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43 Cards in this Set
- Front
- Back
Salpingitis
- what is? - cause? - results of CHRONIC salpingitis? - results of ACUTE? |
= inflammation of the fallopian tube
- usually caused by ascending infection - e.g., gon, chlam, e. coli, mycoplasma CHRONIC - plasma cells and lymphocytes - leads to tubular distortion and impaired function... infertility and ectopic pregnancy might occur ACUTE - tube lumen might become blocked... purulent exudate (pyosalpinx = neutrophils) or serous fluid (hydrosalpinx) might accumulate - could lead to PID if organisms gain access to peritoneum... can lead to adhesions and abscesses in adnexa and cause infertility |
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What is Pyosalpinx?
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Purulent fluid that accumulates in lumen of fallopian tubes - due to salpingitis
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What is Hydrosalpinx?
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Serous fluid that accumulates in lumen of fallopian tubes - due to salpingitis
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Ectopic Pregnancy
- where do most cases (%??) occur? - causes - MOA - when does rupture occur? |
- >95% in fallopian tube
- often due to PID, endometriosis - MOA: bc tube is much thinner than uterus, trophoblasts can penetrate into (placenta increta) or through (placenta percreta) the muscular wall of the tube - Rupture - usually by 12th week of gestation --> assoc'd with life-threatening intraabdominal hemorrhage |
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Placenta Increta?
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when the trophoblasts penetrates into the wall of the fallopian tube during ectopic pregnancy
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Placenta Percreta?
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when the trophoblasts penetrates through the wall of the fallopian tube during ectopic pregnancy
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Non-neoplastic Ovarian Cysts - what are the different varieties?
- descrip? - size? - cause? - clinical sx? |
FOLLICLE CYSTS
- thin-walled, <5 cm diameter - may develop at menopause- due to abnorms in release of pituitary gonadotropins - histo: lined by granulosa cells with underlying layer of theca cells - Clinical sx: associated with precocious puberty in kids, menstrual irregularities, rupture with intraperitoneal bleeding CORPUS LUTEUM CYSTS - due to delayed involution of corpus luteum - central bleeding and cyst formation - yellow wall surrounding the area of hemorrhage - Prolonged progesterone synthesis --> menstrual irregularities THECA LUTEIN CYSTS - often multiple and bilateral - due to high circulating gonadotropin/HCG levels -e.g., pregnancy, hydatidiform mole, choriocarcinoma - causing exaggerated stim of theca interna - occasional rupture and intraabdominal hemorrhage |
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Polycystic Ovarian Syndrome
- aka - pathogenesis - typical age? - symptoms/signs - tx? - gross appearance of ovary? - histo appearance of ovary? |
- aka: Stein-Leventhal Syndrome
- due to abnormal regulation of 17 alpha- hydroxylase --> increased ovarian production of androgens - androgens inhibit follicle maturation in ovary --> mult follicles at various stages of development - premature follicular atresia --> anovulation - in adiopose tissue, androgens converted to estrogen --> increases pituitary secretion of LH; negative feedback on FSH --> LH stims theca cells of ovary to increase androgen production... - hyperinsulinemia --> increase GnRH pulse freq (but LH >>> FSH) and increase androgens - age: usually in young 20s - persistent anovulation - obesity (assoc'd with hyperinsulinemia and increased adipose tissue) - sx of excess androgen secretion - e.g., hirsutism, acne, male-pattern alopecia - marked insulin resistance --> further increases androgen synth and LH release - infertility due to anovulation - increased incidence of endometrial hyperplasia and adenocarcinoma due to unopposed estrogen - Gross: ovary appears enlarged and smooth, but contains numerous small cortical cysts within - Histo: follicle cysts in early stages of development and increased ovarian stroma - Tx: hormonal tx to reduce androgen production |
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Ovarian Carcinoma
- frequency? - diagnosis/prognosis? - cause? |
= 2nd-most common gyn. malignancy (endometrial cancer = #1)
- higher mortality than all other gyn cancers bc late-stage diagnosis - can arise from: 1. surface eptihelium (90%) 2. germ cells 3. stromal cells 4. metastasis from other cancers - e.g., krukenberg tumor comes from GI tract |
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Krukenberg Tumor
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- secondary ovarian cancer -- comes from GI cancer that metastasizes to ovary (usually both)
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Epithelial Ovarian Tumors
- frequency? - pathogenesis? - genetic? - benign or malignant? - histo? |
- most frequent (90%) ovarian tumor
Path: - repeated disruption and repair of surface epithelium ... more common in nulliparous women ... less common in women who have been pregnant or used OC GENETICS - increased incidence if first-degree relative had ovarian cancer - BRCA-1 gene implicated TYPES: - benign cystic adenomas - solid, malignant invasive carcinoma - borderline group - cytologic atypia and some malignant potential, but no frank invasion HISTO - all cellular forms of mullerian differentiation * serous (fallopian tube) * mucinous (endocervix) - endometriod (endometrium) - clear cell (glycogen-rich endometrium from pregnancy) - transitional cell (bladder) ***serous and mucinous are most common |
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Benign Ovarian Cystadenomas
- types - histo - size? |
- serous or mucinous differentiation
- can grow to large size - unilocular (serous) or multilocular (mucinous) Histo: - serous - lined by single layer of well-differentiated ciliated columnar epithelium - mucinous - lined by mucin-producing glandular epithelium *another type benign: Brenner Tumor - solid (not cystic) - contains nests of transitional type epithelium in dense fibrous stroma |
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What is a Brenner Tumor?
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Type of Benign Ovarian Tumor
- solid (not cystic) - contains nests of transitional type epithelium in dense fibrous stroma |
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Borderline Ovarian Tumors
- what are? - differentiation from benign? - tx? - prognosis? |
= tumors of low malignant potential
- generally cystic - usually either serous or mucinous Distinction from Benign: - presence of epithelial atypia - increased mitotic activity - architectural complexity (e.g., papillary structures) - NO INVASION of underlying ovarian tissue - slight potential to metastasize into peritoneal cavity or regional lymph nodes Tx: surgical removal Prognosis: excellent following surgical removal |
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Invasive Adenocarcinoma of the Ovary
- differentiation? - most common? - gross? - histo? - sx? - metastasis - where? how? - tx? - prognosis? |
= Cystadenocarcinoma
- any type of differentiation - serous, mucinous, endometrioid, clear cell, transitional - Serous = most common - often both cystic and solid areas - Histo: often papillary growth and frank invasion; psammoma bodies (focal calcifications) within invasive epithelial nests ** Sx often only after achieved large size or metastasized Metastasis: - Intraperitoneal Seeding (pseudomyxoma peritonei) may occur - Lymph Spread - usually paraaortic or external iliac nodes Tx: surgical removal and chemo Recurrance not uncommon... Prognosis: - depends on surgical staging - overall 5-year survival = 35% |
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Pseudomyxoma Peritonei
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Massive intraperitoneal seeding of ovarian cancer
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Germ Cell Tumors of the Ovary
- types? - population? |
- analygous to those seen in testis
Include: - dysgermanoma - teratoma - yolk sac tumors - choriocarcinoma **Tend to occur in YOUNGER women when compared to epithelial malignancies; may be seen in children/infants |
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Dysgerminoma
- what is? - frequency? - gross appearance? - histo? |
= malignant transformation of germ cells with NO histologic differentiation
= ovarian counterpart to seminoma (but much more rarely) - only 2% of ovarian cancers - gross: homogenous tan appearance - histo: sheets of uniform clear cells with surrounding lymphocytic infiltrate |
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Psammoma Bodies
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focal calcifications found in ovarian cystadenocarcinomes; found within nests of invasive epithelial cells
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Teratoma
- what is? Types? |
= germ cell tumor with evidence of somatic differentiation- usually along all 3 embryonic layers
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Struma Ovarii
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type of teratoma composed of only thyroid tissue
- rarely associated with hyperthyroidism |
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Mature Cystic Teratoma
- aka? - frequency? - pathogenesis? - description? - malignancy? |
- aka: dermoid cysts
- 25% all ovarian tumors PATH: - parthenogenesis (autofertilization of haploid ova --> female diploid tumor cells) Descrip: - may contain skin, sebacious glands, hair (90% of time - hence dermoid) - may contain any epithelium (GI, repir, etc.), mesenchymal cells (bone, cart), neural tissue (glia), teeth - Struma Ovarii - all thyroid tissue - 1% undergo malignant transform - usually to SCC |
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Immature Teratoma
- what is? - malignancy? - prognosis? |
- contain elements from all 3 germ layers, but may have an embryonal appearance
- malignant - prognosis correlates with amt embryonal tissue present |
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Yolk Sac Tumors
- what are? - population? - gross? - histo? - malignant? - how do you monitor them? |
= germ cell tumors
- highly malignant! - younger women <30 - gross: identical to testicular lesions - areas of hemorrhage and necrosis - histo: presence of Schiller-Duval Bodies - monitor: HIGH alpha- fetoprotein levels... monitor effectiveness of tx and disease recurrence |
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Choriocarcinoma
- what is? - population? - gross? - histo? - monitor? |
= germ cell tumor that mimics epithelial components of placental chorionic villi - i.e., cytotrophoblasts and syncytiotrophoblasts
- occur in young girls - may cause precocious puberty and menstrual irregularities - in older women, usually represents metastasis from intrauterine tumor - gross: extensive hemorrhage - histo: malignant cyto- and syncytiotrophoblasts - monitor: tumor cells make HCG - diagnose, monitor, etc |
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Benign Fibromas
- what are? - gross? - histo? - associated problem? |
= most common type of ovarian stroma tumor
- gross: solid, white, firm - histo: well-differentiated fibroblasts and collagen, uniform spindle cells Meigs Syndrome - association of ovarian fibroma with ascites and pleural effusions |
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Meigs Syndrome
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association of ovarian fibroma with ascites and sometimes pleural effusion
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Thecomas
- what are? - population? - gross? - histo? - associated problem? |
= benign estrogen-producing tumors
- post-menopausal women - gross: solid, yellow - histo: lipid-laden theca cells - increased estrogen level can lead to endometrial hyperplasia or adenocarcinoma |
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Granulosa Cell Tumors
- pop? - cause? - gross? - histo? - associated with? - metastasis? |
- post-menopausal women
- estrogen-producing - development related to loss of oocytes, which normally regulate granulosa cell proliferation - gross: partially cystic; contain hemorrhagic areas - histo: sheets of uniform cells with grooved nuclei - form Call-Exner Bodies (follicular-like lesions) - increased estrogen may cause endometrial hyperplasia or adenocarcinoma - 10% metastasize |
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Sertoli-Leydig Tumors
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= similar to testicular lesions
- may produce androgens - associated with virilization and hirsutism |
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Gonadoblastoma
- what is? - frequency? - cause? |
- rare ovarian tumor
- due to gonadal dysgenesis - contains both germ cell and primitive sex cord elements |
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Granulosa Cell Tumors
- pop? - cause? - gross? - histo? - associated with? - metastasis? |
- post-menopausal women
- estrogen-producing - development related to loss of oocytes, which normally regulate granulosa cell proliferation - gross: partially cystic; contain hemorrhagic areas - histo: sheets of uniform cells with grooved nuclei - form Call-Exner Bodies (follicular-like lesions with granulosa cells in a rosette pattern) - increased estrogen may cause endometrial hyperplasia or adenocarcinoma - 10% metastasize |
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Sertoli-Leydig Tumors
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= similar to testicular lesions
- may produce androgens - associated with virilization and hirsutism |
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Gonadoblastoma
- what is? - frequency? - cause? |
= contains both germ cell and stromal elements
- rare ovarian tumor - due to gonadal dysgenesis |
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Call-Exner Body
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= histology of granulosa cell tumors in ovary
- follicular-like lesions with granulosa cells (with grooved nuclei) in a rosette pattern |
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Chorioamnionitis
- what is? - cause? - gross? - histo? - result of acute chorioamnionitis? |
= Inflammation of placental membranes
- due to ascending bacterial infection - esp in setting of premature rupture! - gross: membranes and cord appear dusky, opaque and edematous - histo: neutrophilic infiltrate ** umbilical cord may become secondarily involved ACUTE - might result in premature labor, fetal infections, intrauterine hypoxia |
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Villitis
- what is? - cause? |
= inflammation of the placental villi
- due to complication of underlying endometritis or hematogenous spread of maternal infection |
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Preeclampsia
- what is? - when does it occur? - cause? - can lead to...? - tx? |
= hypertension associated with proteinuria and edema
- during third trimester - often in first pregnancy - eclampsia = seizure = type of trophoblastic disease - bc occurs with mole Path: - improper invasion by trophoblasts into spiral arteries --> impaired dilation of spiral arteries --> placental blood flow markedly diminished ... leads to endothelial cell injury an DIC - involves rbain, kidneys, liver ... can lead to placental infarction - tx: delivery and removal of placenta |
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Gestational Trophoblastic Disease
- types? |
= spectrum of conditions that demonstrate abnodmal proliferation and maturation of trophoblasts
- includes complete/partial hydatidiform mole; choriocarcinoma |
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Complete Hydatidiform Mole
- what is? - cause? - chromosomes? - risk factors? - gross? - histo? - clinical sx? - can lead to...? |
= placenta containing swollen chorionic villi (resembles a bunch of grapes) with trophoblastic proliferation, but no demonstrable embryo
- due to fertilization of an empty ovum by sperm --> then duplication of paternal chromosomes = usually 46,XX Risk Factors: - pregnancy when <15 y.o. or >40 y.o. - Asian - previous molar pregnancy - gross: uterine cavity completely filled with edematous villi - histo: atypical trophoblasic hyperplasia Sx: - excessive uterine enlaregement - abnormal uterine bleeding - serum HCG rises RAPIDLY - becomes markedly elevated - ~2% patient develop choriocarcinoma following uterine evacuation |
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Partial Hydatiform Mole
- cause? - chromosomes? - gross? - consequences? |
- due to fertilization of an ovum with 2 sperm OR 1 diploid spem (has not yet undergone meiosis)
= triploid karyotype - some chorionic villi appear normal; others enlarged and edematous - mild, focal trophoblastic proliferation - fetus usually aborted after 10 wks gestation - fetal parts recognizable - no risk of choriocarcinoma |
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Invasive Hydatidiform Mole
- what is?` - metastasis? - distinguish from choriocarcinoma? |
- villi invade into/through uterine wall (can cause perforation)
--> may enter dilated uterine blood vessels and spread distantly in body (e.g., to lungs), but does not invade other structures - difficult to distinguish from choriocarcinoma, but the latter does NOT have chorionic villi |
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Choriocarcinoma
- what is? - malignant? - gross? - histo? - metastasis? - monitor? |
= fully malignant neoplasm derived from trophoblasts
Risk Factors: (same for complete mole) - pregnancy at <15 y.o. or > 40 y.o. - Asian - previous molar pregnancy - gross: foci within placenta can be small or extensive; hemorrhage and necrosis - histo: prolif of atypical cytotrophoblasts and syncytiotrophoblasts BUT NO TRUE FORMATION OF CHORIONIC VILLI!!! (differentiates from invasive mole) - may metastasize widely - sometimes not for many years after preg - elevated serum HCG - can monitor |