Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
39 Cards in this Set
- Front
- Back
|
Epidemiology of ovarian tumors
|
80% benign, young women age 20-45 Malignant more common in older white women - >90% of malignant ovarian neoplasms are carcinoma (epithelial) |
|
|
Categories of ovarian tumors
|
1. Surface epithelial cells - can occur anywhere in peritoneum after Mallerian degeneration/transformation. 2. Germ cell 3. Sex cord-Stroma - hormone-secreting cells 4. Metastases to ovaries |
|
|
Surface epithelial tumors of ovary - behavior and histologic types
|
Behavior: - Benign - cystadenoma, cystadenofibroma - Borderline - low malignant potential - Malignant - carcinoma, cystadenocarcinoma. Histologic types - Serous (most common) - Mucinous - Endometrioid - Clear cell - Brenner/Transitional cell Can have any combination! |
|
|
Serous tumors of ovary - percentage malignant and benign? |
2/3 benign, 1/3 malignant |
|
|
Benign serous tumor of ovary - population and appearance, histology |
- Occur in middle aged women - Can be bilateral - Typically cystic - Serous cystadenoma Histology: Lined by benign, nonproliferative epithelium, not thrown into papillae (don't need to know) |
|
|
Borderline serous tumors (of low malignant potential) of ovary - population, appearance/location |
Population: Slightly older than benign serous tumor population Appearance: Frilly, soft, lush papillary projections - Can be inside cyst or on surface of ovary - Can be bilateral - Multifocal - both ovary and other sites in peritoneum involved. INDEPENDENT origin, not metastatic. |
|
|
Borderline serous tumors (of low malignant potential) of ovary - prognosis and treatment |
Prognosis depends on surgical complications and number of sites. - Limited to ovary - 100% 5-yr survival - Extra-ovarian - 90% 5-yr survival Treatment - No chemotherapy!! |
|
|
Serous carcinoma of ovary - typical presentation, gross appearance, and prognosis |
Most common ovarian malignant tumor Presentation: Silent until stage 3 when involves omentum - Ascites, omentum kick Appearance: - Bilateral ovarian involvement, solid cystic necrotic ovaries by the time detected Prognosis - determined by stage |
|
|
Precursor of carcinoma of ovary |
No precursor ever detected! IT'S A MYSTERY Proposed that significant percentage of BRCA1-- and BRCA2- related ovarian tumors and some sporadic high-grade ovarian and primary peritoneal serous carcinomas may originate from distal/fimbriated end of fallopian tube. - Called serous/tubular intra-epithelial carcinoma (STIC) - Then implant on ovary or peritoneum. |
|
|
Molecular underpinnings of serous ovarian carcinoma |
Type I (very rare) - Low grade pathway - Arise from borderline tumors or endometriosis - Mutations in KRAS, BRAF, or HER2/Neu Type II (majority) - Serous/tubular intraepithelial carcinoma (STIC) - Precursor in fallopian tube - Involves abdominal organs quickly, deadly - Mutations in p53 |
|
|
Ovarian cancer in patients with double hysterectomy
|
Can still develop primary peritoneal cancer from "serous/tubular intra-epithelial carcinoma". |
|
|
Mucinous ovarian carcinoma - general behavior, and appearance |
75% benign. Carcinomas are very rare If bilateral, probably a metastasis (like from colon cancer) Appearance - Largest of all ovarian tumors |
|
|
Example of metastasis appearing like mucinous ovarian carcinoma |
Pseudomyxoma peritonei Appendiceal mucinous tumor metastasis Very low grade but creates surgical problems. Abdomen filled with sticky mucin (abdomen, peritoneal surface). |
|
|
Types of ovarian carcinoma associated with endometriosis |
Endometrioid and clear cell carcinoma Arise in different site than endometriosis |
|
|
Metastatic tumors to ovaries |
Most - from other Gyn organs GI: - Colon - Stomach - Krukenberg tumor - gastric metastasis, usually with signet ring cells Mets are almost always bilateral |
|
|
Germ cell tumors of ovary - population and general behavior Types |
Accounts for 60% of ovarian tumors by age 20 (young). Mostly benign, 30% malignant. Almost all are unilateral! Types: Teratoma, choriocarcinoma, yolk sac tumor, dysgerminoma |
|
|
Mature teratoma germ cell tumor of ovary - gross appearance, histology
|
Most common germ cell tumor of ovary. Aka dermoid cyst Gross appearance: - Greasy, matted hair (sebaceous glands, skin appendages). May have teeth - Have mature tissues (immature teratomas have fetal tissues) - Cystic, 80% unilateral, large Histology: - Keratin, hair follicles, sebaceous glands - May have brain tissue, thyroid, GI, bronchial, retina. Usually from all three dermal layers. |
|
|
Mature and immature teratoma behavior |
Mature teratoma - benign Immature teratoma - malignant |
|
|
Immature teratoma - patient, histology, behavior |
Rare, 3% of all teratomas. More common in Younger patients. Histology: Immature, embryonal tissues in addition to mature tissue - Grading depends on how much immature elements Behavior: Gross and metastasize rapidly |
|
|
Dysgerminoma germ cell tumor of ovary - population, prognosis, and marker |
Ovarian counterpart of seminoma
Very rare Happens in 20s to 30s Excellent prognosis Marker: LDH |
|
|
Yolk sac tumor of ovary - patient, behavior, histology, and marker |
20s to 30s
Malignant and fatal without chemotherapy Histology: - Schiller-Duval bodies - glomerular bodies, florets of cells around vessels - Endodermal sinus formation Marker - Stain with and detect with AFP |
|
|
Sex cord-Stroma tumor of ovary and important presentation |
Famous for ability to produce estrogens or androgens (virilizing) - Estrogen-producing - hyperplasia and carcinoma of endometrium - Androgens - hirsutism, male pattern baldness, acne, |
|
|
Most common Sex cord-Stroma tumor of ovary and associated symptoms |
Fibroma-thecoma group. Produces:- Meig's syndrome - Fibroma of ovary, pleural effusion, and ascites. - Treat with surgery. |
|
|
Adult granulosa cell tumor - population, behavior, and histology |
Very rare
Any age Behavior: - Estrogen-producing, resulting in other hyperplasias - Elevated serum inhibin(tumor marker) - Low malignant potential but can met or recur decades later Histology: - Coffee bean nuclei - Call-Exner bodies |
|
|
Placental anatomy - parts and physiology |
Endometrium/decidua - Placental disk tightly adherent to uterus Vessels from mother come into decidua and go into placental disk. In placental disk, chorionic villi are bathed in pool of maternal blood. - Vessels in villi are babies vessels connected to umbilical cord. |
|
|
Mature placenta - maternal and fetal surface appearance |
Fetal surface - Vessels, umbilical cord projecting out Maternal surface - Where was tightly adherent to uterus. - Look for whether piece missing that could be retained leading to endometritis. |
|
|
Histology of chorionic villi and considerations in inspection |
Thin membranes of fetal capillaries bathed in maternal blood More vessels/capillaries = better blood exchange Abnormalities of interface can lead to growth retardation and fetal demise. |
|
|
Inspection of normal umbilical cord - considerations
|
Can have knots, abnormal length. Short umbilical cord - Associated with extrophy (abdominal organs outside abdominal cavity, genital malformations) Long umbilical cord Normal vessels (2 arteryies and vein) - Single umbilical artery associated with fetal abnormalities) |
|
|
Developmental sequence caused by Oligohydramnios and consequence |
Baby swallowing amniotic fluid leads to appropriate lung development. Potter sequence - - Renal abnormalities (aplasia, obstruction) - Don't pee into amniotic fluid (oligohydramnios) - Do not swallow amniotic fluid, inappropriate lung development Consequence: - Potter facies - low-set ears, hypertelorism, flat nose - Club feet - Amnion nodosum - skin deposited on inside of membrane |
|
|
Examining meconium of fetus and histology |
Not supposed to poop until after born - Meconium If distressed, poop in utero - Green discoloration of membranes/fetal surface - Can produce spasm of umbilical cord vessels, worsening situation. Histology: Brown macrophages that were eating meconium |
|
|
Abnormal placental adherence - types
|
Placenta tightly adherent to uterus - Placenta previa - Too tightly adherent or in wrong place - Placenta accreta - Myometrium attached to maternal surface of placenta - Placenta increta - Villi invading myometrium. Requires hysterectomy ): - Placenta percreta - Villi on uterine serosa. Requires hysterectomy. |
|
|
Twin pregnancie examination |
Examine dividing membrane microscopically to decide whether di/di, mono/mono, or mono/di Interconnected vessels between baby can cause "twin transfusion syndrome" - One suffers from lack of blood - One from anasarca, too much blood vessel |
|
|
Infections of placenta |
Placenta: villitis Membranes: Chorioamnionitis Cord: Funisitis Most common reason for premature labor (TORCH) Gross - Green, slimy membranes on fetal surface Histology - - Bacterial/acute so neutrophils |
|
|
Toxemia of pregnancy - pathogenesis |
Abnormalities in development of spiral arteries of uterus - Normally thick and wiry - Supposed to be relaxed and gaping in placenta to allow free bloodflow - Pre-eclampsia - spiral arteries remain muscular, spasm. Not enough blood to baby Thromboxane and PGA, endothelial dysfunction. Life threatening! |
|
|
Toxemia of pregnancy (pre-eclampsia and eclampsia) - clinical signs |
Pre-ecclampsia - Mom: Edema, proteinuria, pregnancy-induced hypertension in 3rd trimester. Resoolves after delivery - Fetus - Hypoxemia, premature birth, IUGR Ecclampsia - Critical illness (seizures, DIC) |
|
|
Placental changes in toxemia of pregnancy
|
Placenta has infarcts Placental/decidual vasculopathy - vhanges |
|
|
Placental abruption - |
Trauma or other cause causes placenta to rip off uterus Hemorrhage between placenta and uterus Mother - Bleed out, shock Baby - Die |
|
|
Gestational Trophoblastic Disease/Molar pregnancy - types, gross appearance, and histology |
Molar pregnancy - abnormal fertilization of egg
Partial - three sets of chromosomes - two paternal, one maternal Complete - Paternal chromosomes only. No fetus development because requires maternal DNA. - Villi appear hydropic, look like clusters of grapes - Histology: very edematous, watery |
|
|
Types of molar pregnancy - lab values and complication (behavior) |
Both have elevated HCG, complete have much more HCG Complete mole has complication of choriocarcinoma - Malignant neoplasm of trophoblastic cells - Respond to chemotherapy but is discovered late, rapidly invsaive, widely metastasizing |
