Repro Zaman; Fallopian And Ovaries; Kek

Front 1

name different routes of getting acute salpingitis.

Back 1

1) ascending infection (usually gonorrhea); 2) lymphatic and hematogenous spread (ie. strep or staph infection from abortion or birth); 3) local spread (appendicitis and peritonitis);

Front 2

what are complications of acute salpingitis?

Back 2

1) tubo-ovarian abcess, 2) PID

Front 3

define PID.

Back 3

pelvic inflammatory disease is an ascending infection (from the vulva or vagina) of the endometrium, fallopian tubes, and/or ovaries; it may result in abscess, peritonitis, scarring, bowel obstruction, and future ectopic pregnancy

Front 4

chronic salpingitis can result in these lesions. name them and what they are filled with.

Back 4

hydrosalpinx - tube filled with watery fluid; pyosalpinx - tube filled with pus; hematosalpinx - tube filled with blood; or atrophic form

Front 5

name the condition that involves the mucosa of the fallopian tube to invaginate in the muscle and is a common cause of infertility and ectopic pregnancy.

Back 5

Salpingitis isthmica nodosum (thickened isthmis region composed of hypertrophied smooth muscle and multiple glandular lumina)

Front 6

why would PID cause ectopic pregnancies? what are the complications of this?

Back 6

fertilization occurs in the ampulla of the fallopian tube, if the tube is scarred by PID it would be difficult for the zygote to travel to it 9 month home (the uterus); thus it gets stuck and implants in the fallopian tube. the COMPLICATIONS: ruptured fallopian tube and hemorrhage and possible death (most common cause of death in early pregnancy)

Front 7

what are the hydatids of morgagni?

Back 7

these are fluid filled cysts that are remnants of the cystic mullerian duct. they are usually located around the fimbrae (paratubal or paraovarian) not significant, but may be seen at surgery

Front 8

how common are ectopic pregnancies?

Back 8

1 in every 300 pregnancies; impossible to carry to term; result in spontaneous abortion because their villi will be immature and have no nutrition to attach to

Front 9

cancers of the fallopian tubes are very rare (1% of all gynecologic Ca). if it is there, what kind would it be? how aggressive? and what is classically found in fallopian Ca?

Back 9

adenocarcinoma; very aggressive (5yr survival 51%); hydrops tubae profluens (which is not usually found - but if is, it is definitely adenocarcinoma)

Front 10

name the different types of adenocarcinoma and their percentage of occurence.

Back 10

Out of the adenocarcinomas of the tubes: 50% are serous; 25% endometrioid; transitional cell, undifferentiated, mixed, and clear cell

Front 11

how would you diagnose an ectopic pregnancy?

Back 11

urine or serum b-hCG + with no intrauterine chorionic tissue (patient would have a sudden onset of lower abdominal pain with abnoraml uterine bleeding, adenexal mass, and possible hypovolemic shock)

Front 12

what are the three types of ovarian tumors?

Back 12

1) Surface-derived or epithelial; 2) Germ Cell; 3) Sex-Cord STROMAL/mesenchymal tumors; 4) Mixed - germ and stromal

Front 13

name the three general classes of ovarian neoplasms.

Back 13

1) benign; 2) borderline - important in women that want to keep their ovaries for future pregnancies (therapy is less aggressive); 3) malignant

Front 14

name the different surface-derived epithelial ovarian tumors.

Back 14

serous, mucinous, endometrioid, Brenner tumor, (clear cell and undifferentiated - not in goljan)

Front 15

name the stromal tumors.

Back 15

granulosa-thecal cell tumor, Fibrothecoma aka Thecoma-fibroma; Sertoli-Leydig Cell Tumor

Front 16

name the Germ cell tumors.

Back 16

Dysgerminoma, Yolk sac Carcinoma, Teratoma, (Embryonal carcinoma and choriocarcinoma - not in goljan)

Front 17

name the mixed tumor.

Back 17

the Gonadoblastoma - malignant mixed germ (dysgerminoma with stromal cells)

Front 18

the majority of testicular tumors are of _____ cell origin, while the majority of ovarian tumors are of _____ origin.

Back 18

testicular- germ (seminomas) and ovary - surface-derived epithelial (serous)

Front 19

stromal cell tumors occur more in females or males?

Back 19

3% in males, 30% in females

Front 20

name the 99% of the time BENIGN germ cell tumor of the ovaries.

Back 20

teratoma (dermoid cyst)

Front 21

if an ovarian teratoma has functioning thyroid tissue, what is it called?

Back 21

struma ovarii (benign) - may become hyperthyroid; histo: pink globules of thyroglobulin

Front 22

name the tumor that is associated with Peutz-Jegher's syndrome (AD, have pigment on lips, hands, genitals, harartomatous polyposis, GI problems, etc). describe it.

Back 22

SCTAT: Sex Cord Tumor with Annular Tubules - Type of stromal cell tumor associated with hyperestrinism; 1/3 of people with this tumor have PJ syndrome; SCTAT (with PJ) is bilateral, benign, and often calcifies; on HISTO: looks like well-defined tubules

Front 23

these germ tumors are malignant but have a good prognosis (survival - 5yr of 90-100%).

Back 23

Dysgerminoma - females and Seminoma - males (composed of undifrerentiated germ cells); remember, germ cell tumors are much more common in males

Front 24

these germ tumors are malignant and have a very poor prognosis (0-50%).

Back 24

1)embryonal carcinoma - increased hCG and AFP in 90% of cases 2)choriocarcinoma trophoblast-like cells (produce hCG); and Yolk-sac carcinoma (produce AFP- alpha fetal protein)

Front 25

name the most common malignant germ cell tumor in the ovary.

Back 25

dysgerminoma - histo: have clear, glycogen-filled cytoplasm and central nuclei; fibrous septa containing lymphocytes transverse the tumor

Front 26

where are embyronal carcinomas (germ cell tumors) more commonly seen? how do they look under a microscope?

Back 26

testes; look like tissues of an early embryo; it is rare in the ovary, but if it occurs, its usually <30yrs old and is often prepubertal

Front 27

ovarian yolk-sac tumors (germ) contain this histiologic thing.

Back 27

schiller-duval bodies; ovarian yolk-sac tumors are the most common ovarian cancer in girls <4years old; increase in AFP

Front 28

of the different areas of the body, where are most germ cell tumors found? at what age are they more common?

Back 28

midline of the body; in order of occurence= gonads, retroperitoneium, mediastinum, sacrum, and midline of CNS; reproductive age

Front 29

all germ cell tumors are _________ except teratomas. however, teratomas found in men are ________.

Back 29

malignant; malignant

Front 30

germ cell tumors may produce what? it is useful in diagnosing and managing the tumors.

Back 30

hCG and Alpha fetal protein

Front 31

gonadal stromal cell tumors (either male or female) have the same supporting cell origin (ie precursor to sertoli and thecal cells). from this info, now can you tell me what stromal tumors have the capacity to secrete?

Back 31

androgens, estrogen, progesterone, corticosteroids, or combinations of these

Front 32

what brings the mostly benign stromal cell tumors to the attention of a physician?

Back 32

the extra hormonal, endocrine effects

Front 33

name the uncommon ovarian tumor that preduces precocious puberty in children and masculinization, amenorrhea, and atrophy of the breasts in adults.

Back 33

Sertoli-Leydig Cell Tumor (stromal tumor)

Front 34

name the low-grade stromal malignant ovarian tumor that produces estrogen (feminizing tumor).

Back 34

granulosa cell tumor or Granulosa-theca cell tumor; histo: solid sheet of granulosa cells with multiple spaces respresenting Call-Exner Bodies

Front 35

name the normally post-menopausal stromal tumor that is associated with ovarian stromal hyperplasia, endometrial hyperplasia, and adenocarcinoma of the endometrium.

Back 35

Thecoma - can be distinguished from fibromas by the presence of lipids (steroids) within their cells.

Front 36

this neoplasm arises from ovarian stroma. it is 5-10% of ovarian neoplasms. most likely inactive, non-hormone producing. 20% of pts have ascities. also associated with Meigs Syndrome. what is it and what is Meigs syndrome?

Back 36

Fibroma; Meigs Syndrome- triad of: ovarian fibroma, ascites, and pleural effusion (regression of effusion after removal of tumor)

Front 37

what is the other name for Sertoli-Leydig Cell tumor; this tumor will secrete androgens and cause virilization.

Back 37

arrhenoblastomas

Front 38

what are the risk factors for getting ovarian cancer?

Back 38

1)nulliparity (increases in ovulation, increase in risk); 2)Genetics (BRCA1&2), Lynch Syndrome, Turner's Syndrome, Peutz-Jeghers syndrome, 3)Smoking

Front 39

what decreases the risk of getting ovarian cancer?

Back 39

less ovulatory cycles (ie. pregnant, breast feeding, birth control)

Front 40

what is used to help diagnose (the more common in women) epithelial cell tumors?

Back 40

transvaginal ultrasound, measurement of the serum protein CA-125 (cancer antigen); most common tumor that is bilateral

Front 41

how are epithelial derived tumors classified?

Back 41

benign (-omas), malignant (carcinomas), if in between behavior = low malignant behavior or "intermediate" or "borderline"; also classified by histologic appearance

Front 42

describe the histology of epithelial cell tumors for benign, low malignant potential, and malignant.

Back 42

benign: no atypia, one layer of epithelium; low malignant potential: mild atypia and layers are 3 or less; MALIGNANT: stratified with marked atypia with invasion in the stroma

Front 43

what do you call a benign serous epithelial tumor?

Back 43

serous cystadenoma - cured by surgery

Front 44

what do you call an intermediate serous epithelial tumor?

Back 44

borderline serous cystadenocarcinoma (usually cured); watch closely

Front 45

what do you call a malignant serous epithelial tumor?

Back 45

serous cystadenocarcinoma - treat aggressively; poor survival rate - histo: see psammoma bodies

Front 46

epithelial tumors often mimic tissue from parts of the reproductive tract; serous tumors mimic _____.

Back 46

fallopian tube epithelium.

Front 47

epithelial tumors often mimic tissue from parts of the reproductive tract; mucinous tumors mimic ______.

Back 47

endocervical glands

Front 48

epithelial tumors often mimic tissue from parts of the reproductive tract; endometrioid tumors mimic _____.

Back 48

endometrium; must exclude endometrial cancer of the uterus to make the diagnosis of endometrioid

Front 49

of the epithelial tumors, which two are more common?

Back 49

serous and mucinous

Front 50

what is a psammoma body and when is it found in ovarian cancer?

Back 50

PB are round collections of calcium; if they are microscopically present, this indicates serous papillary cystadenocarcinoma

Front 51

describe the gross and microscopic appearance of a mucinous cystadenoma of the ovary.

Back 51

multiloculated gelatinous tumor that can grow very large (largest recorded: 328lbs); HISTO: single layer (if benign) of mucinous epithelial cells); nuclei line basal surface

Front 52

out of benign and malignant types of mucinous and serous tumors, which one is most common? which one has the lowest survival rate?

Back 52

serous cystadenocarcinoma; serous cystadenocarcinoma

Front 53

If a mucinous tumor seeds in the peritoneal cavity and can produce massive amounts of mucous within the cavity known as "jelly belly"; what is the medical term for this seeding?

Back 53

pseudomyxoma peritonei

Front 54

what are the most common symptoms of ovarian cancer?

Back 54

painless mass with local pressure and abdominal fullness (if advanced: pain, ascites, possible metastatic presentations)

Front 55

ovarian carcinomas are the ___#___ in incidence in OB-Gyn tumors (after cervix and endometrium) but is ___#____ in deaths.

Back 55

3rd in incidence; 1st in deaths

Front 56

if a person has this disease, one it's prime sites of involvement are the ovaries.

Back 56

lymphoma; especially in Burkitt's lymphoma (t 8,14)

Front 57

there are 3 cancers that if become metastatic, target the ovary. name them.

Back 57

50% breast; 40% GI tract; 10-20% endometrium

Front 58

name the metastatic tumor to the ovary and how it looks on histo.

Back 58

Krukenberg Tumor; HISTO: contains signet rings filled with mucoid material most likely from GI cancer

Front 59

explain non-neoplastic cysts of the ovary.

Back 59

these cysts are non-neoplastic, they arise from normal functional tissue.

Front 60

this non-neoplastic cyst arises from one of the hundreds of primary follicles that develop in the ovary; it is common in the reproductive years; usually hormonally inactive and should go away within the month (aka Phantom Cyst).

Back 60

Follicular Cyst - excessive fluid collects in the developing follicle and a cyst results

Front 61

what non-neoplastic cysts are found in women of reproductive age that are secondary to increased androgen levels and are associated with amenorrhea, infertility, obesity, and hirsutism.

Back 61

Polycystic Ovarian Disease (aka Stein-Leventhal Syndrome); this is an endocrine disorder that affects 7% of women; the LH:FSH >2

Front 62

describe the gross appearance of PCOS.

Back 62

enlarged ovary with thickened capsules and multiple cysts of the follicle type.

Front 63

this non-neoplastic cyst occurs in the reproductive years and results from hemorrhage into a persistent mature corpus luteum. name it and its symptoms.

Back 63

corpus luteum cyst; symptoms: menstrual irregularity (amenorrhea to vaginal spotting); if it ruptures, pain and hemoperitoneium result; this cyst should disappear in 2 menstrual cycles

Front 64

this non-neoplastic cyst is caused by increased hCG stimulation (multiple pregnancies, gonadotropin therapy for infertility, and trophoblastic dz).

Back 64

Theca-lutein cysts - most commonly associated with diseases of the placenta and trophoblasts (hydatidiform mole; choriocarcinoma); usually asymptomatic; once hCG is removed, back to normal

Front 65

this tumor is only found during pregnancy. it causes hyperplasia of theca-lutein cells and have produced virilization of mother and female fetus.

Back 65

Luteoma of Pregnancy

Front 66

name the non-neoplastic cysts that occur when the ovary contracts following ovulation. small portions of the surface epithelium become entrapped forming small cysts. (every ovary has some)

Back 66

surface inclusion cysts

Front 67

this non-neoplastic cyst comes from the graafian follicle; it is lined by a simple epithelium because of the pressure on it it couldn't expand and differentiate.

Back 67

simple cyst

Front 68

this non-neoplastic cyst is often called a "chocolate cyst". what is it and what are the possible symptoms?

Back 68

endometriosis/endometrioma - endometrial-like glands and strom are found in a cyst containing thick brown old blood; symptoms range from none to infertility, dysmenorrhea, dyspareunia, and urinary and bowel complaints

Front 69

where is the most common location of endometriosis?

Back 69

ovaries, then rectal pouch -> fallopian tubes