma)
  • malignant (cystadenocarcinoma)
  • teratoma (benign + malig.)
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5
Q

Why are ovarian cysts typically quite large?

A
  • typically asymptomatic in the early stages

- therefore –> lots of time for growth of tumor

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6
Q

What are the 2 phases of ova development?

A
  1. proliferative phase

2. luteal phase

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7
Q

What do the abnormal follicles in PCOS produce?

A

increased androgens AND estrogens –> clinical features

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8
Q

What % of teens/young adults get PCOS?

A

6-10%

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9
Q

What are the clinical features of PCOS?

A
  • oligomenorrhea/amenorrhea
  • acne
  • hirsutism
  • infertility
  • obesity, HTN, T2DM (syndrome X)
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10
Q

What happens to follicle development in PCOS?

A

instead of graafian follicles undergoing normal ovulation, they become cysts

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11
Q

What is the possible outcome of increased estrogens in PCOS?

A

-increased risk of endometrial hyperplasia and cancer

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12
Q

What is the pathology of PCOS?

A
  • enlarged ovaries (6-8cm)
  • bilateral subcortical follicular cysts
  • incr. androgens/etrogens
  • stromal hyperplasia
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13
Q

Irregular bleeding in a patient since menarche with hirsutism and normal 17 hydroxyprogesterone levels suggests what?

A

PCOS

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14
Q

Irregular bleeding in a patient since menarche with increased 17hydroxyprogesterone levels suggests what?

A

CAH (congenital adrenal hyperplasia)

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15
Q

What is menopause?

A

-physiological cessation of ovulation, menstrual cycles with associated genital atrophy

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16
Q

What are the characteristic hormone levels in menopause?

A
  • decreased estrogens and inhibin
  • increased androgens and FSH

inhibin inhibits FSH

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17
Q

Why are there short anovulatory cycles in menopaue?

A

due to rapid follicle maturation from increased FSH (+decreased inhibin = decreased neg. feedback on FSH)

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18
Q

What is diagnostic of menopause with regards to hormone levels?

A
  • gonodotropin levels >30 mlU

- FSH > LH = diagnostic

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19
Q

What are the clinical features of menopause?

A
  • vasomotor hot flushes (80%) –> few minutes, night sweats at night
  • mood changes
  • irritability
  • fatigue
  • anxiety/depression
  • vaginal dryness
  • lack of sleep
  • atrophy of labia, vagina, uterus, breast and endometrium
  • bone atrophy –> osteoporosis
  • CVD –> IHD, incr. cholesterol
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20
Q

What are the diagnostic criteria for PCOS?

A

*at least 2 out of the following 3:

  1. oligoovulation/anovulation
  2. signs of androgen excess (hirsutism)
  3. polycystic ovaries on USS
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21
Q

What hormone is measured to differentiate between CAH and PCOS in a pt. with irregular bleeding since menarche?

A

17OHP

-17 hydroxyprogesterone

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22
Q

What is commonly used to treat Sx. of menopause?

A

HRT

  • estrogen/progesterone
  • ONLY estrogen in pts with previous hysterectomy
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23
Q

What are the pros and cons of HRT?

A

Pros:

  • menopause Sx. relief (e.g. sleep, mood, joint pain)
  • decreased fracture risk (osteoporosis)
  • increased QOL, decr Sx
  • decreased risk of CRC

Cons:

  • potential risj factors for:
  • breast ca. (>5yrs HRT)
  • uterine ca.
  • MI/IHD
  • stoke/DVT/VTE (when first start HRT)
  • increase risk of gall bladder disease
  • increased dementia risk
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24
Q

What is the epidemiology of ovarian neoplasms?

A

80% benign, cystic, young (<50)

20% malignant, solid, older (>50)

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25
True or False? | With regards to ovarian neoplasms - cysts are malignant and solids are benign
FALSE * the rule: - cysts = benign - solid = malignant
26
Why do ovarian neoplasms have a high mortality rate?
50% | -due to silent, asymptomatic growth + late detection
27
What are the risk factors for ovarian ca.?
- not fully known - nullparity - gonadal dysgenesis - FHx. - BRCA1 (17q12) - BRCA2 (13q12)
28
What is the classification of ovary tumors and which is the commonest type?
1. surface epithelial cells** (commonest) - 65-70% 2. germ cell - 15-20% 3. sex cord-stroma - 5-10% 4. metastases - 5%
29
What are the commonest surface epithelial cell tumors?
1. serous tumor - clear fluid 2. mucinous tumor - mucous **cystadenomas serous > mucinous
30
What are the commonest germ cell tumors?
1. teratoma | 2. choriocarcinoma
31
What % of cystadenomas are benign vs malignant?
75% benign; 25% malignant
32
True or False? | Cystadenomas are usually bilateral
True | 30-66%
33
What cells typically line cystadenomas?
simple single layer columnar (mucous secreting) epithelium
34
Compare benign vs borderline vs malignant serous cystadenomas
benign: -small papillary (solid) growth within cyst borderline: - aggressive - extensive papillary (solid) growth but limited within cyst malignant: -large papillary (solid) growth extending outside of cyst
35
What are teratomas?
-germ cell tumors made up of many different types of tissues
36
What is the commonest benign teratoma?
Dermoid cyst: - skin lining - mature tissues, cystic - ectodermal structures present (hairs, teeth, etc) - different tissues present (i.e. thyroid, lymphoid, sebaceous glands, etc)
37
What is microscopy of malignant teratomas?
many different types of pleomorphic, irregular cancers present
38
What is the name of the ovarian tumor that is similar to seminoma of the testes?
dysgerminoma
39
What are some 'other' ovarian tumors (apart from the main types)?
- fibroma --> benign - dysgerminoma (seminoma) - endometrioid carcinoma - brenner --> benign/malignant - granulosa cell tumor --> benign
40
What is krukenberg tumor?
- special type of metastases to the ovary - from an adenocarcinoma usually of a GIT origin - no haemorrhage or necrosis (solid greyish/white) - bilateral
41
What are complications of ovarian cysts?
- large tumor --> uses a lot of nutrition - torsion, infarction, rupture, hemoperitoneum - autoamputation - perforation (acute --> acute abdomen/chronic (slow) --> granulomatous peritonitis) - hemolytic anemia --> clears after removal - progress to malignancy
42
What is the staging of ovarian cancer?
stage 1 --> ovaries stage 2 --> adnexal structures (fallopian tubes/uterus) stage 3 --> peritoneal cavity stage 4 --> distant mets
43
What tumor marker is present in ovarian cancer?
CA-125 | -measurements are of greatest value in monitoring response to Tx.
44
What are placental villi lined by and what function do these cells have?
trophooblasts | -allow exchange of nutrients between maternal and fetal circulation
45
What is chorioamnionitis?
- infection and inflammation of chorionic membrane and villi | - 1-4% normal births; 40-70% premature births
46
What are risk factors for chorioamnionitis?
-early rupture of membranes, nullparity, prolonged labour, race/ethinicity
47
What are local and systemic organisms that can lead to chorioamnionitis?
Local: -vaginal flora, genital mycoplasma, candida Systemic: -TB, syphillis, toxoplasmosis, rubella, CMV (TORCH --> toxoplasmosis, other, rubella, CMV, herpes)
48
What are the complications of chorioamnionitis?
- inflammation, WBC, infarctions | - neonatal sepsis, asphxiation, death
49
Where is the commonest site of ectopic pregnancy?
fallopian tubes (90%)
50
What are the risk factors for ectopic pregnancy?
- obstruction, PID, stricture, IUD, tumors, endometriosis (50%) - idiopathic (50%)
51
What would be the typical findings of an ectopic pregnancy?
-embryo/placental tissue within dilated tube filled with haemorrhage
52
What are the complications of ectopic pregnancy?
-abortion, bleeding, chorioamnionitis, choriocarcinoma (rare)
53
What is the Dx of pre-eclampsia and eclampsia?
HTN, proteinuria, oedema in 3rd trimester (pre-eclampsia) + seizures, DIC (eclampsia) -5-10% pregnancies
54
What are risk factors for pre-eclampsia/eclampsia?
primi/molar pregnancy, later age
55
What is the pathogenesis of pre-eclampsia/eclampsia?
*placental ischaemia --> abnormal spiral arteries --> decreased placental vasodilators and RAS inhibition --> HTN + GN --> placental infarction, haemorrhage and necrosis is typically seen + chronic villi underperfusionl; cytotrophoblast hyperplasia
56
What are complications of pre-eclampsia/eclampsia?
DIC, CCF, fatal
57
What are the types of hydatidiform moles?
- spectrum of trophoblast neoplasms - benign --> malignant 1. patial mole --> benign, fetal parts seen. Ovum + 2 sperms (triploid) - bHCG 2. complete mole --> no fetal parts, 2 sperms NO ovum (diploid). 2% go on to choriocarcinoma 3. invasive mole --> complete mole that is v aggressive 4. choriocarcinoma --> malignant. Asian/Africans more common
58
What does increased bHCG indicate in trophoblast neoplasms (hydatidiform moles)?
increased bHCG --> high grade --> poor prognosis :(
59
What does partial mole look like?
-few oedematous cysts with surrounding fetal tissues
60
What does a complete mole look like?
- entire uterine cavity filled with swollen villi (hydropic villi) --> look like 'grapes' - considerable trophoblastic hyperplasia
61
What does invasive mole look like?
- same molar tissue as complete mole starts infiltrating into wall of uterus - USS --> moles = "snowstorm" - micro --> hydropic villi
62
Compare partial vs complete mole
Partial: - partially cystic, few BV - fetal parts + - focal hyperplasia of trophoblasts - triploid (ovum + 2 sperms) - rare carcinoma - relatively less bHCG --> good prognosis Complete: - all villi cystic, no BV - no fetal parts - diffuse trophoblastic hyperplasia - diploid (2 sperms, NO ovum) - 2% choriocarcinoma - high bHCG --> poorer prognosis
63
What is choriocarcinoma and what is its clinical presentation?
- high grade malignancy of trophoblasts | - clinically --> bloody, brownish discharge accompanied by rising titre of hCG
64
What are risk factors for choriocarcinoma?
- extremes of age (<20, >40) - 25% after abortion - abnormal gestation
65
What are the 2 types of choriocarcinoma?
1. gonadal - poor prognosis - occurs in gonads 2. gestational - occurs from the mole (complete mole) - good prognosis --> 100% cure with chemo.

Pathology Term 5 (6 decks)

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