Hrm 3: Ovary Path

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causes of Salpingitis

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chlamydia and gonococcus

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common serous filled cysts usually near fimbria

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Paratubal cysts & hydatid cysts of Morgagni

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MC site of ectopic pregnancy

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Ampulla of fallopian tube

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MCC of fallopian tube causing ectopic pregnancy

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PID (endometriosis, leiomyomas, IUD, adhesions also causal)

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Triad of Pre-eclampsia

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HTN, proteinuria and edema

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Absence of decidua of endometrium so placenta adheres directly to myometrium: failure of placental separation

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Placenta accreta

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Often when placenta implants on scar (C-section)

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Placenta acreta

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Placenta previa

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placenta implants over lower uterine segment or cervix. During labor --> hemorrhage.

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Mech of Complete Mole

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: ovum loses nuclear DNA; sperm “fertilizes” with 23X, doubles to 46XX (Two sperm in the egg); all chromosomes are paternal!

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Rapid uterine enlargement to excessive size; high urinary gonadotropin

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Complete Mole

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2% of complete moles are associated with what?

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Choriocarcioma

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Mech of Partial Mole

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2 sperm fertilize ovum that retains its nucleus --> triploidy (69, XXY or 69,XXX) or rarely tetraploid (92, XXXY)

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Difference of partial mole vs complete

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Less > of HCG in partial and partial rarely leads to choriocarcinoma

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hydropic villi

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Mole

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Cistern formation

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COMPLETE moles

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Malignant transformation of trophoblastic tissue from any form of pregnancy

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Choriocarcinoma

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dimorphic histology (cytotrophoblasts & syncytiotrophoblasts) without chorionic villi

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Choriocarcinoma

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multiple follicular cysts and foci of hyperthecosis with stromal fibrosis

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Polycystic ovary (Stein-Leventhal) syndrome

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persistent anovulation, hirsutism (50%), obesity (40%), infertility

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Polycystic ovary (Stein-Leventhal) syndrome

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Mech of Polycystic ovary

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Excessive LH causes theca lutein --> androgens

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Most neoplasms of the ovary come from what?

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Surface epithelium

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MCT of Serous tumors

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Benign

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MCT of Malignant Ovarian tumors

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Serous

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fibrous stroma; transitional (urothelial) epithelium; usually benign

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Brenner Tumor

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Dermoid Cyst AKA

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Teratoma

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Karyotype of Teratoma

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46XX

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Dominant type of Teratoma/Dermoid Cyst

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Thyroid (struma ovarii) --> hyperthyroidism and will cause the native thyroid gland to atrophy

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A malignant teratoma will show what?

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more embryonic tissue (immature teratoma) may lead to seeding of the abdomen

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Identical to testicular seminoma

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Dysgerminoma

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What may you see in children with choriocarciomas?

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Precocious puberty

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Granulosa-theca cell tumors are derived from what?

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Ovarian stroma

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Call-Exner bodies that may resemble follicles

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Granulosa-theca cell tumors

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may stain + for Inhibin

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Granulosa-theca cell tumors

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Oil red O fat stain

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of luteinized theca cells in granulosa cell tumor or Thecoma fibroma

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Coffe bean nuclei with grooves and Call Exner bodies

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granulosa cell tumor

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hydrothorax, ascites & ovarian tumor

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Meig's syndrome associated with Thecoma fibroma

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Yellow colored deposition

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Thecoma fibroma

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What age group do Sertoli-Leydig cell tumors occur?

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young adult

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Reinke crystalloids

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Sertoli-Leydig cell tumors (androblastoma)/Hilus cell tumor

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MC mets to ovary

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uterus and tube

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Signet ring carcinoma

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Krukenberg tumor

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When gastric mucionus adenocarciomas met to both ovaries

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Krukenber tumor (simulates primary ovarian primary ca)

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Pseudomyoxoma peritonei from appendix may present with what type of mets?

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Ovarian

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MC precursor of choriocarcioma

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Hydatiform mole

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"honeycombed uterus" "Cluster of grapes"

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Hydatiform mole

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Tx of Hydatiform mole

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D&C and MTX

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Karyotype of Complete Mole

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46XX; 46XY

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Karyotype of Partial Mole

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69,XXX; 69XXY; 69XYY

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When is hCG >>>>>>>>, partial or complete mole?

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Complete

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Fetal parts seen, complete or partial mole?

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Partial (PARTial)

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2 sperm + empty egg

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Compete mole

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2 spem + 1 egg

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Partial mole

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Def of Eclampsia

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Preeclampsia (HTN, edema, proteinuria) and seizures

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What causes Preeclampsia/Eclampsia?

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Placental ischemia

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Defective decidual layer allows placenta to attach tomyometrium

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Placenta accreta (no separation of placent after birth)

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Attachment of placenta to lower uterine segment occluding perhaps occluding internal os

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Placenta Previa

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Endometrial bx shows decidualized endometrium but no chorionic villi

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Ectopic

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Gonadotropin and Steroid hormones in polycystic ovarian syndrome?

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LH, Testosterone and Estrogen are all > while FSH is <

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MC ovarian mass in young women

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Follicular cyst

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Distention of unruptured graafian follicle

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Follicular cyst

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Ovarian germ cell tumors are MC in what age group?

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adolescents

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Ovarian germ cell tumor with sheets of uniform cells; associated with Turner syndrome (XO)

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Dysgerminoma

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Tumor markers for Dysgerminoma

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hCG, LDH

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Malignancy of trophoblastic tissue; chorionic villi are NOT present

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Choriocarcinoma

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An > of what type of cysts may you see with choriocarcinoma

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Theca lutein cysts

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Gestational trophoblastic neoplasia

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Moles and Choriocarcinoma

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Tumor marker for choriocarcinoma

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hCG

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Yellow, friable, solid masses with Schiller Duval bodies (resemble glomeruli)

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Yolk Sac

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90% of ovarian germ cell tumors

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Teratoma

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Mature teratoma AKA

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dermoid cyst

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Frequently bilateral and lined with fallopian tube-like epithelium; benign

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Serous cystadenoma

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General ovarian cancer marker

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> CA-125 (good for monitoring progression, not screening)

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45% of ovarian tumors

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Serous cystadenocarcinoma

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Psammoma bodies, malignant and frequently bilateral ovarian tumor

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Serous Cystadenocarcinoma

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RF for Serous cystadenocarvinoma

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BRCA1, BRCA2 and HNPCC

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Multiolovular cyst lined by mucus secreting epithelium ; intestine like tissue; benign

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mucinous cystadenoma

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Pseudomyxoma peritonei (intraperitoneal accumulation of mucinous material from ovarian or appendiceal tumor)

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Mucinous cystadenocarvionma

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Benign and UNILATERAL; looks like bladder

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Brenner tumor (solid and yellow/tan)

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Pulling sensation in the groin; bundles of spindle shaped fibroblasts; Meigs' syndrome

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Fibromas

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What does a granulosa cell tumor secrete?

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estrogen (precocious puberty in kids)

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Call Exner bodies

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Granulosa cell tumor

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Krukenberg tumor is a GI malignancy that mets to ovaries cuasing a mucin-secreting what?

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Signet cell adenocarcinoma