11. Fallopian tube, Ovary Path Flashcards by Andrew Niemann

Fallopian tubes are from unfused mullerian ducts, MC affected by infections and associated with inflamm conditions, also affected by ectopic pregnancies and endometriosis. What salpingitis is caused by N. gonorrhea (60%) and the rest of cases by chlamydia trachomatis?

Suppurative Salpingitis

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What salpingitis is rare in the US, accounting for 1-2% of all salpgitis, more common in parts of the world where the infection is more common and is an important cause of infertility in those areas (AFRICA)?

Tuberuculous Salpingitis

fallopian tubes affected when bacteremia dissemination = systemic miliary Tb

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What is the MC primary lesion of the fallopian tubes (besides endometriosis) and are small translucent cysts filled with clear serous fluid?

Paratubal Cysts

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What type of paratubal cysts are larger near the fimbriated end of the tube or in the broad ligaments that arise from remnants of the mullerian duct and are lined with benign, serous (tubal type) epithelium? (insignificant)

Hydatids of Morgagni

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The fallopian tube and ovaries togethere is called the?

adnexa = parts that adjoin an organ

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What tumor is uncommon and benign, occuring subserosally on the tube or in the mesosalpinx- small nodules?

Adenomatoid Tumor

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Primary adenocarcinoma of the fallopian tube is rare and may be detected via pelvic exam, others may come to attention via abnormal discharge, bleeding or abnormal cells on pap, 50% are stage 1 at dx, 60% 5yr survival, treated with?

Ovarian cancer chemotherapy protocols

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What are very common ovarian cysts that originate from unruptured graafian follicles or in follicles that rupture and then sealed, seen as multiple cysts >2cm, filled w clear serous fluid, lined by gray glistening membrane, hyperthecosis is assoc w increased estrogen production and endometrial abnormalities?

Follicle cyst (if less than 2cm then cystic ovarian follicle)

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What cyst is seen in normal ovaries of reproductive age females, lined w a rim of bright yellow tissue** containing leutinizing granulosa cells (yellow cause hormone secretion), may rupture causing peritoneal reaction?

Luteal Cyst (corpora lutea)

old hemorrhage + fibrosis makes them look like endometriotic cysts (CHOCOLATE)

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What is a complex endocrine disorder characterized by hyperandrogenism (hirsutism, acne, deep voice), menstrual abnormalities (amenorrhea), polycystic ovaries, chronic anovulation and decreased fertility?

Polycystic Ovarian Syndrome PCOS

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PCOS affects 6-10% reproductive females, associatd with underlying metabolic disorder, obesity, T2DM, premature athersclerosis, increased free serum estrone (E1), which places the patient at an increased risk of endometrial hyperplasia and?

carcinoma

(E2: estradiol- most potent estrogen produced by aromatization of testosterone
E3: estriol- least potent placental estrogen from fetal adrenal gland as DHEA)

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About 80% of ovarian tumors are benign and occur mostly in young women between 20-45, borderline tumors appear at an older age, and malignant tumore are MC in older women between 45-65, what has occured by the time of diagnosis?

Spread beyond the ovary = disproportionate amount of deaths from cancer in female GT

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Tissue source for ovarian cancer is either surface/fallopian tube epithelium and endometriosis, pluripotent germ cells that migrate to the ovary from the yolk sacm and stromal cells (sex cords) what are forerunners of the endocrine apparatus of the postnatal ovary…Sx include abd pain and distention, urinary and GI tract sx due to compression or invasion and ?

vaginal bleeding are the most common

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Most primary ovarian neoplasms arise from mullerian epithelium* with 3 types, serous, mucinous and endometrioid, classified as cystic or fibrous and may be benign, borderline or malignant, making up 47% of all ovarian cancers, which kind is MC?

SEROUS ***BILATERALITY w epithelial derived ovarian tumors

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Type 1 ovarian epithelial tumors are low grade (serous endometrioid or mucinous) often associated with borerline tumors or endometriosis. Type 2 ovarian epithelial tumors are HIGH grade and mainly serous, associated with inclusion cysts from fallopian tube or?**

Serous tubal intraepithelial carcnioma (STIC?)

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Serous tumors are cystic with tubal like epithelium, MC malginant ovarian tumor* 40% of all cancers, 70% are b9 or borderline (20-45y/o) and 30% are malignant occuring later in life, **all serous tumors have what(histo)?

Psammoma Bodies*** = concentric calcifications

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Risk factors for malignant serous tumors includes nullparity, fam hx of breast/ovarian cancer, and what two mutations? (note: 40-59 y/o who took OCP therapy or had tubal ligation at a dec risk)

Heritable mutations in BRCA1/BRCA2

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Low grade arise in serous borderline tumors w KRAS,BRAF,ERBB2, wildtype TP53 , responds better to chemo. High grade have inc. freq in TP53 mut, BRCA1/2 mut rare, No KRAS/BRAF, inc freq of genomic imbalances, amplification of oncogenes and deletion of tumor suppressors

MEOW

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Benign serous tumors have smooth glistening cyst wall w no epithelial thickening or with small papillary projections, 20% bilateral, cysts are lined w columnar epithelium with lots of?

Cilia

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Borderline tumor morphology has an *inc # of papillary projections, 30% are bilateral, involve the surface of the ovary, increased complexity of the stromal papillae, mild nuclear atypia but NO?

stromal invasion

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High grade serous morphology includes complex patterns of growth, widespread infiltration of underlying stroma, MAKRED nuclear atypia and pleomorphism and multinucleation, increased mitotic activity, are they bilateral?

YAS 66% (malignant)

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What has cells identical to high grade but there is no invasion, marked epithelial atypia in fallopian tubes*, indicating a fallopian tube origin, females are BRCA1/2 germline mutations, assoc w sporadic high grade serous ovarian cancer?

Serous Tubal Intraepithelial Carcinoma STIC

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Serous tumors usually spread to peritoneal surfaces and omentum**.. Low grade even after spread outside the ovary often progress slowly and patients survive for a long time.. high grade tumors are widely metastatic through the abdomen, associated w rapid?

clinical deterioration

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Mucinous tumors from epithelium covers 20-25% of all ovarian neoplasms, most are benign or borderline, common in middle adult life, rare before puberty or after menopause, most have what mutation if it is malignant?

KRAS mutation

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Mucinous tumors from epithelium rarely involve the surface of the ovary and are rarely** bilateral, if bilateral think non-ovarian (appendix), produce larger cystic masses, will see multiloculated tumors w sticky gelatinous fluid rich in glycoproteins- can grow V large , will see what growth?

papillary growth v similar to tubular adenmoas and adenomas of the intestine

What is an extensive mucinous ascites, cystic epithelium implants on peritoneal surfaces, adhesions and frequent involvment of the ovaries, result in obstruction and death, *MC extraovarian source is appendix, most primary mucinous are unliateral so if mucinous and bilateral - think nonovarian origin?

Pseudomyxoma Peritonei

What carcinoma comprises 10-15% of ovarian cancers,good prognosis, 15-20% coexist with endometriosis, the main difference is presence of tubular glands resembling benign or malignant endometrium (differ from serous/mucinous)?

Endometrioid Carcinoma

Endometrioid Carcinoma w endometriosis occurs in patients 10 years younger, has PI3K/AKT mutation of PTEN, and mutation of DNA MMR, they are solid and cystic areas of growth, epithelium consists of tubular glands resemblin endometrium, 40% are bilateral*, low grade tumors, 5 year survival of?

75%

Ovarian epithelial tumors (serous, mucinous, endometrioid) all have the same clinical manifestations, most commonly lower abdominal pain, and abdominal enlargment either due to the tumor or?

Ascites Note: tumor can impinge on other organs causing different symptoms = GI complaints, urinary frequency, dysuria, pelvic pressure

Because most ovarian cancers spread beyong the ovary when they present (high stage), other symptoms include weakness, weight loss, cachexia, ascites/omental cake, and with mets to liver, lungs GI and?

opposite ovary! (50% cross midline and indicate downhill course w death in months)

HE4 and what are two biomarkers that can be used to monitor disease recurence and progression?

CA125

85-90% of ovarian cancer is sporadic, 10-15% is due to BRCA1/2 RAD51C/D mutation and other syndromes such as Lynch, LiFraumeni, Cowden, Gorlin and?

Puetz Jeghers

germ cell tumors make up 15-20% of ovarian tumors, majority of them are benign cystic (mature) teratomas aka dermoid cysts, immature teratomas are?

Malignant

Mature teratomas are benign and most are cystic referred to as dermoid cysts and always lined with skin like structures, young women, discovered incidentally, all are 46,XX - majority arise from ovum after first meiotic division, 1% undergo malignant transformation to?

Squamous Cell Carcinoma (skin component)

Mature benign teratomas morphologically 10-15% are bilateral, unlilocular cysts with hair and sebaceous material, tooth structures alng with carilage, thyroid, and neural tissue, the walls are usually made of stratified?

squamous epithelium

Immature malignant teratomas tumor tissue resembles empryonal and immature fetal tissue, seen in prepubertal teens and young women 18yrs, is a solid, bulky tumor w smooth external surface, may see hair cartilage bone and calcification, grows rapidly and can?

penetrate the capsule and spread locally/ distantly | recur in first two years

Monodermal or specialized teratomas are either struma ovarii or carcinoid, Strumal carcinoid is RARE, combo of both in the ovary, **always unilateral, only 2% metastasize. What is composed entirely of mature thyroid tissue that may be function causing hyperthyroidism always unlilateral?

Struma Ovarii

What arises from intestinal tissue in teratomas and may be functional, >7cm causes 5HT production leading to carcinoid syndrome even in absence of hepatic metastasis because ovarian veins are connected directly to systemic circulation- always unliateral?

Ovarian Carcinoid

What tumor that makes up 50% of all malignant ovarian germ cell tumors and is the ovarian counterpart of testicular seminoma, 2% of all ovarian cancers, may produce **hCG**, 75% patietns in 20-30s, ALL are malignant*!?

Dysgerminoma | polyhedral tumor cells w round nuclei and adjacent inflammation

Dysgerminoma has OCT3, OCT4, NANOG mutation which maintain pluripotency, 33% have KIT mutations, they are unliateral tumors, large vesicular cells with clear cytoplasm, well defined borders, central nuclei, grow in sheets or cords and have scant fibrous?

stroma infiltrated by mature lymphocytes +/- granulomas tx w salpingooophrectomy

What tumor is rare and derived from malignant germ cells, produces *a-fetoprotein AFP*, looks like a glomerulus like structure with central blood vessels envelopbed by the tumor cells in a space lined by tumor cells: ***Schiller Duval Body - characteristic

Yolk Sac tumor aka Endodermal Sinus Tumor | children/young females, adb pain, rapidly growing pelvic mass, 80% survival

What is extraembryonic differentiation of malignant germ cells of palcental origin, exists in combo w other tumors, they are aggressive and metastasized by presentation, HIGH levels of hCG, **unresponsive to chemo and fatal if in ovary, if in placental tissue - responsive?

Choriocarcinoma

What are ovarian neoplasms derived from ovarian stroma which came from the sex cords of embryonic gonad, females: granulosa and thecal and fibroblasts are the kinds?

Sex cord stromal tumors

Granulosa and theca cell tumors secrete estrogen and are feminizing while leydig and sertoli cells secrete androgens (male sex cord tumors) and are therefore?

masculinizing

What sex cord tumor is composed of cells that look like granulosa cells of a developing ovarian follicle, 5% of all ovarian tumors and most are adult cell tumors, 2/3 ** ocur post-menopausal, may elaborate large amounts of estrogen and may behave like low grade malignancies?

Granulosa Cell tumors

Granulosa Cell tumors clinically cause precocious puberty if it is functionally active in a juvenile patient, along with early menarche, early breast (thelarche) development and what?

pubic or underarm hair

Granulosa Cell tumors clinically cause precocious puberty if it is functionally active in a juvenile patient, along with early menarche, early breast (thelarche) development and what?

pubic or underarm hair

Granulosa Cell tumors clinically in adult females may have proliferative breast disease, endometrial hyperplasia and endometrial carcinoma in 15%, (high amounts of estrogen) what can occur if it is secreting estrogens?

Masculinization

Serum inhibin produced by Granulosa Cell tumors inhibits FSH, allows diagnosing and treatment, most adult type have FOXL2 mutations**, all are potentially malignant, tumors w predominantly theca cells are unlikely to be malignant, histology does not predict?

tumor behavior

What is a sex cord tumor arising in the ovarian stroma composed of well differentiated fibroblasts w scant intersperse collagenous stroma, hormonally *inactive*, 90% are unilateral, solid, spherical lobulated encapsulate masses w glistening cover, intact ovarian serosa, benign?

Fibroma

What sex cord tumor arises in the ovarian stroma composed of *plump spindle cells with lipid droplets*, pure is rare, may be hormonally active, *benign?

Thecoma

What are functional tumors that often lead to masculinization or defeminization, some have estrogenic effects, cells are in various stages of development, femalles of all ages - peaks in 20-30s, ****secrete androgens?

Sertoli-Leydig Cell tumors

Sertoli-Leydig Cell tumors have a DICER1 mutation in more than 50%, endonuclease essential for microRNA processing, *unilateral, solid grey to golden brown, well differentiated sertoli/leydig cells interspered in the stroma, poor differentiated have a sarcomatous pattern w disorderly deposition of?

epithelial cell cords (leydigs may be absent)

Sertoli-Leydig Cell tumors can block normal female sexual development in children and in adults, there may be atrophy of breasts, amenorrhea, sterility and loss of hair, progressing to virilization w male distribution of hair (hisutism), hypertrophy of clitorus and voice chainges, do they often recur or met?

NO <5%

What is a sex cord tumor of PURE leydig cells, rare, unilateral, mainly testosterone producin tumors, benign w clusters of polygonal cells around hilar vessels?

Hilus Cell Tumors

Hilus Cell Tumors are unilateral w large, lipid laden leydig cells with distinct borders, present w evidence of masculinization such as hirsutism, voice change, clitoral enlargement, tx w surgical excision-B9, what is a characteristic pink cytoplasmic structure?

*Reinke Crystalloids

What is uncommon ovarian tumor of sex cord or stromal origin, seen in pts w abnormal sexual development, 80% are phentypic females, 20% are males w undescended testicals and female internal secondary organs, have coexistent dysgerminoma in 50% of cases, *excellent prognosis?

Gonadoblastoma

Metastatic tumors to ovaries derived from tumors of mullerian origin is MC, involving uterus, fallopian tube, contralateral ovary, and pelvic peritoneum. Extra-mullerian metastasis to the ovaries is commonly seen in stomach*, breast colon biliary tract and?

Pancreas

What tumor is metastatic GI tumor involving the ovaries- when gastric carcinoma metastasizes, usually *bilateral mets of mucin producing, signet ring cells?

Krukenberg Tumor | diffuse gastric carcinoma = linitis plastica

What in children is caused by congenitally malformed or long fallopian tubes or absent mesosalphinx, during pregnancy due to enlarged corpus luteum/laxity in ligaments, and due to ovarian tumors MC dermoid?

Ovarian Torsion

Ovarian Torsion is infrequent but significant cause of lower abdominal pain, reproductive age around 28, second peak post menopausal, tube is often involved, delay in dx can lead to vascular compromise of adnexa and subsequent?

Infarction (5th MCC of gynecologic emergency)

What is pregnancy loss before 20 weeks gestattion, usually before 12 weeks, occurs in 10-15% of recognized pregnancies, occurs in another 20% which are not recognized by women, 70% terminant within 14 days of fertilization w passage of some abnl tissue?

Spontaneous Abortion (antiphospholipid antibody syndrome, coagulopathy, HTN = systemic DOs affecting maternal vasculature ***APS = false + for syphilis)

Histologically, in the first trimester there are chorionic villi composed of delicated mesh of central stroma surrounded by two layers, outer is syncytiotrophoblast and inner is cytotrophoblast. Third trimester chorionic villi is composed of stroma w dense network of dilated capillaries surrounded by a thinned out?

syncytiotrophoblast/cytotrophoblast | sampling done via Chorionic Villus Sampling

At birth the placenta is 500g, 15-25 centimeters, 3cm thick, anchoring villi, with decidual septa = 15-20 cotelydons, there is only 1 umbilical vein but?

*2 umbilical arteries

Functions of the placenta include nutrient and waste diffusion, hormone production (endocrine) such as hCG, progesterone and hPL, and is a miraculous immunologic organ which down regulates?

antigen expression

Placental infarcts commonly occurs due to vasoconstriction, like cocaine, and you will see what kind of necrosis?

Coagulative Necrosis

Umbilical arteries become medial umbilical ligament Ductus venosus becomes ligamentum venosum Ductus arteriosus becomes ligamentum arteriosum Foramen ovale becomes?

Fossa Ovalis

Infections also cause spontaneous abortions, such as the TORCH infections and the MC are ureaplasma urealyticum, mycoplasma hominis, gardnerella vaginalis, trichomonas, gonorrhea, and?

Chlamydia | developing countries: malaria/HIV

What is fetal implantation outside the normal intrauterine location, MC in fallopian tube (90%), 2% of confirmed pregnancies and 4-10% of pregnancy related deaths, predisposing condition in 35-50% pts is chronic salpingitis secondary to PID?

Ectopic Pregnancy

Peritubal scarring and adhesions due to appendicitis, endometriosis and prior surgery may also cause Ectopic Pregnancy, or if you get pregnant with an IUD, and ?

Smoking (duh)

Tubal pregnancy is the MCC of hematosalpinx (blood filled fallopian tube) and should always be suspected when blood is present.. the embryonal sac implants in the lumen and is surround by chorionic villi+ trophoblasts which invade the wall, causing distention and thinning of the wall which can lead to?

RUPTURE = massive intraperitoneal hemorrhage = fatal = MEDICAL EMERGENCY

Ecoptic pregnancy presents with mod/severe abd pain and bleeding, usually 6-8 weeks post last menstrual period, diagnosed w hCG titers, pelvic sonography (DONUT SIGN), and an endometrial biopsy is done for dx to see decidua without?

chorionic villi or implantation site

Most disorders occuring in the third trimester of preg are due to complex anatomy of the maturing placenta. What is the MCC of SAB?

Ascending bacterial infections and 2) hematogenous dissemination = TORCH

Twin placentas is common cause of issues in third trimester, dizygotic means fertilization of two ova, monozygotic means division of one fertilized ovum- 3 typesdiamnionic dichororionic (may be fused), diamnionic monochorionic, and monoamnionic?

monochrorionic (monzygotic = identical) | Dichorionic = may be mono/dizygotic

What syndrome is a complication of monochroionic/monozygotic/identical twin preg in which vascular anastomoses connect the circulation and may include 1 or more AV shunts, leading to fluid overload for one and under perfusion for the other bb, may lead to death of one or both?

Twin Twin transfusion syndrome

What occurs when the placenta implants in the lower uterine segment or cervix, serious 3rd trimester bleeding, - complete covers the internal cervical os and requires Csection to avoid placental rupture and fatal maternal hemorrhage?

Placenta Previa (get a preview of placenta- no digital exam cause could rupture)

What is abnormal attachment of the placenta, either partial or absence of the decidua allowing direct attachment to the myomettrium, failure of placental separation at birth- sever life threating postpartum bleeding?

Placenta Accreta | increta and percreta (deep and v deep)

what term is used to describe a mummified fetus associated with multiple gestations where one fetus dies and is flattened between the membranes of living fetus and uterine wall?

Fetus Papyraceus

placental infection can cause premature rupture of membranes = preterm delivery, amniotic fluid is cloudy w purulent exudate, chorioamnion has neutrophils+ edema, fetal vasculitis of umbilical and fetal chorionic plate vessels may occur, acute villitis due to hematogenous spread is?

Uncommon

TORCH infections affect the placenta and can cause chorionic villitis- from mother via transfusion across placenta, Toxoplasmosis Other (To Light Pasing Hovering Zambonis; Tb, Listeria, Parovirus, HIV, Zika) Rubella CMV and H?

Herpes Simplex Virus | syphilis

What is a systemic sundrome with widespread maternal endothelial dysfunction presenting during pregnancy with HTN, edema, *proteinuria, and is MC in 3rd trimester and primiparas (first preg), may lead to eclampsia?

Preeclampsia

What is a severe manifestion of preeclampsia where women are very ill, convulsions occur (**seizures**), and can progress to coma?

Eclampsia

What occurs in 10% of women with severe preeclampsia in which there is microangiopathic hemolytic anemia, elevated liver enzymes, and low platelets?

HELLP syndrome

Preeclampsia path is unknown, but placenta plays central role, sx rapidly disappear post birth, potentially due to factors released from placenta into circulation, diffuse endothelial dysfunction, vasoconstriction leading to HTN, increased vascular permeability leads to?

proteinuria and edema

Abnormal placental vasculature due to abnormal trophoblastic implantation and lack of physiologic remodeling of maternal vessels, failure leaves the placenta ill equipped to meet the increased circulatory demands of late gestation causing what?

Placental ischemia*

Endothelial dysfucntion may also lead to preeclampsia due to imbalance of angiogenic/ anti-angiogenic factors.. ischemic placenta releases factors that antagonize the release of **VEGF and TGFB**, such as FMS like tyrosine kinase SFLTL, and endoglin... maternal vessels remain small caliber high resisitance vessels which leads to?

HTN and Tissue hypoperfusion

The hypercoagulable state seen w preeclampsia is likely due to decreased PGI2, which is normally stimulated by VEGF (which is antagonized), normally PGI2 is potent antithrombotic factor and def leads to formation of thrombi in arterioles and capillaries in the ?

liver kidney brain pituitary

Preeclampsia: remodeling of maternal endothelial cells with fetal trophoblastic cells does not occur leaving placenta ill equiped to meet circulatory demands

MEOW

With preeclampsia, the placenta has infarcts that are larger and more numerous (coagulative), exaggerated ischemic changes of chorionic villi and trophoblasts = *syncytial knots, frequently retroplacental hematomas are seen along with abnormal?

decidual vessels

with preeclampsia, the liver has irregular focal subcapsular*** and intraparenchymal hemorrhage, this is due to fibrin thrombi int he portal capillaries leading to what gross presentation?

Subcapsular Hemorrhage * he likes dis

with preeclampsia, brain has foci of hemorrhage and thromboses, same with heart and anterior pituitary, usually occurs >34 weeks, risk factors include >40 age, AA, renal disease, HTN, DM, fam hx, 1st preg, and?

clotting disorders (antiphospholipid ab?)

tx of preeclampsia if mild is close monitoring, delivery if there is and end organ damage or fetal compromise or HELLP, at term: deliver, HTN and proteinuria goes away in 12 weeks, the HTN will not be helped with?

AntiHTN meds (DOESNT WORK)

What is a cystic swelling of the chorionic villi and trophoblastic proliferation, diagnosed at 9 weeks via sonogram, increased risk of persistent trophoblastic disease (invasive mole) or choriocarcinoma?

Hydatidiform Mole

risk for Hydatidiform Mole include teenagers and/or females >40, 2x more likely in southeast asia. what type of mole occurs when fertilization of an egg that has lost its female chromosomes and genetic material- so it is completely paternal?

Complete Hydatidiform Mole

Complete Hydatidiform Mole: 90% are *46XX* where one sperm duplicates it genetic material, 10% are 46XY, there is NO fetal tissue with complete absence of? (lol)

fetal tissue

What Hydatidiform Mole is due to fetilization of an egg by TWO sperm - polyspermy, usually *69XXY (triploid)* or 92XXXY (tertaploid), fetal tissue present, NOT associated with choriocarcinoma, only some villi enlarged/edematous?

Partial Hydatidiform Mole

Generally, Hydatidiform Moles are delicate, friable masses in thin walled, tranlucent, cystic grapelike* structures with swollen edematous hydropic villi, what type is characterized by the following? All chroinic villi enlarged, scalloped in shape with central cavitation, convered by extensive trophoblastic proliferation of the entire/complete villi circumference?

Complete Hydatidiform Mole

What Hydatidiform Mole morphology is the following? | only fraction of the villi are enlarged and edematous, trophoblastic hyerplasia is focal and less marked than :)

Partial Hydatidiform Mole

Hydatidiform Moles clinical have spontaneous miscarriage or curettage due to abnormal villous findings on ultrasound, which dobson likes and is named?

Snowstorm pattern*

In a complete Hydatidiform Mole, HCG rate of rise is markedly increased and rises more, removed via curettage, patients are monitored for 6-12m to ensure what?

hCG levels return to normal | invasive moles occur when the HCG levels remail high- 15% of the time

An invasive mole penetrates or perforates the uterine wall, invasion of the myometrium by hydropic chorionic villi accompanied by proliferation of cyto and syncytotrophoblasts (produce hCG), usually presents with vaginal bleeding and irregular uterin enlargement with persistently elevated?

HCG :) (comes from complete Hydatidiform Mole) tx w chemo

What is an uncommon malignant neoplasm of trophoblastic cells derived from a perviously normal or abnormal pregnancy, rapidly invasive and metastazies widely, V aggressive but responds well to chemotherapy?

Choriocarcinoma

Preceeding factors to Choriocarcinoma include complete hydatidiform moles (50%), prevous abortion, normal pregnancy, ectopic pregnancy... it is a soft fleshy yellow white tumor with large pale areas of necrosis and extensive hemorrhage, associated with abundant?

mitoses and invades underlying myometrium, penetrating the blood vessels (hematogenous spread)

Clinically, Choriocarcinomas present with irregular vaginal spotting of bloody, brown fluid, may occur months after preg/abortion, larger than expected uterus with a high propensity for hematogenous spread to lungs, vagina, brain, liver, bones, kidney, what is usually VERY high, unless tumor is necrotic?

HCG** tx w chemo, 100% remission

What is a neoplastic proliferation of extravillois trophoblasts (intermediate), normal to be found in non-villous sites like placental parenchyma and placental membrane, *produce increased human placental lactoge hPL*****? (aka human chorionic somatomammotropin)

Placental Site Trophoblastic Tumor PSTT

Placental Site Trophoblastic Tumor PSTT presents with uterine mass and abnormal uterine bleeding/amenorrhea w moderatly elevated HCG, following normal pregnancy, SAB or hydatidiform mole, localized disease has what prognosis?

EXCELLENT | disseminated dz = 10-15% mortality