Flashcards in 4c.pathology Gynecological tumor epidemiology Vaginal tumors Cervical pathology Premature ovarian failure Most common causes of anovulation Polycystic ovarian syndrome (Stein-Leventhal syndrome) Ovarian cystsOvarian neoplasms Deck (62):
What fetal malformations are associated with polyhydramnios (greater than 1.5–2 L of amniotic fluid)?
Esophageal/duodenal atresia and anencephaly, both causing an inability of the fetus to swallow amniotic fluid
List these cancers in order of worsening prognosis: cervical, endometrial, ovarian.
Ovarian, cervical, endometrial
A woman is concerned about her risk of gynecologic cancers. List incidence in the U.S. from most to least common. How about worldwide?
In U.S. = endometrial, ovarian, cervical; worldwide = cervical cancer is the most common due to lack of HPV screening or HPV vaccine access
What vaginal cancer develops secondary to cervical carcinoma?
Vaginal squamous cell carcinoma develops from cervical squamous cell carcinoma (primary vaginal cancer is rare)
A female patient presents with clear cell adenocarcinoma of the vagina. What drug was she likely exposed to in utero?
A 3-year-old girl presents with a clear, grape-like, polypoid mass emerging from her vagina. Diagnosis?
Sarcoma botryoides (rhabdomyosarcoma variant), which are spindle-shaped cells on histology, desmin positive, & typically affect girls
On histology, where would you expect to see the initial stages of cervical dysplasia or carcinoma in situ?
At the basal layer of the squamocolumnar junction (dysplasia begins basally and progressively extends to the apical surface)
A 19-year-old woman receives the HPV vaccine. It protects against which two carcinogenic HPV strains? How do they cause cervical cancer?
16 and 18 (E6 gene product inhibits p53 suppressor gene, E7 gene product inhibits RB suppressor gene)
What characteristics of cervical cancer make it amenable to screening and effective intervention?
Slow development and identifiable precursor lesions, which can be located and removed at an early stage
Name four risk factors for cervical cancer.
Multiple sexual partners (largest risk factor), early sexual intercourse, HIV infection, and smoking
A 40-year-old woman with a history of cervical carcinoma now has oliguria and a creatinine of 4.0 mg/dL (elevated). What is likely cause?
Lateral invasion by the carcinoma, resulting in obstruction of the ureters
What is the classification system for cervical intraepithelial neoplasia (CIN)?
CIN I is mild dysplasia, CIN 2 is moderate dysplasia, CIN 3 is severe dysplasia or carcinoma in situ
A woman has invasive cervical carcinoma due to HPV infection. The carcinoma is more likely of ____ (squamous/glandular) cell origin.
A 24-year-old woman presents with postcoital bleeding. She has a history of smoking and several sexual partners. How would you diagnose her?
She is at high risk for cervical dysplasia, which is typically asymptomatic but can present with abnormal bleeding (do a Pap smear)
What distinguishes premature ovarian failure from menopause?
Menopause occurs after age 40 years, premature ovarian failure occurs before age 40, and both are caused by ovarian follicle atresia
A 40-year-old woman has hot flashes, and you suspect premature ovarian failure. What do you expect to see on blood laboratory results?
Decreased estrogen and increased follicle-stimulating and luteinizing hormones
Name two causes of anovulation, other than pregnancy, that are due to increased levels of circulating estrogens.
Polycystic ovarian syndrome and obesity
Name four endocrine abnormalities that can cause anovulation.
Thyroid disorders, Cushing syndrome, adrenal insufficiency, hyperprolactinemia
What might cause anovulation in a 30-year-old woman who is experiencing hot flashes, irregular menstrual cycles, and dyspareunia?
Premature ovarian failure
Disrupting what endocrine signaling system may cause anovulation?
The hypothalamic-pituitary-ovarian (HPO) axis (such as in Kallmann syndrome, where there is a failure of gonadotrope cells in the pituitary)
Which of the following conditions is not a common cause of anovulation: pregnancy, being a competitive athlete, eating disorders, or HPV?
HPV infection (other three conditions are common causes of anovulation)
An obese woman has amenorrhea/oligomenorrhea and dark hair above her lips. Pregnancy test is negative. What is the cause of her infertility?
Polycystic ovarian syndrome, which causes anovulation due to elevated luteinizing hormone levels (common cause of subfertility in women)
A woman is diagnosed with Stein-Leventhal syndrome. What is the etiology of the increased serum testosterone level?
Deranged steroid synthesis by theca cells results in hyperandrogenism (it is also known as polycystic ovarian syndrome)
How does polycystic ovarian syndrome affect luteinizing (LH) and follicle-stimulating (FSH) hormones, and androgen levels?
LH is increased; FSH is increased, LH:FSH ratio is increased, and androgens are increased
A woman with polycystic ovarian syndrome is at increased risk for what type of cancer?
Endometrial cancer secondary to unopposed estrogen from repeated anovulatory cycles
A woman has hirsutism, infertility, oligomenorrhea, and enlarged cystic ovaries bilaterally. Diagnosis and treatment options?
Polycystic ovarian syndrome—treated with weight loss, oral contraceptives, clomiphene citrate, ketoconazole, and spironolactone
What causes the increased luteinizing hormone (LH) levels in polycystic ovarian syndrome?
Increased LH due to pituitary/hypothalamus dysfunction secondary to hyperinsulinemia/insulin resistance
What is an ovarian cyst that consists of an unruptured, distended graafian follicle called?
A follicular cyst (most common ovarian mass in women)
A woman with endometrial hyperplasia and anovulatory cycles is found to have an ovarian cyst. What is the most likely type?
A follicular cyst, which can be associated with endometrial hyperplasia and elevated estrogens
What type of cyst is most likely to form in the presence of elevated gonadotropins?
Theca-lutein cysts, which respond to gonadotropins and are thus often multiple and bilateral
What type of cysts are associated with choriocarcinoma and hydatidiform moles?
A 25-year-old woman has an adnexal mass. Ultrasound detects a pelvic tumor. What germ cell tumor does she most likely have?
Mature cystic teratoma (dermoid cyst), which is the most common benign ovarian tumor in women 20–30 years of age
A woman has palpitations, sweating, weight loss, and low thyroid-stimulating hormone levels. What ovarian pathology may be responsible?
Struma ovarii, in which functional thyroid tissue within a teratoma can cause symptoms of hyperthyroidism
What rare tumor associated with multiple theca-lutein cysts can occur in either the mother or fetus during pregnancy?
How can serum markers help distinguish choriocarcinoma from dysgerminoma?
A dysgerminoma will cause elevated lactate dehydrogenase, and both neoplasms express human chorionic gonadotropin
Which benign ovarian neoplasm is frequently bilateral and has a fallopian tube–like epithelium?
Serous cystadenoma, which is the most common ovarian neoplasm—often bilateral
A woman has an abnormally high hCG level, shortness of breath, hemoptysis, and theca-lutein cysts. Treatment?
Very responsive to chemotherapy (this is likely a choriocarcinoma)
Does genetic predisposition play a role in the development of ovarian neoplasms? What are three associated genetic mutations?
Yes (there is a strong family history and genetic component); BRCA-1, BRCA-2, and HNPCC are related to ovarian cancer
Which germ cell tumor is very aggressive and appears as a yellow, solid, and friable mass on gross pathology?
An endodermal sinus (yolk sac) tumor (most common tumor in male infants, can appear in ovaries or testes in young children
What serum marker would you measure in a patient with an ovarian neoplasm?
CA-125, which is a general marker for ovarian neoplasia used for monitoring disease progression (but not good for screening)
What benign ovarian neoplasm resembles bladder epithelium and has coffee-bean nuclei on H&E stain? Describe the gross appearance.
Brenner tumor (Brenner is Benign and looks like Bladder); encapsulated, pale yellow–tan
A male infant is found to have a sacrococcygeal mass. What tumor marker test would you order to confirm your suspected diagnosis?
α-fetoprotein (this is likely a yolk sac [endodermal sinus] tumor)
A 50-year-old woman has an ovarian tumor removed. The neoplasm contains bundles of spindle-shaped fibroblasts. Diagnosis?
Fibroma of the ovary, a benign neoplasm
Is there a difference in the prognosis of a patient with an immature teratoma vs. a mature teratoma?
Yes (immature teratomas are malignant and aggressive, mature teratomas are benign)
A 50 yo woman presents with unilateral pleural effusion, ascites, and an enlarged ovary. What will ovarian biopsy show?
Ovarian fibroma - bundles of spindle-shaped fibroblasts. This is Meigs syndrome; her symptoms will disappear once the fibroma is excised.
A girl has sexual precocity, breast tenderness, and abnormal uterine bleeding. Does her mass secrete anything?
Yes (a granulosa cell tumor with Call-Exner bodies—elements resemble primordial follicles and may produce estrogen and/or progesterone)
A 60-year-old woman is diagnosed with a thecoma. What hormone is produced by this benign ovarian neoplasm? What is a common presentation?
Estrogen, like granulosa cell tumors; usually presents as abnormal uterine bleeding in postmenopausal women
What histologic appearance is seen in Krukenberg tumor of the ovaries? From which organ system does it originate from?
Signet cell adenocarcinoma, which secretes mucin; caused by a GI malignancy (often gastric cancer) that metastasizes to the ovaries
A 55-year-old woman presents with pelvic pain, dyspareunia, and dysmenorrhea. Ultrasound shows a complex mass within the ovary. Diagnosis?
Endometrioma, which presents as a mass from growth of ectopic endometrial tissue within ovary with cyst formation (a "chocolate cyst")
Which malignant ovarian neoplasm is the most common ovarian neoplasm, frequently bilateral, and presents with psammoma bodies?
Ovarian neoplasms are the most common adnexal mass found in women over 55 years of age. They can arise from which three origins?
Surface epithelium, germ cells, and sex cord stromal tissue (can be benign or malignant)
Which malignant ovarian neoplasm can progress to pseudomyxoma peritonei?
Mucinous cystadenocarcinoma (pseudomyxoma peritonei is intraperitoneal accumulation of mucinous material from an ovarian/appendiceal tumor)
The majority of malignant ovarian neoplasms arise from which origin?
The majority (95%) are of epithelial origin, with serous cystadenocarcinoma being the most common
A woman is diagnosed with a granulosa cell tumor. This tumor is predominant in women of what age group, and can produce which two hormones?
Often produces estrogen and/or progesterone (granulosa cell tumor is predominant in women in their 50s)
An elderly woman has a pleural effusion, bowel obstruction, abdominal distention, and an adnexal mass. How would you diagnose this patient?
Diagnose surgically—her symptoms are common for an ovarian neoplasm
Mature teratomas are more likely to contain thyroid tissue. In contrast, what type of tissue is more likely present in immature teratomas?
Immature teratomas most typically contain immature/embryonic-like neural tissue (such as fetal tissue and neuroectoderm)
A woman had infertility issues, endometriosis, and polycystic ovarian syndrome. She is at increased risk for what type of neoplasm?
A 55-year-old woman has an ovarian malignancy removed. The pathologist sees psammoma bodies. Is the tumor likely unilateral or bilateral?
Frequently bilateral (this is likely a serous cystadenocarcinoma)
What are some factors that decrease a woman's risk for developing ovarian neoplasms?
Previous pregnancy, OCPs, tubal ligation, history of breastfeeding
A 50-year-old woman has the most common malignant stromal tumor. Describe the histologic findings expected.
Cells arranged haphazardly around eosinophilic fluid pockets, resembling primordial follicles (granulosa cell tumor with Call-Exner bodies)
A 55-yo woman presents with uterine bleeding. Biopsy shows Call-Exner bodies. Symptoms of the homologous tumor in men?
This pt has an ovarian granulosa cell tumor. These correspond to androblastomas (usually asymptomatic) in men, arising from Sertoli cells.