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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
Q

True or False?

With regards to ovarian neoplasms - cysts are malignant and solids are benign

A

FALSE

  • the rule:
  • cysts = benign
  • solid = malignant
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26
Q

Why do ovarian neoplasms have a high mortality rate?

A

50%

-due to silent, asymptomatic growth + late detection

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27
Q

What are the risk factors for ovarian ca.?

A
  • not fully known
  • nullparity
  • gonadal dysgenesis
  • FHx.
  • BRCA1 (17q12)
  • BRCA2 (13q12)
28
Q

What is the classification of ovary tumors and which is the commonest type?

A
  1. surface epithelial cells** (commonest) - 65-70%
  2. germ cell - 15-20%
  3. sex cord-stroma - 5-10%
  4. metastases - 5%
29
Q

What are the commonest surface epithelial cell tumors?

A
  1. serous tumor - clear fluid
  2. mucinous tumor - mucous
    **cystadenomas
    serous > mucinous
30
Q

What are the commonest germ cell tumors?

A
  1. teratoma

2. choriocarcinoma

31
Q

What % of cystadenomas are benign vs malignant?

A

75% benign; 25% malignant

32
Q

True or False?

Cystadenomas are usually bilateral

A

True

30-66%

33
Q

What cells typically line cystadenomas?

A

simple single layer columnar (mucous secreting) epithelium

34
Q

Compare benign vs borderline vs malignant serous cystadenomas

A

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
Q

What are teratomas?

A

-germ cell tumors made up of many different types of tissues

36
Q

What is the commonest benign teratoma?

A

Dermoid cyst:

  • skin lining
  • mature tissues, cystic
  • ectodermal structures present (hairs, teeth, etc)
  • different tissues present (i.e. thyroid, lymphoid, sebaceous glands, etc)
37
Q

What is microscopy of malignant teratomas?

A

many different types of pleomorphic, irregular cancers present

38
Q

What is the name of the ovarian tumor that is similar to seminoma of the testes?

A

dysgerminoma

39
Q

What are some ‘other’ ovarian tumors (apart from the main types)?

A
  • fibroma –> benign
  • dysgerminoma (seminoma)
  • endometrioid carcinoma
  • brenner –> benign/malignant
  • granulosa cell tumor –> benign
40
Q

What is krukenberg tumor?

A
  • special type of metastases to the ovary
  • from an adenocarcinoma usually of a GIT origin
  • no haemorrhage or necrosis (solid greyish/white)
  • bilateral
41
Q

What are complications of ovarian cysts?

A
  • 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
Q

What is the staging of ovarian cancer?

A

stage 1 –> ovaries
stage 2 –> adnexal structures (fallopian tubes/uterus)
stage 3 –> peritoneal cavity
stage 4 –> distant mets

43
Q

What tumor marker is present in ovarian cancer?

A

CA-125

-measurements are of greatest value in monitoring response to Tx.

44
Q

What are placental villi lined by and what function do these cells have?

A

trophooblasts

-allow exchange of nutrients between maternal and fetal circulation

45
Q

What is chorioamnionitis?

A
  • infection and inflammation of chorionic membrane and villi

- 1-4% normal births; 40-70% premature births

46
Q

What are risk factors for chorioamnionitis?

A

-early rupture of membranes, nullparity, prolonged labour, race/ethinicity

47
Q

What are local and systemic organisms that can lead to chorioamnionitis?

A

Local:
-vaginal flora, genital mycoplasma, candida

Systemic:
-TB, syphillis, toxoplasmosis, rubella, CMV (TORCH –> toxoplasmosis, other, rubella, CMV, herpes)

48
Q

What are the complications of chorioamnionitis?

A
  • inflammation, WBC, infarctions

- neonatal sepsis, asphxiation, death

49
Q

Where is the commonest site of ectopic pregnancy?

A

fallopian tubes (90%)

50
Q

What are the risk factors for ectopic pregnancy?

A
  • obstruction, PID, stricture, IUD, tumors, endometriosis (50%)
  • idiopathic (50%)
51
Q

What would be the typical findings of an ectopic pregnancy?

A

-embryo/placental tissue within dilated tube filled with haemorrhage

52
Q

What are the complications of ectopic pregnancy?

A

-abortion, bleeding, chorioamnionitis, choriocarcinoma (rare)

53
Q

What is the Dx of pre-eclampsia and eclampsia?

A

HTN, proteinuria, oedema in 3rd trimester (pre-eclampsia) + seizures, DIC (eclampsia)

-5-10% pregnancies

54
Q

What are risk factors for pre-eclampsia/eclampsia?

A

primi/molar pregnancy, later age

55
Q

What is the pathogenesis of pre-eclampsia/eclampsia?

A

*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
Q

What are complications of pre-eclampsia/eclampsia?

A

DIC, CCF, fatal

57
Q

What are the types of hydatidiform moles?

A
  • spectrum of trophoblast neoplasms
  • benign –> malignant
    1. patial mole –> benign, fetal parts seen. Ovum + 2 sperms (triploid) - bHCG
  1. complete mole –> no fetal parts, 2 sperms NO ovum (diploid). 2% go on to choriocarcinoma
  2. invasive mole –> complete mole that is v aggressive
  3. choriocarcinoma –> malignant. Asian/Africans more common
58
Q

What does increased bHCG indicate in trophoblast neoplasms (hydatidiform moles)?

A

increased bHCG –> high grade –> poor prognosis :(

59
Q

What does partial mole look like?

A

-few oedematous cysts with surrounding fetal tissues

60
Q

What does a complete mole look like?

A
  • entire uterine cavity filled with swollen villi (hydropic villi) –> look like ‘grapes’
  • considerable trophoblastic hyperplasia
61
Q

What does invasive mole look like?

A
  • same molar tissue as complete mole starts infiltrating into wall of uterus
  • USS –> moles = “snowstorm”
  • micro –> hydropic villi
62
Q

Compare partial vs complete mole

A

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
Q

What is choriocarcinoma and what is its clinical presentation?

A
  • high grade malignancy of trophoblasts

- clinically –> bloody, brownish discharge accompanied by rising titre of hCG

64
Q

What are risk factors for choriocarcinoma?

A
  • extremes of age (<20, >40)
  • 25% after abortion
  • abnormal gestation
65
Q

What are the 2 types of choriocarcinoma?

A
  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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