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Path 4 > uterus, fallopian tubes, ovary > Flashcards

uterus, fallopian tubes, ovary Flashcards

1
Q

histo of endometritis

A

acute: neutros in gland and inflammatory cells in stroma
chronic: plasma cells, may be hemosiderin
* may prevent pregnancy

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2
Q

endometriosis pathogenesis and epi

A

epi: repro age women (40-50), a/w infertility
hypotheses: retrograde menstruation w implantation, pelvic peritoneum metaplasia, lymphovascular invasion

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3
Q

endometriosis histo

A

serosal surface dull w adhesions, “chocolate” cysts

endometrial glands and/or stroma, hemosiderin-laden MFs, abundant scarring

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4
Q

endometriosis clinical

A

asymptomatic or severe pelvic pain w menstruation, dyspareunia, dysuria, pain on defecation
hormonal therapy or surgery
ablation of ovaries eradicates disease

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5
Q

adenomyosis

A

endometrial glands and stroma in myometrium, causes thickened myometrium

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6
Q

endometrial polyp pathogenesis and clinical

A

unknown- may be local hyperresponsiveness to estrogen or failure to respond to progesterone
asymptomatic or abnormal bleeding, removal is curative

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7
Q

endometrial polyp gross and histo

A

gross: pedunculated or sessile, usually soft; varied size, may protrude through os
histo: glands (proliferative to hyperplastic and irregular), dense fibrous stroma, thickened vessels with fibrotic walls, glands may be atrophic

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8
Q

simple endometrial hyperplasia etiology

A

a/w unopposed estrogen (usually endogenous d/t adipose)
a/w granulosa and other estrogen-producing tumors and PCOS
a/w obesity, DM, HTN

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9
Q

simple endometrial hyperplasia pathogenesis and clinical

A

continued proliferation of endometrium
no progesterone = no maturation of endometrium = no menses
asymptomatic or abnormal bleeding

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10
Q

simple endometrial hyperplasia gross and histo

A

gross: plush, thick, tan endometrium
histo: increased gland:stroma ratio, crowded and dilated glands, pseudostratified nuclei w mitotic activity and nucleoli, retain orientation

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11
Q

complex endometrial hyperplasia etiology and pathogenesis

A

a/w unopposed estrogen, may be exogenous or endogenous (obesity)
a/w granulosa and estrogen-producing tumors and PCOS
estrogen and no progesterone = no maturation of endometrium = no menses

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12
Q

complex endometrial hyperplasia epi and clinical

A

obese post-menopausal women
a/w DM, HTN
asymptomatic or abnormal bleeding

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13
Q

complex endometrial hyperplasia histo

A

crowded glands often w budding
pseudostratified nuclei w mitotic activity
retain orientation
small nucleoli and normal chromatin

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14
Q

atypical endometrial hyperplasia etiology, pathogenesis, epi, and clinical

A

same as other endometrial hyperplasias

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15
Q

atypical endometrial hyperplasia gross and histo

A

plush, thick, tan endometrium
histo: crowded glands +/- dilation or budding
stratified nuclei with mitoses, loss of orientation
prominent nucleoli w hyperchromatic nuclei or nuclear clearing
no necrosis

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16
Q

type 1 endometrial carcinoma/ adenocarcinoma

A

d/t unopposed estrogen, a/w obesity, HTN, DM
usually endometrioid adenocarcinoma
a/w PTEN mutation

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17
Q

endometrial adenocarcinoma etiology and pathogenesis

A

etiology same as hyperplasias, but a small group of women w high grade neoplasms lack hyperestrinism
path: continued proliferation d/t estrogen, evental somatic mutations acquired

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18
Q

endometrial adenocarcinoma epi

A

obese post-menopausal women, a/w DM and HTN, inc age
m/c invasive carcinoma of female genital tract
*not reliably detected on pap smear

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19
Q

endometrial adenocarcinoma gross and histo

A

fungating, tan mass +/- myometrial involvement
“back to back” glands, stratified nuclei w mitoses, loss of orientation
prominent nucleoli, vesicular nuclei
may be necrosis

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20
Q

endometrial adenocarcinoma clinical

A

sx: post-menopausal bleeding, others rare and indicate advanced dz
most pts stage 1 at dx and respond to hysterectomy
spread to cervix, myometrium, ovary, LNs, distant sites; death d/t pelvic dz

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21
Q

adenocarcinoma grading

A

1 - well-differentiated, less than 5% solid growth
2 - mod diff, less than 50% solid growth
3 - poorly diff, predominantly solid growth (over 50%)

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22
Q

type 2 endometrial carcinoma/ sporadic adenocarcinoma

A

usually occur later than type 1 in setting of atrophy
poorly differentiated
a/w p53 mutations and psommoma bodies; aggressive
usually serous carcinoma

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23
Q

carcinosarcoma (malignant mixed Mullerian tumor)

A

u/k etiology and pathogenesis
in post-meno women, 1-2% uterine malignancies
post-meno bleeding, spreads to LNs and hematogenously to lungs
tx: surgery, radiation
poor prognosis

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24
Q

carcinosarcoma (malignant mixed Mullerian tumor) gross and histo

A

gross: fungating intraluminal mass w poorly circumscribed borders, often bulky
hemorrhage and necrosis common
may protrude through os
histo: malignant epi and stroma; adeno and/or squamous carc; stromal sarc or leiomyosarc (homologous) or osteo/chondro/fibro-sarcoma (heterologous)

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25
Q

adenosarcoma

A

normal glands in malignant endometrial stroma

may be a/w endometriosis outside of uterus

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26
Q

leiomyoma etiology, pathogenesis, epi, clinical

A

u/k etiology and patho, but clonal and estrogen sensitive
epi: up to 25% women of repro age
usually asymptomatic; heavy painful menses, pelvic fullness, infertility, spont miscarriage, bowel sx if pressure
estrogen-sensitive, occasional rapid growth in pregnancy, atrophy common w menopause

27
Q

leiomyoma gross and histo

A 
1+ well-circumscribed neoplasms; submucosal, intramural, or subserosal
whorled white surface, may be hemorrhagic, cystic, fibrotic, myxoid, or calcified; +/- necrosis
spindle cells (like cigars) in bundles, some atypia or mitoses, may be necrosis or hemorrhage
28
Q

leiomyosarcoma etiology, pathogenesis, epi, clinical

A

u/k etiology and pathogenesis
women 40-60 (perimenopausal), de novo or in existing fibroid
a-sx or abnormal bleeding, abd enlargement or evidence of mets (lung via blood)
tx: surgery, radiation
40% 5 yr survival

29
Q

leiomyosarcoma gross and histo

A

in myometrium or into endometrial cavity, fleshy, pink, w/o whorls
cigar spindle cells, atypia, hyperchromatic nuclei, mitoses, necrosis possible

30
Q

salpingitis

A

acute: dilated lumen and edematous plicae
chronic: scarring and fusion of plicae
may cause infertility or ectopic pregnancy
a/w G- infections, PID, chlamydia, gonorrhea, E. coli

31
Q

hydrosalpinx etiology and pathogenesis

A

chlamydia, gonorrhea, other organisms infection resolution

d/t fusion of fimbriated end of tube, proteolysis of neutros and debris leaves serous fluid

32
Q

hydrosalpinx epi and clinical

A

repro age women, 2’ to STD, postpartum, postabortal, post instrumentation, or IUD
sequel to acute PID, a/w infertility

33
Q

hydrosalpinx gross and histo

A

dilated fallopian tube w clear colorless fluid, thin tubal wall, may be adhesions
dilated thin-walled tube w flattened ciliated and secretory tubal epithelium

34
Q

pyosalpinx etiology, pathogenesis, and epi

A

2/2 bacterial infxn (chl/gon) or staph, strep, coliforms - organisms ascend through cervix across endometrium
acute inflammatory response facilitated by estrogen -> fusion of end of tube and accumulation of pus in dilated tube
part of PID, in repro age women, may be after delivery, abortion, instrumentation, IUD placement

35
Q

pyosalpinx gross, histo, clinical

A

enlarged hyperemic tube with serositis, full of pus
acute inflam infiltrate in lumen and epithelium, uterine tenderness and pain w vaginal discharge
systemic sx: fever, malaise, leukocytosis
tx: abx
*pronounced risk of infertility

36
Q

ectopic pregnancy gross, histo, clinical

A

lumen has first trimester chorionic villi w cyto and syncytiotrophoblast stroma w vessels
typical sx of pregnancy until 8 wk -> acute abdomen w shock from hemorrhage into peritoneal cavity
surgical emergency - remove entire tube or just contents

37
Q

ovarian papillary cystadenoma pathogenesis and clinical

A

aka serous cystadenoma
derives from germinal epithelium pinched off into strome following follicle rupture, may undergo metaplasia
in repro age women, adnexal mass with heaviness or pressure (if large)
cured by removal
20% bilateral

38
Q

ovarian papillary cystadenoma gross and histo

A

smooth external surface, uni- or multilocular cysts, clear fluid, smooth internal lining w small papillae possibly
pseudostratified epithelium + cartilage and secretory cells, indistinguishable from tubal epithelium, bland stroma

39
Q

ovarian mucinous cystadenoma pathogenesis and clinical

A

derives from germinal epithelium pinched off into stroma following follicle rupture, may undergo metaplasia
repro age women
adnexal mass, pressure or heaviness, cured w removal, 5% bilateral

40
Q

ovarian mucinous cystadenoma gross and histo

A

may be large, smooth external surface, uni- or multilocular, clear viscous fluid, smooth internal surface
columnar epithelium w mucin-containing cells, like endocervical or intestinal epi, bland stroma

41
Q

ovarian cystadenofibroma

A

benign, looks firm

shiny and smooth, papillary projections

42
Q

ovarian papillary serous cystadenocarcinoma (serous adenocarcinoma) etiology, epi, pathogenesis

A

10% pts have evidence of ovarian or ovarian-breast cancer syndrome, rest are sporadic
a/w BRCA1 mutations
peri- or post-meno women of low parity, gonadal dysgenesis,
serous: 40% ovarian cancers (which are 50% cancer deaths in women), 2/3 bilateral

43
Q

ovarian papillary serous cystadenocarcinoma (serous adenocarcinoma) gross and histo

A

smooth, irregular, or papillary surface; solid and cystic areas, interior papillae soft and tan over firm stroma, thin clear cyst fluid
papillae w fibrovascular core covered by cuboidal or columnar epi, nuclei are hyperchromatic w prom nucleoli, mitoses, psammoma bodies, invasion of stroma by fibrosis

44
Q

ovarian mucinous cystadenocarcinoma etiology, epi, pathogenesis

A

10% pts ovarian or ovarian-breast cancer syndrome, others sporadic
BRCA1 mutations in some families
peri- or post-meno women of low parity, gonadal dysgenesis
mucinous: 10% ovarian cancers (50% cancer deaths in women), 20% bilateral

45
Q

ovarian mucinous cystadenocarcinoma gross and histo

A

smooth external surface, partially cystic (sticky fluid) and part solid
multiple glands of mucin-containing cells ~intestinal adenocarcinoma, nuclear atypia and hyperchromasia, prominent nucleoli, invasion of stroma

46
Q

ovarian mucinous cystadenocarcinoma clinical

A

early sx vague
late sx: abdominal distention, ascites
rarely detected on routine exam, spreads across serosal surfaces and LN mets
tx: remove bulk of tumor, chemo

47
Q

other ovarian cancers

A 
clear cell carcinoma - a/w endometriosis
endometrioid adenocarcinoma (like the uterine kind)
48
Q

ovarian cancer staging

A 
1 - confined to ovary
2 - confined to pelvis
3 - extension to abdominal cavity
4 - distant metastases
*most women 3-4 at presentation
49
Q

Brenner tumor etiology, epi, pathogenesis, clinical

A

u/k etiology and patho
peri- and post-meno women, 10% bilateral
almost always benign, usually asymptomatic, may accompany mucinous neoplasm
tx: resection

50
Q

Brenner tumor gross and histo

A

solid or cystic, yellow-tan firm, sometimes microscopic

nests or cysts of cells resembling urothelium, bland, monotonous, benign nuclei

51
Q

dermoid cyst (mature cystic teratoma) etiology, pathogenesis, epi, clinical

A

proliferation of meiotic germ cell in repro age women

repro age women w unilateral mass, 10-15% bilateral, generally incidental finding

52
Q

dermoid cyst gross and histo

A

smooth external surface, usually filled with hair and cheesy material, may have teeth, soft neural tissue, fat, bone, cartilage

histo: mature skin and hair, tissue from all three germ layers
* any immature tissue = malignant potential

53
Q

struma ovarii

A

proliferation of meiotic germ cell in repro age women, 10-15% bilateral, incidental finding, may be functional
smooth externally, red meaty cut surface like thyroid
follicles indistinguishable from normal thyroid

54
Q

immature teratoma etiology, epi, pathogenesis, clinical

A

proliferation of meiotic germ cell, rare
women under 21 w abd pain and enlargement
tx: surgery and chemo

55
Q

immature teratoma gross and histo

A

smooth externally, solid but may be cystic, necrosis and hemorrhage, hair and keratinaceous debris, bone, cartilage
immature tissue from all 3 germ layers
malignant

56
Q

dysgerminoma etiology, pathogenesis, epi, clinical

A

u/k etiology and patho
teenage/young women, 2% ovarian neoplasms, 50% malignant GC neoplasms
a/w gonadal dysgenesis
tx: surgery if confined to ovary and

57
Q

dysgerminoma gross and histo

A

usually unilateral and confined, homogenous tan, fleshy w/o hemorrhage or necrosis
histo: like seminoma, cells in nests separated by fibrovascular septae that may have lymphos or granulomas; round-oval nuclei, clear cytoplasm, well defined borders

58
Q

yolk sac tumor

A

rare, 2nd m/c malignant GC tumor
rich in AFP and a1-antitrypsin
aggressive

59
Q

granulosa cell tumor etiology, pathogenesis, epi, clinical

A

u/k etiology and patho
rare neoplasm of children and repro age women
low grade malignancy, estrogen-producing -> precocious puberty, endometrial hyperplasia or carcinoma
tx: surgery

60
Q

granulosa cell tumor gross and histo

A

smooth external, solid, brilliant yellow (steroidogenesis), tan or white, firm, may be hemorrhagic
sheets, cords, ribbons of cells w coffee bean nucleus, relatively homogenous nuclei w small nucleoli
Call-Exner bodies - spheres of cells around eosinophilic center resembling follicles w/o ova

61
Q

Sertoli and Leydig cell tumors

A

possible in ovary
Leydig: stromal, Reinke crystals
Sertoli: look like seminiferous tubules

62
Q

ovarian fibroma etiology, epi, pathogenesis, clinical

A 
u/k etiology and patho
epi: rare
repro age women, 40% ascites (Meig's syndrome) like ovarian adenocarc
ascites gone when removed
a/w basal cell nevus syndrome
rare malignancy = fibrosarcoma
63
Q

ovarian fibroma gross and histo

A

smooth external, firm tan or white interior with interlacing fiber bundles, large neoplasm w cystic spaces
spindle cells ~fibroblasts, some collagen production, occasional lipid-laden thecal cells

64
Q

Krukenberg tumor

A

metastases to ovary

commonly diffuse gastric adenocarcinoma (signet ring cells, mucicarmine+)

Path 4 (8 decks)

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