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69 Cards in this Set

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  • Back
name different routes of getting acute salpingitis.
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);
what are complications of acute salpingitis?
1) tubo-ovarian abcess, 2) PID
define PID.
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
chronic salpingitis can result in these lesions. name them and what they are filled with.
hydrosalpinx - tube filled with watery fluid; pyosalpinx - tube filled with pus; hematosalpinx - tube filled with blood; or atrophic form
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.
Salpingitis isthmica nodosum (thickened isthmis region composed of hypertrophied smooth muscle and multiple glandular lumina)
why would PID cause ectopic pregnancies? what are the complications of this?
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)
what are the hydatids of morgagni?
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
how common are ectopic pregnancies?
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
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?
adenocarcinoma; very aggressive (5yr survival 51%); hydrops tubae profluens (which is not usually found - but if is, it is definitely adenocarcinoma)
name the different types of adenocarcinoma and their percentage of occurence.
Out of the adenocarcinomas of the tubes: 50% are serous; 25% endometrioid; transitional cell, undifferentiated, mixed, and clear cell
how would you diagnose an ectopic pregnancy?
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)
what are the three types of ovarian tumors?
1) Surface-derived or epithelial; 2) Germ Cell; 3) Sex-Cord STROMAL/mesenchymal tumors; 4) Mixed - germ and stromal
name the three general classes of ovarian neoplasms.
1) benign; 2) borderline - important in women that want to keep their ovaries for future pregnancies (therapy is less aggressive); 3) malignant
name the different surface-derived epithelial ovarian tumors.
serous, mucinous, endometrioid, Brenner tumor, (clear cell and undifferentiated - not in goljan)
name the stromal tumors.
granulosa-thecal cell tumor, Fibrothecoma aka Thecoma-fibroma; Sertoli-Leydig Cell Tumor
name the Germ cell tumors.
Dysgerminoma, Yolk sac Carcinoma, Teratoma, (Embryonal carcinoma and choriocarcinoma - not in goljan)
name the mixed tumor.
the Gonadoblastoma - malignant mixed germ (dysgerminoma with stromal cells)
the majority of testicular tumors are of _____ cell origin, while the majority of ovarian tumors are of _____ origin.
testicular- germ (seminomas) and ovary - surface-derived epithelial (serous)
stromal cell tumors occur more in females or males?
3% in males, 30% in females
name the 99% of the time BENIGN germ cell tumor of the ovaries.
teratoma (dermoid cyst)
if an ovarian teratoma has functioning thyroid tissue, what is it called?
struma ovarii (benign) - may become hyperthyroid; histo: pink globules of thyroglobulin
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.
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
these germ tumors are malignant but have a good prognosis (survival - 5yr of 90-100%).
Dysgerminoma - females and Seminoma - males (composed of undifrerentiated germ cells); remember, germ cell tumors are much more common in males
these germ tumors are malignant and have a very poor prognosis (0-50%).
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)
name the most common malignant germ cell tumor in the ovary.
dysgerminoma - histo: have clear, glycogen-filled cytoplasm and central nuclei; fibrous septa containing lymphocytes transverse the tumor
where are embyronal carcinomas (germ cell tumors) more commonly seen? how do they look under a microscope?
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
ovarian yolk-sac tumors (germ) contain this histiologic thing.
schiller-duval bodies; ovarian yolk-sac tumors are the most common ovarian cancer in girls <4years old; increase in AFP
of the different areas of the body, where are most germ cell tumors found? at what age are they more common?
midline of the body; in order of occurence= gonads, retroperitoneium, mediastinum, sacrum, and midline of CNS; reproductive age
all germ cell tumors are _________ except teratomas. however, teratomas found in men are ________.
malignant; malignant
germ cell tumors may produce what? it is useful in diagnosing and managing the tumors.
hCG and Alpha fetal protein
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?
androgens, estrogen, progesterone, corticosteroids, or combinations of these
what brings the mostly benign stromal cell tumors to the attention of a physician?
the extra hormonal, endocrine effects
name the uncommon ovarian tumor that preduces precocious puberty in children and masculinization, amenorrhea, and atrophy of the breasts in adults.
Sertoli-Leydig Cell Tumor (stromal tumor)
name the low-grade stromal malignant ovarian tumor that produces estrogen (feminizing tumor).
granulosa cell tumor or Granulosa-theca cell tumor; histo: solid sheet of granulosa cells with multiple spaces respresenting Call-Exner Bodies
name the normally post-menopausal stromal tumor that is associated with ovarian stromal hyperplasia, endometrial hyperplasia, and adenocarcinoma of the endometrium.
Thecoma - can be distinguished from fibromas by the presence of lipids (steroids) within their cells.
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?
Fibroma; Meigs Syndrome- triad of: ovarian fibroma, ascites, and pleural effusion (regression of effusion after removal of tumor)
what is the other name for Sertoli-Leydig Cell tumor; this tumor will secrete androgens and cause virilization.
what are the risk factors for getting ovarian cancer?
1)nulliparity (increases in ovulation, increase in risk); 2)Genetics (BRCA1&2), Lynch Syndrome, Turner's Syndrome, Peutz-Jeghers syndrome, 3)Smoking
what decreases the risk of getting ovarian cancer?
less ovulatory cycles (ie. pregnant, breast feeding, birth control)
what is used to help diagnose (the more common in women) epithelial cell tumors?
transvaginal ultrasound, measurement of the serum protein CA-125 (cancer antigen); most common tumor that is bilateral
how are epithelial derived tumors classified?
benign (-omas), malignant (carcinomas), if in between behavior = low malignant behavior or "intermediate" or "borderline"; also classified by histologic appearance
describe the histology of epithelial cell tumors for benign, low malignant potential, and malignant.
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
what do you call a benign serous epithelial tumor?
serous cystadenoma - cured by surgery
what do you call an intermediate serous epithelial tumor?
borderline serous cystadenocarcinoma (usually cured); watch closely
what do you call a malignant serous epithelial tumor?
serous cystadenocarcinoma - treat aggressively; poor survival rate - histo: see psammoma bodies
epithelial tumors often mimic tissue from parts of the reproductive tract; serous tumors mimic _____.
fallopian tube epithelium.
epithelial tumors often mimic tissue from parts of the reproductive tract; mucinous tumors mimic ______.
endocervical glands
epithelial tumors often mimic tissue from parts of the reproductive tract; endometrioid tumors mimic _____.
endometrium; must exclude endometrial cancer of the uterus to make the diagnosis of endometrioid
of the epithelial tumors, which two are more common?
serous and mucinous
what is a psammoma body and when is it found in ovarian cancer?
PB are round collections of calcium; if they are microscopically present, this indicates serous papillary cystadenocarcinoma
describe the gross and microscopic appearance of a mucinous cystadenoma of the ovary.
multiloculated gelatinous tumor that can grow very large (largest recorded: 328lbs); HISTO: single layer (if benign) of mucinous epithelial cells); nuclei line basal surface
out of benign and malignant types of mucinous and serous tumors, which one is most common? which one has the lowest survival rate?
serous cystadenocarcinoma; serous cystadenocarcinoma
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?
pseudomyxoma peritonei
what are the most common symptoms of ovarian cancer?
painless mass with local pressure and abdominal fullness (if advanced: pain, ascites, possible metastatic presentations)
ovarian carcinomas are the ___#___ in incidence in OB-Gyn tumors (after cervix and endometrium) but is ___#____ in deaths.
3rd in incidence; 1st in deaths
if a person has this disease, one it's prime sites of involvement are the ovaries.
lymphoma; especially in Burkitt's lymphoma (t 8,14)
there are 3 cancers that if become metastatic, target the ovary. name them.
50% breast; 40% GI tract; 10-20% endometrium
name the metastatic tumor to the ovary and how it looks on histo.
Krukenberg Tumor; HISTO: contains signet rings filled with mucoid material most likely from GI cancer
explain non-neoplastic cysts of the ovary.
these cysts are non-neoplastic, they arise from normal functional tissue.
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).
Follicular Cyst - excessive fluid collects in the developing follicle and a cyst results
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.
Polycystic Ovarian Disease (aka Stein-Leventhal Syndrome); this is an endocrine disorder that affects 7% of women; the LH:FSH >2
describe the gross appearance of PCOS.
enlarged ovary with thickened capsules and multiple cysts of the follicle type.
this non-neoplastic cyst occurs in the reproductive years and results from hemorrhage into a persistent mature corpus luteum. name it and its symptoms.
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
this non-neoplastic cyst is caused by increased hCG stimulation (multiple pregnancies, gonadotropin therapy for infertility, and trophoblastic dz).
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
this tumor is only found during pregnancy. it causes hyperplasia of theca-lutein cells and have produced virilization of mother and female fetus.
Luteoma of Pregnancy
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)
surface inclusion cysts
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.
simple cyst
this non-neoplastic cyst is often called a "chocolate cyst". what is it and what are the possible symptoms?
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
where is the most common location of endometriosis?
ovaries, then rectal pouch -> fallopian tubes