Chapter 22- Female GU Tract Flashcards Preview

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Flashcards in Chapter 22- Female GU Tract Deck (287)
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1
Q

Which condition contains embryoid bodies

A

Polyembryona, which is a malignant tumor

2
Q

Which form of MMMTs have a poorer prognosis

A

Those with heterologous mesenchymal components

3
Q

What is the most common location of metastasis of leiomyosarcomas

A

Lung

4
Q

Following an abnormal Pap smear, what is done to the cervix to visualize any potential changes

A

Acetic acid is added with highlights the abnormal epithelium

5
Q

Which condition is presenting with histological findings of papillary, exophytic, treelike cores of stroma covered by thickening squamous epithelium with characteristic viral cytopathic changes, aka koilocytic atypia, which manifests as nuclear enlargement, hyperchromasia and cytoplasmic perinuclear halo

A

Condylomata acuminatum caused by low risk HPV

6
Q

What condition has small, distinctive, glandlike structures filled with an acidophilus material like a follicle like structure

A

Aka Call-Exner bodies seen in granulosa cell tumors

7
Q

What are the mutations seen in dysgerminomas

A

OCT-3,4 NANOG

KIT gene

8
Q

When does preeclampsia begin and which conditions can change that

A

Normally 34 weeks, but earlier in the case of:

  • hydatidiform mole
  • Preexisting kidney disease
  • Hypertension
  • coagupathies
9
Q

Which form of Molluscum contagiosum is most prevalent and how are they transmitted

A

MCV1 is most prevalent (direct contact or shared clothes)

MCV2 being sexually spread

10
Q

What is the typical morphological feature of atypical hyperplasia

A

Patterns of proliferating glands displaying nuclear atypia

Cells are rounded and lose normal orientation in the stroma

11
Q

Women with family history of hereditary nonpolyposis colorectal carcinoma are at a higher risk for which condition

A

Endometrial carcinoma

12
Q

How does classic valvular intraepithelial neoplasm (VIN) present clinically

A

Discrete white (hyperkeratosis) or slightly raised pigmented lesion

13
Q

What are the precipitating events in the pathogensis of preeclampsia

A
  • Abnormal trophoblastic implantation

- Failure of physiological remodeling of the maternal vessels

14
Q

What are the histological features of a dysgerminoma

A

-Large vesicular cells having a clear cytoplasm, well defined cell boundary, and centrally placed regular nuclei

15
Q

What is endometriosis defined by

A

Ectopic endometrial tissue at the site outside of the uterus

16
Q

What is the most common cause of a hematosalpinx

A

Aka bloody Fallopian tube:

-Tubal pregnancy

17
Q

Which phase is the endometrium currently in if there is:

  • Straight glands
  • tubular structure line with regular tall pseudostratified columnar cells
  • proliferation
A

Proliferative phase

18
Q

What are the characteristic of leiomyomas

A

Most commonly multiple, but benign

19
Q

What are the features of eclampsia

A

Preeclampsia with the addition of convulsions

20
Q

What is the relation between OCs and ovarian cancer

A

Decreased risk

21
Q

Which conditions are patients withe PCOS at a higher risk for

A

-Endometrial hyperplasia and carcinoma

22
Q

What are the predisposing factors to placenta accretion

A
  • Placenta previa

- Past cesarean section

23
Q

What conditions are mature teratomas associated with

A

Paraneoplastic syndromes, such as inflammatory limbic encephalitis

24
Q

What are the features of preeclampsia

A
  • Hypertension
  • edema
  • proteinuria
25
Q

Patients with Cowdren syndrome have which mutation and which increased condition risks

A

-PTEN with increased in endometrium and breast cancer

**Very commonly has harmatomas

26
Q

What is the most common type of malignant endometrial carcinomas

A

Endometrial carcinomas

27
Q

During endometrial carcinoma Type 1, 2, and Mixed mullarian tumors will show which location during Stage 3

A

Extends outside the uterus but not outside true pelvis

28
Q

What is the morphology of trichamonas vaginialis

A

Large, flagellated ovoid protozoan

29
Q

What is the characteristic of the lesions in HSV

A

-Red papulules that progress to vesicles that then lead to ulcers

30
Q

Which products are producted in the proliferative phase of the endometrium as a result of high levels of estrogen

A

-IGF-1 and epidermal growth factor

31
Q

What are the characteristics of the type 1 endometrial carcinoma

A

Well differentiated and mimic proliferative endometrial glands

32
Q

The outcome of MMMTs are determined by which feature

A

Depth of invasion and stage

33
Q

Metastasis of the ovaries are from which origin

A

Mullarian

34
Q

Which patients do keratinizing squamous cell carcinoma of the vulva most common arise

A
  • Long standing lichen sclerosis or Squamous cell hyperplasia
  • Not related to HPV

*80 year old patients most commonly

35
Q

What is the relation between BRCA and ovarian cancer

A

Increased risk

36
Q

MMMTs tend to contain mutations of which kind

A

The ones that follow the endometrial carcinomas with TP53, PTEN, and PIK3CA

37
Q

What is the characteristic of stroma ovarii

A

Composed of entirely thyroid tissue, which can cause hyperthyroidism

*always unilateral

38
Q

What are the factors and where are they released from in eclampsia that affects blood flow

A

Increased FMS like tyrosine kinase (sFltl) and endoglin which antagonist VEGF, leading to hypertension

39
Q

Monochorionic placentas imply what

A

Monozygotic twins

40
Q

What is secreted by choriocarcinomas

A

Chorionic gonadotropins

41
Q

How do ovarian carcinomas normally present

A
  • Abdominal pain with abdominal distention

- Most have high stage disease (poor prognosis)

42
Q

What do Yolk sac tumors secrete

A

Alpha-fetoprotein

43
Q

The presence of ovarian endometrioid carcinomas suggest there may be the presence of which other neoplasm

A

Endometrial carcinomas (15-30% of the time)

44
Q

Sertoli-Leydig cells are associated with which gene mutations

A

DICER1

45
Q

What are the classifications of Type 1 ovarian tumors

A

Low grade that arise in association with borderline or endometriosis

46
Q

What infection is causing symptoms of thin, green-grey, malodorous (fishy) vaginal discharge

A

Gardnerella vaginalis

47
Q

What are the characteristics of endometrioid ovarian tumors

A

Bilateral, commonly seen with endometrial carcinomas

-Good prognosis

48
Q

Histologically, which level is of the epithelium will show changes

A

Lower 1/3 only is LSIL, while into the upper is considered HSIL

49
Q

During endometrial carcinoma Type 1, 2, and Mixed mullarian tumors will show which location during Stage 2

A

Corpus and cervix

50
Q

Which conditions is presenting with smooth white plaques or macules that create a surface that resembles porcelain or parchment

A

Lichen sclerosus

51
Q

What is HELLP associated withe eclampsia

A
  • Hemolytic anemia (microangiopathic)
  • Elevated Liver enzymes
  • Low Platelets
52
Q

Fibromuscular, thecomas, and fibrothecomas are commonly found with which syndome

A

Mieg syndrome, which is pleural effusion (right side), benign ovarian tumor, and ascites

*also associated with basal cell nexus syndrome

53
Q

How will well differentiated endometrial tumors be distinguished from hyperplasia

A

Lack of intervening structures

54
Q

What is the characteristic of carcinoid tumors

A
  • From intestinal tumors of teratomas

- Produced 5 hydroxytryptamine to cause carcinoid syndrome

55
Q

What are the genetic abnormalities with leimyomas

A

12q14 and 6p involving the HMGIC and HMGIY genes, which regulate the chromatin structure
-MED12 also

56
Q

What is the affect of the leiomyomas in pregnant women

A

-Increased frequency of spontaneous abortions, fetal Malpresentation, uterine interstial, and post partum hemorrhage

57
Q

How are leiomyomas and leiomyosarcomas differentiated from one another

A

-Nuclear atypia, mitotic index, and zonal necrosis

58
Q

What is secreted by choriocarcinomas

A

Chorionic gonadotropins

59
Q

Which condition is associated with pink cytoplasms structures known as Reinke crystaloids

A

Hilo’s cell tumors, aka pure Leydig cell tumors

60
Q

What are the characteristics of the serous tumors of the ovary

A

Most common malignancy of ovarian tumors and 40% or all ovarian tumors

61
Q

Which portion of the vagina is most commonly affected by neosplasms

A

Upper vagina, particularly the posterior wall at the junction with he exctocervix

62
Q

What are the characteristics of type 2 ovarian carcinoma

A

-High grade serous carcinomas that arise from serous intraepithelial carcinoma, especially from Fallopian tube

63
Q

Which form of squamous cervical precursor lesions are considered premalignant

A

-HSIL

64
Q

Ovarian cancers are most commonly found with which affect

A

Most have spread beyond the ovary at the time of diagnosis

65
Q

What is the condition in the cause of the clinical presentation of a vulvar lesion that is pruritic, red, crusted, maplike area on the labia Majorca

A

Paget’s disease

66
Q

How does age and the prognosis of ovarian tumors relate

A

The younger one are more benign, middle age are borderline and older patients are more malignant

67
Q

What does the prognosis of a serous ovarian tumor largely depend on

A

The spread, as confined to the ovary will have a better prognosis

68
Q

What is the histological findings of differentiated VIN

A

-Marked atypia of the basal layer with normal superficial layer

69
Q

Gertner ducts cysts are arise from which structure and where are they found

A

Fluid filled cysts Lateral walls of the vagina and are a remnant of the wolffian duct

70
Q

What are the characteristics of dysgerminomas

A

-malignant, but aggressiveness is variable

71
Q

What is a major risk factor for an ectopic pregnancy

A

Previous PID

  • Adhesions from appendicitis, endometriosis, and previous surgery
  • IUD
72
Q

What are the predisposing factors to placenta accretion

A
  • Placenta previa

- Past cesarean section

73
Q

What is the classification of ovarian tumors based on

A
  • Extent of proliferation

- Differentiation

74
Q

What are the features of eclampsia

A

Preeclampsia with the addition of convulsions

75
Q

What is the risk of spread with an immature teratoma based on

A

Ratio of tissue counting immature neuroepithelium

76
Q

What is occurring during acute endometritis and what is the common cause

A

-Bacterial Infection after delivery and miscarriage.

77
Q

When do most dysgerminomas occur

A

75% in the second and third decade

78
Q

What are the features of preeclampsia

A
  • Hypertension
  • edema
  • proteinuria
79
Q

What is the histological feature of papillary hidraadenoma most similar to

A

-Bening valvular lesion that resembles intraductal papilloma of the breast

80
Q

What is the most common tumor in women

A

-Uterine leiomyoma, aka fibroids

81
Q

Most primary ovarian neoplasms arise from which source

A

Mullarian epithelium

82
Q

Dermis cysts can undergo malignant transformation into which type of cells

A

Squamous cell carcinoma

83
Q

Which mutation is commonly seen to be affected in differentiated VIN

A

Aka classical vulvar intraepithelial neoplasia (VIN)

-TP53

84
Q

What marker is overexpressed in the case of HPV infection

A

P16, or the cell cycle inhibitor

85
Q

What is the most common tumor in women

A

-Uterine leiomyoma, aka fibroids

86
Q

What is the relation between BRCA and ovarian cancer

A

Increased risk

87
Q

What is the cardinal morphological feature of non-atypical hyperplasia

A

Increased gland to stromal ratio, usually due to prolonged exposure to estrogen

88
Q

What type of virus is HSV, what are the subtypes and the locations that they infect

A

HSV is a DNA virus:
HSV1-oropharyngeal area
HSV2- Genital area

89
Q

What are the characteristics of the immature teratomas

A
  • aka malignant,

- Contains the normal components of a teratoma, but also immature neuroepithelium

90
Q

Which is the histological findings of in the case of invasive keratinizing squamous cell carcinomas arising from differentiated VIN

A

-nests and tongues of malignant squamous epithelium with prominent keratin pearls

91
Q

Which mutation is strongly associated with mucinous tumors

A

KRAS Protooncogene

92
Q

What is the cause of the clinical presentation of pearly, dome shaped papules with a dimpled center. Central waxy core withe cytoplasmic viral inclusions

A

Molluscum contagiosum

93
Q

Most ovarian granulosa cell tumors are made of what

A

-adult granulosa cells

94
Q

What is a spectate or double vagina arising from

A

Mullarian duct fusion

95
Q

Dermis cysts can undergo malignant transformation into which type of cells

A

Squamous cell carcinoma

96
Q

What are the morphological characteristics of the histology in HSV

A

-Multinucleated squamous cell containing viral inclusions withe a “ground glass appearance”

97
Q

What is endometrial hyperplasia associated with arising from

A

Increased prolonged estrogenic stimulation of the endometrium

98
Q

What is the clinical presentation in a female with a granulosa cell

A

Production of high amounts of estrogen cause:

  • Early sexual development
  • endometrial hyperplasia and carcinoma
99
Q

Which phase is the endometrium currently in if there is:

  • endometrial proliferation ends
  • progesterone made by the corpus luteum in the ovary
A

Ovulation

100
Q

What does the survival of the serous endometrial carcinoma depend on

A

Stage, with 1/2 having a good prognosis with not so good with higher grades

101
Q

What is the prognosis of yolk sac tumors

A

-most seen in children and young women, are are good prognosis

102
Q

What is the prognosis of the majority of ovarian tumors

A

Benign

103
Q

What is the clinical presentation in a female with a granulosa cell

A

Production of high amounts of estrogen cause:

  • Early sexual development
  • endometrial hyperplasia and carcinoma
104
Q

What are the other factors associated with preeclampsia

A
  • Hypercoaguability
  • acute renal failure
  • Pulmonary edema
  • HELLP
105
Q

Atypical hyperplasia commonly has which condition

A

Endometrial Carcinomas when the hysterectomy is preformed

106
Q

Sertoli-Leydig cells are associated with which gene mutations

A

DICER1

107
Q

What is the most common malignancy of the vagina

A

1-Carcinoma spreading from the cervix

2- Primary squamous cell carcinoma of the vagina

108
Q

What infection is indicate by yellow, frothy vaginal discharge, vulvovaginal discomfort, with painful intercourse and urination

A

Trichomonas vaginalis

109
Q

Which conditions are associated withe PCOS

A
  • Obesity
  • Type 2 DM
  • Decreased fertility
110
Q

Which extramullarian metastasis to the ovaries are common

A

Breast, GI, colon, stomach, biliary, and pancreas

111
Q

What is the most common primary lesion of the Fallopian tubes

A

-translucent cysts filled with clear serous fluid, called paratubual cysts

112
Q

How do Type1 and Type2 endometrial carcinomas compare

A

Type 1- low grade and indolent

Type2-High grade and aggressive

113
Q

How do ovarian carcinomas normally present

A
  • Abdominal pain with abdominal distention

- Most have high stage disease (poor prognosis)

114
Q

What is the prognosis of a granulosa tumor, particular if there are theca cells

A

-Good prognosis, especially with theca cells as they are almost never malignant

115
Q

When does preeclampsia begin and which conditions can change that

A

Normally 34 weeks, but earlier in the case of:

  • hydatidiform mole
  • Preexisting kidney disease
  • Hypertension
  • coagupathies
116
Q

What is the age group that serous endometrial carcinomas are seen

A

-55 to 65, with very few before the age of 40

117
Q

Which conditions are associated with endometrial carcinomas

A

-Obesity
Diabetes
Hypertension

118
Q

How does a mucinous and serous tumor of the ovary differ from one another

A

-Mucinous carcinomas are unilateral, while serous is not

119
Q

Monochorionic placentas imply what

A

Monozygotic twins

120
Q

How are endometrioid tumors distinguished from serous or mucinous tumors

A

-The presence of of tubular glands resembling being or malignant endometrium

121
Q

During endometrial carcinoma Type 1, 2, and Mixed mullarian tumors will show which location during Stage 4

A

Extends outside of true pelvis or involves the bladder or rectum

122
Q

What is the prognosis of a granulosa tumor, particular if there are theca cells

A

-Good prognosis, especially with theca cells as they are almost never malignant

123
Q

Which levels are elevated in the case of granulosa cell tumors

A

Inhibin and estrogen

124
Q

What is the stain that can be used to visualize Paget’s disease

A
  • PAS, Alcian blue, mucicarmine stains

- Cytokeratin 7

125
Q

How does advanced cervical carcinoma spread

A

Direct extension into contiguoiuos tissues

126
Q

What are the common symptoms seen with ovarian tumors

A
  • Abdomainal pain and distention
  • urinary and GI tract symptoms
  • vaginal bleeding
127
Q

What is the prognosis of clear cell carcinoma

A

Good if it has remained to the ovaries

128
Q

What are the characteristics of a mature teratoma

A

Cystic sometimes called dermis cysts found in reproductive aged females
-Bilateral

129
Q

Where do serous tumors have the propensity to spread

A

Omentum, peritoneal cavity, and commonly associated with ascites

130
Q

Which phase is the endometrium currently in if there is:

  • Secretory vesicles in the glandular epithelium
  • Saw-toothed appearance
  • secretory exhaustion and shrinkage of glands
A

Postovulation

131
Q

Which genes tend to be mutated in granulosa cell tumors

A

FOXL2

132
Q

Which conditions predispose females to candidiasis

A

-Pregnancy, DM, antibiotics

133
Q

What are the characteristics of endometrioid ovarian tumors

A

Bilateral, commonly seen with endometrial carcinomas

-Good prognosis

134
Q

What does the prognosis of a serous ovarian tumor largely depend on

A

The spread, as confined to the ovary will have a better prognosis

135
Q

How does HSV1 infection influence the ability to contract HSV2 and vice versa

A
  • HSV2 infection enhances ability to get HSV1

- HSV1 infection reduces risk for HSV2

136
Q

Endometrial polyps are usually responsive to what

A

-Estrogen, not progesterone

137
Q

What is the cause of failure to ovulate

A

-excessive Estrogen overstimulates endometrium that is unopposed buy progesterone

138
Q

What is secreted from granulosa cells

A

Large amounts of estrogen

139
Q

What is placenta accreta

A

Partial or absence of decides, so the placental villous adheres directly to the myometrium and lack of placental separation at birth

140
Q

What are the genetic abnormalities with leimyomas

A

12q14 and 6p involving the HMGIC and HMGIY genes, which regulate the chromatin structure
-MED12 also

141
Q

Metastasis of the MMMTs contain which type of cell

A

Epithelial only

142
Q

Which form of invasive cardiac carcinomas have the worst prognosis

A

Small cell neuroendocrine tumors

143
Q

Which condition is presenting with leukoplakia and histologically shows thickening of the epidermis (acanthosis) and hyperkeratosis

A

Squamous cell hyperplasia

144
Q

What is the prognosis of yolk sac tumors

A

-most seen in children and young women, are are good prognosis

145
Q

What is the level of estrogen production and its effect in endometriosis

A

Increased levels of estrogen from stromal cells due to increased presence of aromatase, which is normally absent. This is due to prostaglandin E2 stimulating estrogen synthesis

146
Q

What is the prognosis of a choriocarcinoma in the ovary

A

Not good, as an ovarian tumor that is very Agressive and metastasizes to the lungs, live, bone by the time of diagnosis

-Unresponsive to chemo and is fatal

147
Q

What age is most commonly going to get a granulosa cell tumor

A

Postmenopausal women

148
Q

What is secreted from granulosa cells

A

Large amounts of estrogen

149
Q

How are endometrioid tumors distinguished from serous or mucinous tumors

A

-The presence of of tubular glands resembling being or malignant endometrium

150
Q

What is the infection indicated by a vaginal and cervical mucus that is fiery red appearance, marked dilation of cervical mucosal vessels

A

Aka strawberry cervix

-Trichomanas vaginalis

151
Q

During endometrial carcinoma Type 1, 2, and Mixed mullarian tumors will show which location during Stage 1

A

Corpus uteri only

152
Q

What are the characteristics of type 2 ovarian carcinoma

A

-High grade serous carcinomas that arise from serous intraepithelial carcinoma, especially from Fallopian tube

153
Q

How do Type1 and Type2 endometrial carcinomas compare

A

Type 1- low grade and indolent

Type2-High grade and aggressive

154
Q

What are the histological features of a yolk sac tumor

A

Schiller-duval bodies:

-Glomerulus like structure composed of blood vessel enveloped by tumor cells within a space that is lined by tumor cells

155
Q

What is the leading infectious agent in the cause of Fallopian tube issues

A

Gonorrhea

156
Q

What is the underlining cause in eclampsia

A

-Endothelial dysfunction, vasoconstriction, increased vascular permeability

157
Q

What does the rate of metastasis in invasive valvular carcinomas depend on

A
  • Size of Tumor
  • depth of invasion
  • involvement of lymphatic vessels
158
Q

What is the frequency of locations of endometriosis

A

1) Ovaries
2) Uterine ligament
3) Rectovaginal septum
4) Cul de sac
5) pelvic peritoneum

159
Q

When do most dysgerminomas occur

A

75% in the second and third decade

160
Q

What is the most common underlying ultimate cause of abnormal uterine bleeding

A

-Changes in hormones that cause changes that result in dysfunction uterine bleeding

161
Q

What are the definitions of MMMTs

A

Malignant mixed mullarian tumors aka MMMTs, which are endometrial adenocarcinomas with a malignant mesenchymal component

162
Q

What is the complication with sarcoma botryoides

A

-death by penetration isn’t the peritoneal cavity or obstruction of the urinary tract

163
Q

Which patients are more likely to have serous endometrial carcinomas

A

African Americans

164
Q

Fibromuscular, thecomas, and fibrothecomas show which side of characteristics

A

Unilateral, usualy effects on the right

165
Q

EnEndometriosis is associated with which complications

A
  • Ovarian cancer of the endometrium

- Clear cell carcinomas

166
Q

What do basaloid and warty carcinomas of the Vulva arise from

A

-Vlaccic valvular intraepithelial neoplasia (VIN)

Aka carcinoma in situ or Bowen disease

167
Q

What are the histological features of a dysgerminoma

A

-Large vesicular cells having a clear cytoplasm, well defined cell boundary, and centrally placed regular nuclei

168
Q

What are the morphological features of Fibromuscular, thecomas, and fibrothecomas

A

-solid, spherical, encapsulated, hard grey masses that are covered by glistening intact ovarian serosa

169
Q

Most patients with advanced cervical cancer die of which complication

A

Consequences of local tumor invasions such as urethral obstruction, Pyelonephritis, and uremia

170
Q

Which conditions is presenting histologically as:

  • Marked thinning of the epidermis
  • degeneration of basal cells
  • Excessive keratinization
  • Sclerosing of the superficial dermis
  • Chronic bandlike lymphocytic infilitrate of the underlying dermis
A

Lichen Sclerosis

171
Q

What conditions are commonly seen to to be associated with endometrial hyperplasia

A
  • Obesity
  • Menopause
  • PCOS
  • Granulosa tumor of ovary
  • Prolonged administration of estrogens
172
Q

When is HSV infection most deadly and what is done to prevent transmission

A

Dangerous when mother is in active phase with pregnancy, and the must be a cesarean section to prevent

173
Q

What infections are implicated in preterm deliveries

A
  • Ureaplasma urealyticum

- Mycoplasma hominis

174
Q

What type of spread does serous carcinomas have

A

Extrauterine, (lymphatic or transtubal spread)

175
Q

What is the relation between TB and the Fallopian tubes

A

Can cause infertility in areas that TB is prevalent

176
Q

What are the mutations seen in dysgerminomas

A

OCT-3,4 NANOG

KIT gene

177
Q

What is HELLP associated withe eclampsia

A
  • Hemolytic anemia (microangiopathic)
  • Elevated Liver enzymes
  • Low Platelets
178
Q

Which marker is now commonly used to follow ovarian carcinomas

A

CA125

179
Q

What is the prognosis of a choriocarcinoma in the ovary

A

Not good, as an ovarian tumor that is very Agressive and metastasizes to the lungs, live, bone by the time of diagnosis

-Unresponsive to chemo and is fatal

180
Q

Fibromuscular, thecomas, and fibrothecomas show which side of characteristics

A

Unilateral, usualy effects on the right

181
Q

Which gene mutation is commonly seen to be mutated in endometrial carcinomas and hyperplasia

A

PTEN which is part of the PI3K pathway

182
Q

Which form of MMMTs have a poorer prognosis

A

Those with heterologous mesenchymal components

183
Q

What infections are implicated in female infertility

A
  • Neisseria Gonorrhea

- Chlamydia

184
Q

Mothers with eclampsia are at a higher risk for which long term condition

A

Vascular disease of the heart and brain

185
Q

What are the common symptoms seen with ovarian tumors

A
  • Abdomainal pain and distention
  • urinary and GI tract symptoms
  • vaginal bleeding
186
Q

What does the survival of the serous endometrial carcinoma depend on

A

Stage, with 1/2 having a good prognosis with not so good with higher grades

187
Q

What is the prognosis of immature teratomas

A

Low grade have a very good one

-high grade, recurrences happen in the first two year, however if none occur, then curative is good

188
Q

What is the prognosis of the majority of ovarian tumors

A

Benign

189
Q

When are embryonal rhabdomyosarcomas aka sarcoma botryoides normally found

A

Infants and children younger than 5

190
Q

What are the characteristics of the immature teratomas

A
  • aka malignant,

- Contains the normal components of a teratoma, but also immature neuroepithelium

191
Q

What is the leading infectious agent in the cause of Fallopian tube issues

A

Gonorrhea

192
Q

What are the morphological findings in MMMT

A
  • May protrude the cervical os

- adenomacarcinomas Mixed with malignant mesenchymal (sarcomatous)

193
Q

What do Yolk sac tumors secrete

A

Alpha-fetoprotein

194
Q

What is the morphology of gardnerella vaginalis

A

-Gram negative coccobacillius

195
Q

Which conditions are associated withe PCOS

A
  • Obesity
  • Type 2 DM
  • Decreased fertility
196
Q

What is the histological findings in the cause of basaloid carcinomas that arise form classic VIN

A

-Nests and cords of small, tightly packed cells that lack maturation and resemble the normal basal level.

197
Q

The presence of ovarian endometrioid carcinomas suggest there may be the presence of which other neoplasm

A

Endometrial carcinomas (15-30% of the time)

198
Q

What are the morphological findings in MMMT

A
  • May protrude the cervical os

- adenomacarcinomas Mixed with malignant mesenchymal (sarcomatous)

199
Q

Ovarian cancers are most commonly found with which affect

A

Most have spread beyond the ovary at the time of diagnosis

200
Q

What are the characteristics of Type 2 endometrial carcinoma

A

Serous, usually in the setting of endometrial atrophy

-By definition, poorly differentiated with staging of grade 3

201
Q

The proteins E7 in HPV works by which mechanisms

A
  • Binds to hypophosphorylated RB

- Binds to and inhibits p21 and p27

202
Q

Which protein is in HIgh risk HPV but not low risk HPV

A

E6 is not present in low risk HPV

203
Q

What are the morphological features of Fibromuscular, thecomas, and fibrothecomas

A

-solid, spherical, encapsulated, hard grey masses that are covered by glistening intact ovarian serosa

204
Q

What are the features of leiomyosarcomas that are key features of malignancy

A
  • Nuclear atypia
  • Mitotic index of 10 or > hpf
  • Zonal necrosis
205
Q

Most primary ovarian neoplasms arise from which source

A

Mullarian epithelium

206
Q

What conditions are mature teratomas associated with

A

Paraneoplastic syndromes, such as inflammatory limbic encephalitis

207
Q

Which extramullarian metastasis to the ovaries are common

A

Breast, GI, colon, stomach, biliary, and pancreas

208
Q

Which condition contains embryoid bodies

A

Polyembryona, which is a malignant tumor

209
Q

MMMTs tend to contain mutations of which kind

A

The ones that follow the endometrial carcinomas with TP53, PTEN, and PIK3CA

210
Q

What are the conditions associated with chronic endometritis

A
  • PID
  • Retained gestational tissue, postpartum or postabortion
  • IUD
  • TB
211
Q

What are the morphological features of a granulosa cell tumor

A

Unilateral, with a yello coloration to their surface

212
Q

Metastasis of the MMMTs contain which type of cell

A

Epithelial only

213
Q

What is the definition with endometrial hyperplasia

A

-Increased proliferation of the endometrial glands relative to the stroma, resulting in the increased gland to stromal ratio compared to normal

214
Q

Which condition is associated with pink cytoplasms structures known as Reinke crystaloids

A

Hilo’s cell tumors, aka pure Leydig cell tumors

215
Q

What is indicated by presence of endometrioid ovarian tumors bilaterally

A

Implies extension of the neoplasm beyond the genitourinary tract

216
Q

What is the number one cause of dysfunctional bleeding

A

Anovulation

217
Q

What is the characteristic of stroma ovarii

A

Composed of entirely thyroid tissue, which can cause hyperthyroidism

*always unilateral

218
Q

What is the affect of the leiomyomas in pregnant women

A

-Increased frequency of spontaneous abortions, fetal Malpresentation, uterine interstial, and post partum hemorrhage

219
Q

Mothers with eclampsia are at a higher risk for which long term condition

A

Vascular disease of the heart and brain

220
Q

How will a papillary hirdadenoma present clinically

A
  • Sharply circumscribed nodule on the labia Majorca or interlabial folds
  • Will ulcerate (can lead it to be confused with a carcinoma, but it is not)
221
Q

How is the diagnosis of candidiasis made

A

Pseudospores of filamentous fungal hyphae in wet KOH mounts of the discharge or Pap smear

222
Q

What are the classifications of Type 1 ovarian tumors

A

Low grade that arise in association with borderline or endometriosis

223
Q

What are the features of leiomyosarcomas that are key features of malignancy

A
  • Nuclear atypia
  • Mitotic index of 10 or > hpf
  • Zonal necrosis
224
Q

Vaginal adenosis is seen to be found in higher amounts in which patients

A

Those who women exposed to DES

225
Q

What is the microscopic findings in the case of mucinous tumors

A
  • tall, columnar epithelial cells with apical mucin that lack cilia
  • Demonstrate gastric or intestinal differentiation
226
Q

Which levels are elevated in the case of granulosa cell tumors

A

Inhibin and estrogen

227
Q

Where do serous tumors have the propensity to spread

A

Omentum, peritoneal cavity, and commonly associated with ascites

228
Q

What are the precipitating events in the pathogensis of preeclampsia

A
  • Abnormal trophoblastic implantation

- Failure of physiological remodeling of the maternal vessels

229
Q

What is the underlining cause in eclampsia

A

-Endothelial dysfunction, vasoconstriction, increased vascular permeability

230
Q

What is the risk of spread with an immature teratoma based on

A

Ratio of tissue counting immature neuroepithelium

231
Q

What does the risk of developing carcinoma from VIN depend on

A

Duration and extent of disease, along with the immune status of patients

232
Q

Which genes tend to be mutated in granulosa cell tumors

A

FOXL2

233
Q

What is the histological findings of classical valvular intraepithelial neoplasm (VIN)

A

Epidermal thickening
Nuclear atypia
Increased mitosis
Lack of cellular maturation

234
Q

What are the complications as the result of PID

A
  • Infertility due to scarring of the lumen and fimbrae
  • Hydrosalpinnx (tubal secretions and tubal distention)
  • Endocarditis
  • Meningitis
  • Supurative arthritis
235
Q

What are the characteristics of the serous tumors of the ovary

A

Most common malignancy of ovarian tumors and 40% or all ovarian tumors

236
Q

What type of spread does serous carcinomas have

A

Extrauterine, (lymphatic or transtubal spread)

237
Q

What is the characteristic of carcinoid tumors

A
  • From intestinal tumors of teratomas

- Produced 5 hydroxytryptamine to cause carcinoid syndrome

238
Q

Which conditions are patients withe PCOS at a higher risk for

A

-Endometrial hyperplasia and carcinoma

239
Q

What are the other factors associated with preeclampsia

A
  • Hypercoaguability
  • acute renal failure
  • Pulmonary edema
  • HELLP
240
Q

What is the most common type of valvular cancer and what is the mot common cause

A

Squamous cell carcinoma:

  • Unrelated to HPV (70%)
  • HPV caused (30%)
241
Q

What is the prognosis of clear cell carcinoma

A

Good if it has remained to the ovaries

242
Q

What is the microscopic findings in the case of mucinous tumors

A
  • tall, columnar epithelial cells with apical mucin that lack cilia
  • Demonstrate gastric or intestinal differentiation
243
Q

What is the pathological eitiology causing Molluscum contagiosum

A

Poxvirus

244
Q

Most ovarian granulosa cell tumors are made of what

A

-adult granulosa cells

245
Q

Which mutation is strongly associated with mucinous tumors

A

KRAS Protooncogene

246
Q

The outcome of MMMTs are determined by which feature

A

Depth of invasion and stage

247
Q

What are the characteristics of dysgerminomas

A

-malignant, but aggressiveness is variable

248
Q

What are the morphological features of a granulosa cell tumor

A

Unilateral, with a yello coloration to their surface

249
Q

What is a major risk factor for an ectopic pregnancy

A

Previous PID

  • Adhesions from appendicitis, endometriosis, and previous surgery
  • IUD
250
Q

WHich form of squamous cell cervical precessions are associated with a productive HPV infection

A

-Low grade LSIL aka CIN, where there is a high level of viral replication but low level of alterations in cell growth

251
Q

What is the relation between OCs and ovarian cancer

A

Decreased risk

252
Q

What is the karyotype of almost all benign ovarian teratomas and where do they generally arise

A

46XX from ovum after the first meiotic division

253
Q

What is the relation between TB and the Fallopian tubes

A

Can cause infertility in areas that TB is prevalent

254
Q

What is the most common location of metastasis of leiomyosarcomas

A

Lung

255
Q

Fibromuscular, thecomas, and fibrothecomas appear as what histologically

A

Well differentiated fibroblasts and interspersed collagenous stroma

256
Q

What is the most common cause of a hematosalpinx

A

Aka bloody Fallopian tube:

-Tubal pregnancy

257
Q

What is the most common primary lesion of the Fallopian tubes

A

-translucent cysts filled with clear serous fluid, called paratubual cysts

258
Q

What is the most common cause of PID

A

Neisseria gonorrhoeae

259
Q

What condition is present in a 5 year old with polyploid, rounded, bulky masses that appear in grapelike clusters on the vagina, resembling a tennis racket

A

Sarcoma botryoides

260
Q

What are the endocrine disorders that can cause anovulation

A
  • Thyroid disease
  • Adrenal disease
  • pituitary tumors
261
Q

What are the factors and where are they released from in eclampsia that affects blood flow

A

Increased FMS like tyrosine kinase (sFltl) and endoglin which antagonist VEGF, leading to hypertension

262
Q

Which mutation is present in the majority of serous endometrial carcinoma

A

TP53

263
Q

The presence of KI-67 is indicative of what

A

HPV infection

264
Q

What age is most commonly going to get a granulosa cell tumor

A

Postmenopausal women

265
Q

What is the classification of ovarian tumors based on

A
  • Extent of proliferation

- Differentiation

266
Q

What are the characteristics of a mature teratoma

A

Cystic sometimes called dermis cysts found in reproductive aged females
-Bilateral

267
Q

What are the definitions of MMMTs

A

Malignant mixed mullarian tumors aka MMMTs, which are endometrial adenocarcinomas with a malignant mesenchymal component

268
Q

What condition has small, distinctive, glandlike structures filled with an acidophilus material like a follicle like structure

A

Aka Call-Exner bodies seen in granulosa cell tumors

269
Q

Which gene mutation is found in late poorly differentiated endometrial carcinomas

A

TP53

270
Q

How does age and the prognosis of ovarian tumors relate

A

The younger one are more benign, middle age are borderline and older patients are more malignant

271
Q

What are the characteristic of leiomyomas

A

Most commonly multiple, but benign

272
Q

What conditions are patients with Lichen sclerosis seen in and what are they at an increased risk for

A
  • Most common in postmenopausal women

- At a higher risk for squamous cell carcinoma of the vulva

273
Q

What is the cause of condylomata acuminatum

A

-Benign genital warts caused by the low whisk incogenic HPV strains 6 and 11

274
Q

What is indicated by presence of endometrioid ovarian tumors bilaterally

A

Implies extension of the neoplasm beyond the genitourinary tract

275
Q

How does a mucinous and serous tumor of the ovary differ from one another

A

-Mucinous carcinomas are unilateral, while serous is not

276
Q

What are the histological features of a yolk sac tumor

A

Schiller-duval bodies:

-Glomerulus like structure composed of blood vessel enveloped by tumor cells within a space that is lined by tumor cells

277
Q

The initial spread of metastasis for valvular carcinomas go through which locations

A

-Inguinal, pelvic, iliac, periarotic LNs

278
Q

What is placenta accreta

A

Partial or absence of decides, so the placental villous adheres directly to the myometrium and lack of placental separation at birth

279
Q

Which patients are more likely to have serous endometrial carcinomas

A

African Americans

280
Q

Which infection is indicated by vulvovaginal pruritis, erythema, swelling and curdlike vaginal discharge

A

Candidiasis

281
Q

Which marker is now commonly used to follow ovarian carcinomas

A

CA125

282
Q

Metastasis of the ovaries are from which origin

A

Mullarian

283
Q

What is the prognosis of immature teratomas

A

Low grade have a very good one

-high grade, recurrences happen in the first two year, however if none occur, then curative is good

284
Q

What is the karyotype of almost all benign ovarian teratomas and where do they generally arise

A

46XX from ovum after the first meiotic division

285
Q

How are leiomyomas and leiomyosarcomas differentiated from one another

A

-Nuclear atypia, mitotic index, and zonal necrosis

286
Q

Fibromuscular, thecomas, and fibrothecomas are commonly found with which syndome

A

Mieg syndrome, which is pleural effusion (right side), benign ovarian tumor, and ascites

*also associated with basal cell nexus syndrome

287
Q

Fibromuscular, thecomas, and fibrothecomas appear as what histologically

A

Well differentiated fibroblasts and interspersed collagenous stroma