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134 Cards in this Set
- Front
- Back
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Where do germ cells come from?
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yolk sac
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Where do germ cells migrate to in the embryo?
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urogenital ridge (coelomic mesoderm)
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When do germ cells migrate?
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6th week of gestation
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What does the urogenital ridge turn into?
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ovarian surface epithelium, sex cords, ovarian stroma
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What forms the fallopian tubes?
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unfused cephalad portions of mullerian ducts
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What forms the uterine corpus?
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fused caudal parts of the Mullerian ducts
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What are the parts of the post-natal ovary?
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cortex and medulla
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What is in the ovarian cortex?
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germ cells and sex cord cells, hypocellular stroma
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What is in the ovarian medulla?
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stromal elements, hilus cells
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What are the parts of hte fallopian tube?
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mucosa, muscular layer, and serosa
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What is in the mucosa of the fallopian tube?
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folds, epithelium of ciliated columnar cells, non-ciliated secretory cells, intercalated cells
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What is acute salpingitis?
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suppurative inflammatory disorder, due to bacteria, part of pelvic inflammatory disease
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What causes most PID?
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gonococcus, then chalmydia and enteric bacteira
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What are the symptoms of PID?
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pelvic pain, adnexal tenderness, fever, vaginal dischanrge
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Where does PID originate?
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Bartholin, vestibular, or periurethral glands
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Where does PID spread?
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to cervix or fallopian tubes and ovaries
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What are the complications of PID?
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peritonitis and sepsis
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What are the non-STD casues of PID?
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childbirth, abortion
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What bacteria cause non-STD PID?
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staph, strep, coliforms, C. perfringens
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What are the long term complications of salpingitis?
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obliteration of tube lumen with infertility, hydrosalpinx, intestinal obstruction due to peritoneal adhesions
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What is the most common site of ectopic pregnancy?
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Fallopian tube
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What are the risk factors for ectopic pregnancy?
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PID with chronic salpingitis, peritubal adhesions
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How does ectopic pregnancy present?
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sever abdominal pain 6 weeks after onset of LMP
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What is the pathogenesis of ectopic preganancy?
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chorionic villi implanted into the wall of fallopian tube, causes dilation of tube, can have hemorrhage into tube, placental tissue invades tubal wall and causes rupture
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What is the clinical course of ectopic pregnancy?
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rupture produces hemorrhage into peritoneal pregnancy
can spontaneously regress or abort |
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How do you treat ectopic pregnancy?
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methotrexate to cause spontaneous involution
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What are paratubal cysts?
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unilocular cysts filled with serous fluid, lined by mullerian or transitional epithelium
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What is the clinical course of paratubal cysts?
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usually asymptomatic unless large enough to mimic an ovarian mass
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What is a hydatid cyst of morgagni?
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large cyst from mullerian duct at fimbriated end of the tube
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What is an adematoid tumor?
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benign neoplasm from mesothelium in subserosal region of tube
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What is an adenocarcinoma of the tube?
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malignant neoplasm, serous or endometrioid differentiation
like ovarian adenocarcinomas |
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When do tubo-ovarian abscesses occur?
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with PID
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What can cause infectious oophoritis?
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mumps, CMV, actinomyces, fungus, TB
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What is endometriosis?
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endometrial tissue in sites other than the uterus
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Where does endometriosis commonly occur?
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ovaries, uterine ligaments, rectovaginal septum
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Who presents with endometriosis?
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3rd and 4th decade
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How does endometriosis present?
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pelvic pain, infertility, bleeding, pain with menses
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What are the theories of endometriosis development?
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retrograde menses through Fallopian tubes, serosal membrane undergoes Mullerian metaplasia, endometrial tissue travels through lymph and venous channels
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What are some features of endometriosis tissue?
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clonal, can make its own estrogen because it contains aromatase p450
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What does endometriosis look like grossly?
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undergo periodic bleeding, produces dark nodules on or beneath peritoneal lesions
may form chocolate cysts |
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What does endometriosis look like microscopically?
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needs 2/3: endometrial glands, endometrial stroma, hemosiderin pigment
if severe, has post-inflammatory fibrotic destruction of glands and stroma |
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Who gets functional ovarian cysts?
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young women
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What are follicular cysts?
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usually multiple, unruptured graafian follicles or ruptured follicles when sealed
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What do follicular cysts look like microscopically?
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smooth lininig of resting ganulosa cells, filled with clear serous fluid
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What do resting granulosa cells look like microscopically?
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low cuboidal cells with high N/C ratio
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What are luteal cysts?
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usually single, enlarged corpus luteum with/without hemorrhage
distinct bright yellow-orange lining of luteinized granulosa cells |
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What happens in polycystic ovary disease?
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bilateral ovarian enlargement due to multiple follicle cysts, oligomenorrhea with persistent anovulation, obesity, hirsutism, cna have virilism
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What is the pathogenesis of PCOD?
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insulin resistance, hyperinsulinemia and hyperprolactinemia
increased secretion of LH, stimulates theca cells to produce excess androstenedione, convereted peripherally to estrogen and testosterone |
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What does PCOD look like?
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ovaries are enlarged, contain cystic follicles/follicular cells, fibrous thickening of the cortex, hyperplasia of follicular theca cells, lack of corpora lutea
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What are the complications of PCOD?
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endometrial hyperplasia and carcinoma due to unopposed estrogen of anovulatory cycles
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Who gets benign ovarian tumors?
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women < 50 years of age
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Who gets malignant ovarian tumors?
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postmenopausal women
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What are the risk factors for ovarian tumors?
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older, nulliparity, family history, BRCA1, BRCA2, gonadal dysgenesis
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What type of ovarian tumors do patients with BRCA get?
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serous cystadenocarcinomas
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What are the symptoms of ovarian tumor?
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abdominal pain, bloating, increasing abdominal size, ascites, urinary and GI distrubances, vaginal bleeding
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From where do surface epithelial tumors come?
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coelomic epithelium to Mullerian epithelium on ovarian surface
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From where do sex cord stromal tumors come?
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embryonic precursors of ovarian endocrine apparatus *theca and granulosa cells)
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From where do germ cell tumors come from?
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oocytes, which migrate from yolk sac
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What is the most common ovarian tumor source?
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epithelial
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Waht is the most common malignant ovarian tumor?
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epithelial
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Who gets epithelial tumors?
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> 20 years
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Who gets germ cell tumors?
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0-25 years
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Who gets sex cord-stromal tumors?
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all ages, most often middle aged or elderly
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Who gets mets to the ovary?
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variable, tends to be older adults
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Who gets malignant epithelial tumors?
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older patients
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What happens in borderline epithelial tumors?
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more pronounced epithelial proflieration, no stromal invasion, few associated with disease outside of the ovary, typically peritoneal deposits, can recur or progress to adenocarcinoma
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What is the most common epithelial tumor type?
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serous
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What is the prognosis of most epithelial tumors?
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benign
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What is associated with most serous eptihelial tumors?
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bilateral, associated wtih endometriosis or endosalpingiosis
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What do malignant serous tumors look like?
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multilocular, papillary and solid areas, stromal invasion, necrosis
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What do borderline serous tumors look like?
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complex epithelial growth with surface papillations, crowding, infolding, lack stromal invasion
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What are most mucinous tumors?
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benign, unilateral
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What do mucinous tumors look like grossly?
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more complex, multiloculated appearance, contains thick, viscous fluid
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What are the subtypes of mucinous tumors?
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endocervical and gastrointestinal
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What do endocervical mucinous tumors look like?
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looks like benign endocervix, papillary architecture, higher likely to be bilateral
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With what are endocervical mucinous tumors associated?
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endometriosis, endosalpingiosis
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What do gastrointestinal mucinous tumors look like?
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resembles large intestine, may come from GI source, usually appendix
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What are pesudomyxoma peritonei?
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mucinous ascites with implants on peritoneal surfaces
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What is the prognosis of most endometrioid tumors?
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malignant
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With what are endometrioid tumors associated?
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bilateral, endometriosis
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What does an endometrioid tumor look like?
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adenofibromatous architecture, more solid than cystic, lots of fibrous stroma
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With what tumor are endometrioid tumors associated?
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synchronous intrauterine endometrial adenocarcinoma
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What are clear cell tumors?
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subset of endometrioid lesions, associated with endometriosis
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What is the prognosis of clear cell tumors?
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highly malignant, aggressive
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What ist he prognosis of most transitional tumors?
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benign
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What do transitional tumors look like?
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adenofibromatous
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What are transitional tumors associated with?
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mucinous cystadenomas
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What is the prognosis of transitional tumors?
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malignant ones are rare
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How do most malignant surface epithelial tumors spread?
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penetration of ovarian capsule, discontinuous growth along peritoneal surfaces in pelvis by implantation
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With what are malignant surface epithelial tumors associated?
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ascites
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To where do malignant surface epithelial tumors spread?
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pelvic and aortocaval lymph nodes, lungs, pleura, and liver
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What is the best prognostic indicator of malignant surface epithelial tumors?
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stage
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What is a good tumor marker of ovarian carcinoma?
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CA-125
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What is CA-125?
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high molecular weight glycoprotein, elevated in serum of 80% of patients with advanced stage ovarian carcinoma
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How do you treat ovarian carcinomas?
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resection, platinum-based chemotherapy, Taxol
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From where do sex cord stromal tumors come?
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stromal cells: fibroblasts, smooth muscle cells, sex cord cells
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What is the least common ovarian tumor type?
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sex cord stromal tumor
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What do sex cord stromal tumors make?
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feminizing hormones: granulosa, theca cells
masculinizing hormones: sertoli, leydig cells |
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How do sex cord stromal tumors behave?
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often benign, depends on type
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Who gets granulosa-tehca cell tumors?
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post-menopausal women
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What do most granulosa-theca cell tumors have in them?
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can be pure, but usually mixed
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What do granulosa-theca cell tumors look like grossly?
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usually unilateral, cystic and hemorrhagic, yellow
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What do granulosa cell tumors look like microscopically?
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oval nuclei with longitudinal grooves, form gland-like structures with eosinophilic material
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What are Call-Exner bodies?
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gland-like structures with eosinophilic material, associated with granulosa-theca cell tumors
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With what are coffee been nuclei associated?
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granulosa cell tumors
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What do granulosa-theca cell tumors commonly produce?
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estrogen
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What do granulosa-theca cell tumors do to younger patients?
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precocious puberty
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With what conditions are granulosa-theca cell tumors associated in adults?
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endometrial hyperplasia, fibrocystic change in breast, endometrial adenocarcinoma
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What is the prognosis of granulosa-theca cell tumors?
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all can become malignant, recur 10-20 years after initial diagnosis
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What are fibrotehcomas?
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benign tumors of theca cells and fibroblasts
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What do fibrothecomas with a lot of theca cells produce?
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estrogen
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What do fibrotehcomas look like?
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solid white gross appearance with scattered areas of yellow
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With what are fibrothecomas associated?
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ascites, right-sided pleural effusion
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What is Meigs' syndrome?
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fibrothecoma, ascites, right-sided pleural effusion
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With what syndrome are fibrothecomas associated?
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Basal Cell Nevus Syndrome and Meigs'
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What is a fibrosarcoma?
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malignant fibroma
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What are Sertoli-Leydig tumors?
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mix of sertoli and leydig cells, like those in the testis, can produce androgens and cause masculinization
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What is the second most common type of ovarian tumor?
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germ cell tumor
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How do germ cell tumors present in the ovaries?
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10-15% bilateral, usually pure
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What is a dysgerminoma?
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seminoma in the ovary
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What sit he most common germ cell tumor in the ovary?
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mature teritoma
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Of what are most mature teratomas in the ovary composed?
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ectoderm, esp skin
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What do mature ovarian teratomas look like grossly?
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cystic mass with hair and keratin, teeth or body elements
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What is a dermoid cyst?
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mature teratoma in the ovary
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What is a struma ovarii?
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mature teratoma of mostly thyroid tissue
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What is a carcinoid in the ovary?
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mature teratoma of mostly neuroendocrin cells
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What is the complication of struma ovarii?
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hyperthyroidism
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What are "immature" teratomas?
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made of embryonic or fetal elements, most commonly immature neural elements
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What is the karyotype of benign teratomas?
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46XX
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What is the prognosis of ovarian teratomas?
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most are benign, if malignant, mostly squamous cell carcinoma
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How do mets to the ovaries present?
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bilateral, from endometrium, ovary, Fallopian tube
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What extra-Mullerian sites metastasize to the ovary?
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breast, GI tract, biliary tract, pancreas
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What is a Krukenberg tumor?
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bilateral met to the ovaries, of signet ring cells, from gastric origin
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What is the most common metastasis to the ovary?
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Krukenberg tumor
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