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70 Cards in this Set
- Front
- Back
Urogenital ridge cells of origin
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yok sac, endoderm
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epithelium and sex cords and stroma of ovary embryological origin
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urogenital ridge
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fallopian tubes embryological origin
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mullerian ducts
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acute salpingitis definition
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suppurrative inflammatory disorder of bacterial etiology that is a component of pelvic inflammatory disease
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cause of 60% of PID
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gonococcus. remaining due to chlamidia and enteric bacteria.
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Sequela of salpingitis
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fibrous obliteration of the tube lumen with consequent infertility; obliteration at several foci causing cyst in place of tube anatomy (hydrosalpinx); intestinal obstruction from peritoneal adhesions
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ectopic pregnancy
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implantation of embryo somewhere other than endometrium
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ectopic pregnancy most common site
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fallopian tube
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ectopic pregnancy predisposing factors
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prior PID w/ chronic salpingitis; other peritubal adhesions
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ectopic pregnancy presentation
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severe abdominal pain 6 weeks after onset of LMP
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clinical course of ectopic pregnancy
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rupture of tubal pregnancy, hemorrhage into the peritoneal cavity – medical emergency; less common regression;
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Tx tubal pregnancy
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methotrexate, involution of tubal gestations
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paratubgal cysts
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small unilocular cysts filled with clear serous fluid and lined by mullerian or transitional epithelium
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hyatid cyst of morgagni
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large cyst of mullerian duct located at the fimbriated end of the tube
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adenomatoid tumor of fallopian tube
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benign neoplasm derived from mesotheliun occurring in the subserosal region of the tube, similar tumors occur in the epididymis
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adenocarcinoma of fallopian tube
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rare, primary malignant neoplasm of fallopian tube epithelium, usually showing either serous or endometrioid differentiation, similar to lesions of the same histologic types arising in the ovary.
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inflammatory disorders of the overies
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tubo-ovarian abscess in association with pelvic inflammatory disease; other infectious oophoritis (mumps, CMV, actinomyces, fungus, TB); autoimmune Oophoritis
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endometriosis
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presence of endometrial tissue in sites other than uterus.
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Adenomyosis
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presence of endometrial glands and stroma within the myometrium.
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sites of endometriosus
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ovaries, uterine ligaments, rectovaginal septum, pelvic peritoneum, laparotomy scars, rarely in umbilicus, vagina, vulva, GI tract, pleura
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clinical presentation, complications of endometriosus
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reproductive age, infertility; pelvic pain; abnormal bleeding; pain with menses (dysmenorrheal). 10% women affected, some asymptomatic
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theories of endometriosus pathogenesis
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regurgitation theory: retrograde menses thru fallopian tubes, endometrim into peritneum; metaplasia; lymphovascular dissemination
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Endometriosis gross appearance
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responsive to physiologic hormonal cycle. undergo periodic bleeding, producing dark nodules (gun powder appearance). lesions produce cystic masses filled with hemorrhagic material (chocolate cysts) and organization results in adhesions
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endometriosis histologic appearance
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three important features: endometrial glands, endometrial stroma, hemosiderin pigment. Most severe dicfficult to identify microscopically b/c of fibrosis
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Follicular cysts
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multiple, originate from unruptured graafian follicules or ruptured follicles with seal, smooth lining of granulose cells, filled with serous fluid
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luteal cysts
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single enlarged corpus luteum +/- hemorrhage. distinct bright yellow to orange lining composed of luteinized granulose cells
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polycystic ovary disease clinical features
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3-6% women of reproductive age. bilateral ovarian enlargement from multiple follicle cysts. oligomenorrhea, w/ persistent anovulation, obesity, hirsutism, virilism (rarely)
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pathogenesis polycystic ovary disease
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increased LH, stimulates theca-lutein cells to produce androstenedione, converted to estrogen and testosterone; associated insulin resistence, hyperprolactinemia
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histo of polycystic ovary disease
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enlarged ovaries, numerous cystic follicles; fibrous thickening of cortex; hyperplasia of follicular theca cells; variable absence of corpora lutea; ENDOMETRIAL HYPERPLASIA AND CARCINOMA OCCUR IN A SIGNIFICANT PROPORTION OF PATIENTS DUE TO UNOPPOSED ESTROGEN PRODUCTION ASSOCIATED WITH ANOVULATORY CYCLES
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Ovarian tumors epidemiology
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80 % benign; benign in women under fifty; malignant in postmenopausal women
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clinical presentation ovarian tumor
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mild symptoms until large; symptoms and signs include abdominal pain, increasing abdominal girth; ascites; urinary and gastrointestinal tract disturbances; vaginal bleeding; rare hormonal activity
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Classification of ovarian tumors
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surface epithelial tumors; sex cord stromal tumors; germ cell tumors
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surface epithelium of ovary embryological origin
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embryologically derived from coelomic epithelium; embryonic coelomic epithelium gives rise to muellerian epithelium which differentiates into fallopian tube endometrial or endocervical
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sex cord – stromal cells
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embryonic precursors of the ovarian endocrine apparatus (theca and granulose cells)
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germ cells embryonic origins
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oocytes, which migrate from yolk sac, totipotential
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epithelial ovarian tumor affected age group
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over 20 yrs
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germ cell ovarian tumor age group
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0 to 25
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sex cord ovarian tumor age group
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all ages, often middle age or elderly
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metastasis to the ovary age group affected
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variable; tendency for older adults
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histologic subtypes of epithelial ovarian tumor
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serous; mucinous, GI type, endocervical type; endometrioid; clear cell; transitional (Brenner
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histo subtypes of germ cell ovarian tumor
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teratoma, mature, immature; dysgerminoma; yolk sac; choriocarcinoma
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histo subtypes of sex cord ovarian tumor
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granulose cell tumor; fibroma/fibrothecoma; sertoli-leydig cell tumor
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most common primary sties of metasteses to ovary
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opposite ovary; endometrium; colon; pancreas; stomach; breast
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90% of malignant ovarian tumors what cell type?
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epithelial
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ovarian surface epithelial tumors, embryology, differentiation
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ovarian surface epithelium, coelomic mesothelium, differentiation towareds mullerian types of epithelium
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differentiation subclassification of ovarian surface epithelial tumors
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by type of epithelial differentiation: serous (like fallopian tube); mucinous (like endocervical or gastrointestinal); endometroid (like proliferative endometrial glands); clear cell (has glycogen making it clear looking); transitional; squamous; mixed; undifferentiated
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architecture subclassification of ovarian surface epithelial tumor
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cystic (cystadenoma or cystadenocarcinoma); cystic and fibrous (cystadenofibroma); predominately fibrous, minimal cyst formation (adenofibroma)
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clinical behaviour subclassifications of ovarian surface epithelial tumor
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benign (minimal epithelial proliferation and no stromal invasion); borderline (pronounced proliferation without stromal invasion); malignant (stromal invasion)
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serous epithelial ovarian tumors appearance
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benign are unilocular, with clear fluid and smooth internal lining; malignant are complex with papillary and solid areas, stromal invasion and necrosis; bornderline have complex epithelial growth with surface papillations, no stromal invasion
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mucinous tumors of oivarian epithelium subtypes
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endocervical (mullerian) features similar to serous tumors, high incidence of bilaterality, assoc with endometriosis/endosalpingiosis ; and gastrointestinal (resembling lining of stomach or bowel, may be assoc with pseudomyxoma peritonei (mucinous ascites w. implants on peritoneal surfaces) perhaps from GI source
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pseudomyxoma peritonei
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mucinous ascites with implants on peritoneal surfaces from gastrointestinal subtype of mucinous tumor of ovarian epithelium
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mucinous tumors of ovarian epithelium appearance
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multilocualted, more complex than serous, contain thick, viscous fluid
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endometrioid tumors of ovarian epithelium appearance
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adenofibromatous architecture more solid than cystic with much fibrous stroma
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type of ovarian epithelium tumor associated with synchronous endometrial adenocarcinoma
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endometrioid ovarian epithelial tumor 30% associated with this
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transitional tumors of ovarian epithelium (Brenner) appearance, associations, incidence
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benign, adenofibromatous architecture, associated with mucinous cystadenomas, this type very rare
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mode of spreads of malignant ovarian surface epithelial tumors
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primary mode of spread is by penetration of ovarian capsule and rowth on peritoneal surfaces in pelvis and abdomen (assoc with ascites w/ malignant cells); lymph node and metasteses occur after established abdominopelvic deisease
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tumor marker in 80% of advanced stage ovarian carcinoma (esp serous and endometrioid)
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CA-125; useful in monitoring postoperative therapy and detecting recurrences
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treatment of malignant ovarian epithelial tumors
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resection of visible disease, platinum based chemotherapy
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sex-cord stromal tumors cells of origin, clinical
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arise from stromal cells (fibroblasts, smooth muscle) and or sex cord cells of male or female type (granulose, theca, sertoli, leydig), all age groups, can produce feminizing or masculinizing hormones, unpredictable clinical behavior
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granulose theca cell tumors susceptible age
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post menopausal women
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appearance of granulose theca cell tumors
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unilateral, cystic and hemorrhagic, yellow, histo appearance of granulose cell component, coffee bean nuclei eosinophilic Call-exner bodies.
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granulose theca cell tumors clinical
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hormonally active usually estrogen; precocious puberty; endometrial hyperplasia, fibrocystic changes in breast, endometrial carcinoma; potentially malignant
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fibrothecoma and fibroma appearance
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prominent theca component, solid white gross appearance scattered yellow from theca component
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fibrothecoma and fibroma clinical
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benign; assoc with ascites and right sided pleural effusion (meig’s syndrome) common in patients with basal cell nevus syndrome
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ovarian tumor associated with basal cell nevus syndrome
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fibrothecoma nad fibroma
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sertoli leydig celll tumors of ovary
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usually mixture of sertoli and leydig cells, may produce androgens
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major sex cord stromal tumors
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granulose theca cell tumors; fibrothecoma and fibroma; sertoli leydig cell tumors
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Germ cell tumors of ovaries comparison with testicles
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1 second most common type in ovary vs most common in testis;; bilateral 15%; seminoma in overy termed dysgerminoma; usually pure form vs mixed in testis; mature teratoma most common vs seminoma
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characteristics of mature teratoma of ovary
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ectodermal derivatives; sometimes thyroid (struma ovarii) or neuroendocrine (carcinoid); karyotime of benign teratomas 46XX
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Krukenburg tumor
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bilateral metastatic tumor to the ovaries composed of signet ring cells usually of gastric origin
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