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Flashcards in Female Genital Tract 3 Deck (22):
1

ovarian follicle and luteal cysts

unruptured graafian follicles or ruptured follicle that immediately seals
-multiple, small (1 cm), filled with clear serous fluid
-sometimes large 4-5 cm

2

PCOS
Characterized by
Pathogenesis
Histology
Clinical Sequela
Treatment

Characterized by:
1. excess secretion of androgenic hormones
2. persistent anovulation
3. many subcapsular ovarian cysts--enlarged ovaries

Pathogenesis:
Increased secretion of LH
Insulin resistant hyperinsulinism
1. LH>FSH
2. Increased androgens
3. converted to estrones
4. Decreased FSH
5. Cystic follicle degeneration
6. Follicular cysts

Histology
-follicles lined by granulosa cells with hyperplastic theca (interna)
-theca cells produce androgens

Clinical
Reproductive, metabolic, cardiovascular
1. Hirsutism
2. chronic anovulation, oligomenorrhea, infertility
3. insulin resistance
4. obesity
5. endometrial hyperplasia, endometrioid cancer

Treatment
1. Weight reduction
2. Hormone therapy to interrupt constant excess of androgens
3. Metformin
-DM, metabolic drug, increases insulin sensitivity, decreases tost, enables LH surg

3

Surface epithelial cell ovarian neoplasm
Frequency
Proportion of Malignant ovarian tumors
Age
Types

Frequency: 65-70%
Proportion of Malignant ovarian tumors : 90%
Age: 20+
Types: Serous, Mucinous, Endometrioid, Brenner

4

Benign Serous Epithelial tumor (cystadenomas) vs Malignant Serous epithelial tumor (cystadenocarcinomas)

Benign
60%
30-40 yrs
gross: single cavity or multilocular
histology: single layer all columnar cells

Malignant
30%
45-60 yrs
Gross: bulky tumors
Histology: complex papillary formations, invasive of stroma
-Psammoma bodies-concentrically laminated concentrations

Bilateral tumors: more common

5

Benign Mucinous epithelial tumor (cystadenomas)
vs malignant epithelial tumor (cystadenocarcinomas)

Benign
80%
30-40 yrs
Gross: usually multicystic
Histology: mucin producing epithelial cells

Malignant
10%
45-60yrs
Gross: bulk tumors
Histology: complex architecture(solid and cystic cut surface), cytologic atypia, stromal invasion

Bilateral tumors: less common

6

What are risk factors for cystadenocarcinomas?

-nulliparity(repeated disruption and repair of epithelial surface), family history, germline mutations of tumor suppressor genes

-5-10% familial BRCA1, BRCA2 mutations

-overall poor prognosis-mucinous a little better than serous

-tumor marker CA125-monitor response and recurrence

7

Endometrioid Surface epithelial tumor
Behavior
Gross
Histology
Associated Tumor Suppressor gene
May arise from

Behavior
-usually malignant

Gross
-solid or cystic

Histology
-glands similar to endometrium

Associated Tumor Suppressor
gene
-PTEN

May arise from
-PCOS, obesity--excess estrogen

8

Brenner Surface epithelial tumor
Behavior
Gross
Histology

Behavior
-usually benign

Gross
-unilateral, solid, pale-yellow, encapsulated

Histology
-Nests of transitional-type epithelium******-resembling that of urinary tract

9

Germ cell ovarian neoplasms

Frequency: 15-20%
Proportion of Malignant ovarian tumors : 3-5%
Age: 0-25+ years
Types: Teratoma, Dysgerminoma, Endodermal Sinus Tumor, Choriocarcinoma, Embryonal Carcinoma

10

Benign Mature Teratoma vs Malignant vs Immature Teratoma

Benign
90% of teratomas
Derived from all germ layers
-ectoderm, endoderm, mesoderm
-struma ovarii-large portion of thyroid tissue (hyperthyroid)

Malignant
1% of mature teratomas undergo malignant transformation
-squamous cell carcinoma, thyroid carcinoma, melanoma

Immature Teratoma
Presence of immature tissue (usually neuronal)
-bulky necrotic tumors

11

Dysgerminoma
Behavior:
Gross:
Histological:
Tumor marker:

Behavior: malignant, radiosensitive
Gross: solid mass
Histological: large, cells, clear cytoplasm, stroma with lymphocytes
Tumor marker: LDH
Male counterpart=testis seminoma
-associated with gonadal dysgenesis

12

Endodermal SInus Tumor (yolk sac tumor) Behavior:
Gross:
Histological:
Tumor marker:

Behavior: Malignant
Gross: Friable mass
Histological: Schiller-Duvall Bodies**** (glomerulus like structure)
Tumor marker: AFP

13

Choriocarcinoma
Behavior:
Gross:
Histological:
Tumor marker:

Behavior: Malignant, early metastasis, often fatal
Gross: small, hemorrhagic
Histological:like placental tissue with trophoblasts and syncytiotrophoblast, NO VILLI
Tumor marker: hCG
Pure choriocarcinoma rare: usually component of another germ tumor

14

Embryonal Carcinoma
Behavior:
Gross:
Histological:

Behavior: malignant, aggressive
Gross: unilateral mass
Histological: large primitive cells

15

Sex-Cord Stromal ovarian neoplasms

Frequency: 5-10%
Proportion of Malignant ovarian tumors: 2-3%
All ages
Types: Fibroma, Granulosa, Sertoli-leydig cell tumor

-originate from undifferentiated gonadal mesenchyme
-most benign, low malignant potential
-hormonally active

16

Granulosa cell tumor
Histology:
Endocrine:
Clinical:

Histology: Neoplastic Granulosa cells; Call-exner bodies****-gland like structures filled with eosinophilic material-recapitulate ovarian follicle
Endocrine: Estrogen Production
Clinical:
Prepuberty-precocious puberty
Reproductive age- bleeding
Postmenopausal- endometrial hyperplasia


-granulosa cell tumor leading to excess estrogen leading to endometrial cance

17

Sertoli-Leydig cell tumor
Histology:
Endocrine:
Clinical:

Histology: "testicular" sertoli cells(tubules) , leydig cells, reinke crystals
Endocrine: androgen production
Clinical:
-block female sexual development in children
-hirsutism, virilization

18

Thecoma-Fibroma
Histology:
Endocrine:
Clinical:

Histology: Fibroblasts (fibroma)-bland spindle-shaped cells, lipid-laden theca cells (thecoma), mixed proportions
Endocrine: may produce estrogen
Clinical:
Meigs syndrome***
-right sided pleural effusions
-ascites
-ovarian mass

19

Ovarian Neoplasm metastasis to ovaries

Frequency: 5%
Proportion of malignant ovarian tumors: 5%
Age: variable

Krukenberg tumor-metastatic mucinous tumor to the ovaries
-gastric most common

20

Salpingitis

Inflammation of the fallopian tube as a component of PID

21

Are paratubal cysts of the fallopian tube common?

yes

22

What are adenocarcinomas of the fallopian tube?

Serous or endometrioid type
BRCA association
Usually present at advanced stage