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45 Cards in this Set

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What are hydatid cysts of Morgagni?
Cysts located at the fimbriated end of the fallopian tube
What are ovarian follicular and leuteal cysts?
Follicular: a cyst due to distention of unruptured graffian follicle

Leutal: from hemorrhage into a persistant corpus luteum that is assoc with menstrual irregularity.
VIP
What is polycystic ovary syndrome?
A syndrome affecting young women, exhibiting numerous cystic follicles that can cause amenorrhea, obesity, and hirsuitism.
What is one potential cause of polycystic ovary syndrome?
Disturbance of the hypothalamus' pituitary secretion leading to an asychronous release of LH.
Are most ovarian tumors benign or malignant?
Benign
VIP

What is the name and derivation of each of the 3 classes of ovarian neoplasms?
1. Surface epithelial origin (70%)
2. Germ cell orgin (20%)
3. Sex-cord stromal tumor origin (5%)
What are 3 signs of ovarian tumors?
1. abdominal pain

2. bloating

3. increased abdominal girth
What is the only general screening test for tumor?
Regular pelvic exam.
What is the most important prognostic indicator in ovarian tumors?
STAGE
What are the stages of ovarian tumors?
Stage 1 - tumor limited to ovary
Stage 2 -involves one or both ovaries with pelvic extension
Stage 3 - involves one or both ovaries with peritoneal mets
Stage 4 - outside pelvis
What are the types of surface epithelial malignant ovarian tumors?
1. serous (50%)
2. mucinous (10%)
3. endometriod (15%)
4. clear cell (6%)

SMEC (He SMEC'ed me) with a clear mucus hand
What is a common benign ovarian tumor of surface epithelium?
Cystadenofibroma (or cystadenoma)
What are ovarian germ cell tumors characteristics (3)?
1. 15-20% of all tumors
2. children and young adults most commonly effected
3. 90% are benign (mature cystic teratoma)
What are the most common ovarian benign tumors?

What age group is most commonly effected?
Mature cystic teratoma (Dermoid cysts)

10-20yo
What is the ovarian counterpart to the testicular seminoma?
Dysgerminoma

-childhood, 20-30yo
-gonadal dysgenesis is a predisposing factor
- radiosensitive
Describe the proliferative phase that is ended by ovulation:
There is a rapid growth of both glands and stroma. Formation of straight tubular glands. Mitoses occurs
What hormone increases in secretory phase?
Progesterone
What stromal changes occur in the secretory phase?
Edema and spiral arterioles are seen.
What is the most common cause of dysfunctional endometrial bleeding?
Anovulatory cycle (excessive and prolonged estrogenic stimulation without the development of the progestional phase that normally follows ovulation -- ovulation tells cells to stop)
What are the two age groups that are most likely to have an anovulatory cycle?
1. adolescence
2. peri-menopausal
Most common cause of acute endoMETRITIS?
Bacterial infection after delivery or miscarriage
Most common cause of chronic endoMETRITIS
Pelvic inflammatory disease
Endometrial pathology: VIP

1. Adenomyosis
2. Endometriosis
1. Adenomyosis = presence of endometrial glands and surrounding stroma with in myometrium

2. Endometriosis: presence of endometrial and stroma in abnormal locations outside of the uterus
What percentage of women are effected by endometriosis?

Causes? (4)
10%

Causes:
1. severs dysmenorrhea
2. dyspareunia (painful sex)
3. menstrual irreg
4. infertility (30-40%)
What are endometrial polyps and how are they treated?
Polyps:
Benign masses of variable size projecting into endometrial cavity. May cause abnL bleeding, (>40yo)

Treatment: since they respond to estrogen (increase in size), treat with Tamoxifen.
What are the two types of endometrial hyperplasia? And their associations.
1. Low grade = caused by anovulatory cycle

2. High grade = caused by PTEN gene mutation that causes proliferation of endometrial glands and cytologic atypia (premalig)
To diagnose endometrial intraepithelial neoplasia (EIN) what must be confirmed?
Must confirm the loss of PTEN gene expression.
What does PTEN gene do?
PTEN is a tumor suppressor gene that makes a protein expressed by benign endometrial glands during proliferative phase.

Unopposed estrogen stimulation leads to an increase in PTEN protein.

PTEN-absent endometrial glands are more sensitive to estrogen stimulation, which eventually leads to hyperplasia and CA
Compare age of onset of endometrial tumors and ovarian tumors:
Endometrial = postmenopausal

Ovarian = 10-30yo
What are four risk factors for endometrial carcinomas?
1. obesity
2. diabetes
3. hypertension
4. inferility
What is the most curable female cancer?
Endometrial CA
What is stage II endometrial CA mean?
CA has spread out of uterus (Stage 1) into cervix but not further.
What is a DDx for postmenopausal bleeding?
1. malignant endometrial tumor
2. EIN (PTEN)
3. Clear cell tumor
4. Serous papillary CA
5 Carcinosarcoma (malignant mixed mullarian tumor)
Describe the features of a Serous Papillary CA (endometriod CA)
It is highly aggressive and 40-70% of pt having deep myometrial invasion.

Mneumo: Serous Papillary is a "serious" dz of endometrioid
What are clear cell carcinoma of the endometrium?
Nonendometrioid type tumor in postmenopausal women.

Shows glycogen accumulation within cytoplasm.

Poor prognosis
How are endometrial tumors graded?
Based on their architecture and severity of nuclear features.
What is the most common benign mesenchymal tumor in the female repro system?
Leiomyomas (smooth cell tumor) aka fibroids.
What age do you get fibroids (leiomyomas)?
75% of reproductive age
Are leiomyomas estrogen responsive?
Yes
Describe the gross characteristics of leiomyomas:
Well circumscribed, round, firm nodules. They are tan-white (more common in AA)
What is the histologic appearance of leiomyomas?
Whorled bundles of smooth muscle cells
What three clinical symptoms can patients with leiomyomas present with?
1. sudden pain
2. infertility
3. bladder compression
What is the five year survival rate of a leiomyosarcoma?
40% (10-15% if highgrade)
Who is most commonly effected by stromal sarcomas (myometrial)?
Middle aged women
Describe the gross appearance of stromal sarcoma:
Multiple tan-yellow masses with permeation involving irregular tongues and worm-like plugs in myometrial veins.