Female Genital Tumors

Question 1

___ are the most common subtype of ovarian germ cell neoplasms and occur most frequently in women age 10-30. They are benign and show mature tissues derived from multiple germ layers. ​​​​​​​Most patients are asymptomatic and found to have an incidental mass on pelvic examination or ultrasound, but some can present with __________.

Answer 1

Teratomas pain or abdominal discomfort

Question 2

Histologic features include

• ovarian stromal invasion by atypical cells (jagged, crumply, stippled white)
• forming papillae/glandular spaces with a
• fibrovascular core (looks like fibrous blood vessel- kinda looks like a leaf vein)

usually presents in older women.

Answer 2

High-grade serous ovarian carcinoma

Question 3

Risk factors for this tumor include:

• Tamoxifen use
• Pelvic radiation
• Postmenopausal status

Answer 3

Uterine Sarcoma

Question 4

Presents with:

Abnormal/postmenopausal bleeding

Pressure symptoms

• pelvic pressure
• bloating
• Constipation
• Urinary frequency

Immobile uterine/pelvic mass

Answer 4

Uterine Sarcoma

Question 5

Arises from uterine smooth muscle or endometrial stromal cells (Malignant)

Answer 5

Uterine Sarcoma

Question 6

Malignant features:

• Cellular atypia
• Abundant mitoses
• Tumor cell necrosis

Answer 6

Uterine Sarcoma

Question 7

rare but aggressive malignant tumor of the uterine myometrium and/or endometrial stromal tissue.

Presents with

• post-menopausal bleeding
• an immobile mass

Answer 7

Uterine sarcoma

Question 8

unregulated endometrial gland proliferation increased gland-to-stroma ratio

thickened endometrial lining

(+/– heavy menses)

Answer 8

Endometrial hyperplasia

Question 9

Risk factors:

• unopposed estrogen from chronic anovulation
• obesity

Answer 9

Endometrial hyperplasia

Question 10

• Irregularly enlarged, non-tender uterus =

vs

• Diffusely enlarged, tender uterus=

Answer 10

Leiomyoma (Fibroids)

Adenomyosis

Question 11

benign myometrial smooth muscle cell tumors.

Answer 11

Leiomyomas (ie, uterine fibroids)

Question 12

Cause regular, heavy menses due to increased endometrial surface area

Answer 12

• Leiomyoma (Fibroids)
• Adenomyosis
• Endometrial hyperplasia

Question 13

Heavy, prolonged menses

Pressure symptoms

• Pelvic pain
• Constipation
• Urinary frequency

Obstetric complications

• Impaired fertility
• Pregnancy loss
• Preterm labor

Answer 13

Uterine leiomyomas (fibroids)

Question 14

African American women are 2-3 times more likely than Caucasian women to develop

Answer 14

fibroids (Leiomyomas)

Question 15

the presence of endometrial glands within the uterine myometrium.

Abnormal uterine bleeding and painful menses are common, Uterus is generally enlarged.

Answer 15

Adenomyosis

Question 16

common in

• multiparous women
• ​Prior uterine surgery (cesarean delivery)

Answer 16

Adenomyosis

Question 17

• ________and cyclic bleeding within the myometrium leads to dysmenorrhea and uterine tenderness
• abnormal _____________ results in a concentric, uniformly enlarged uterus
• uterine enlargement and subsequently increased endometrial surface area causes ___,___ menstrual bleeding

Definitive therapy for Adenomyosis is with hysterectomy.

Answer 17

endometrial gland proliferation

myometrial hyperplasia and hypertrophy

regular, heavy

Question 18

multiparous women with dysmenorrhea, heavy menses, and a uniformly enlarged uterus.

Diagnosis?

Answer 18

Adenomyosis

Question 19

small uterus

low TSH

Cystic, Oily ovarian mass

Adnexal mass

Answer 19

Struma ovarii

Question 20

an ovarian germ cell tumor composed of >50% mature thyroid tissue that can secrete thyroid hormone (T4).

can be a rare cause of thyrotoxicosis

• weight loss
• irregular menses
• low TSH level

Answer 20

Struma ovarii

Question 21

composed of cells that support the normal ovarian structure for ovulation (serous, mucinous epithelial cells).

Answer 21

Surface epithelial-stroma Tumors

(serous, mucinous, Endometrioid, Clear cell, Transitional cell)

Question 22

composed of cells that support and surround the oocyte. These cells secrete sex hormones including estrogen (granulosa cells) and testosterone (Sertoli-Leydig cells).

Answer 22

Sex cord-stroma Tumors

(Granulosa, Fibroma, Sertoli-Leydig)

Question 23

composed of cells that can develop into an embryo or placenta.

These tumors are composed of varying amounts of germ layers (ie, endoderm, mesoderm, ectoderm), yolk sac, or placenta (ex: chorion).

They often have associated hormonal activity (ex: increased hCG, alpha fetoprotein).

Answer 23

Germ cell Tumors

(Teratoma, Dysgerminoma, Yolk sac, Embryonal Carcinoma)

Question 24

What causes each

Answer 24

Fibroids (Leiomyoma)

Adenomyosis

Endometrial Hyperplasia/Cancer

Question 25

Grossly, ____ appear as discrete, yellow-gray tumors with a thin pseudocapsule that separates the fibroid from the normal uterine myometrium. Diagnosis is confirmed with microscopy, which typically reveals **_monoclonal proliferation_** of ___ & ___ because each fibroid arises from a single progenitor **smooth muscle cell**. cells are uniform in size and shape and have minimal mitotic figures.

Answer 25

fibroids (Leiomyomas) **myocytes** and **fibroblasts** \*Patients with symptomatic uterine fibroids are often treated surgically with a hysterectomy.

Question 26

endometrial glands and stroma within the uterine myometrium

Answer 26

Adenomyosis

Question 27

benign, intracavitary, focal hyperplastic growths of endometrial tissue. In contrast to adenomyosis, they cause painless intermenstrual bleeding rather than painful, cyclic, heavy menses. There is also no associated uterine tenderness or enlargement.

Answer 27

Endometrial polyps

Question 28

**PCOS** has a long-term risk for **_endometrial hyperplasia_** and \_\_\_\_.

Answer 28

adenocarcinoma

Question 29

a primary gastric cancer that has metastasized to the ovary, often presenting with bilateral ovarian lesions. The cardinal histologic feature is nests of signet ring cells. The appearance is a result of large amounts of mucin displacing the nucleus.

Answer 29

Krukenberg tumor

Question 30

**ectopic endometrial glands** induce **myometrial hyperplasia** and hypertrophy, creating a **globular**, uniformly **enlarged** **uterus**.

Answer 30

Adenomyosis

Question 31

**_Adhesions_** may interfere with ovulation and fallopian tube function, resulting in infertility. Implants and adhesions involving the **_uterosacral ligament_** can result in a fixed, **_retroverted uterus_**. Infiltration of the posterior cul-de-sac can result in **_painful intercourse_** and tenderness with palpation of the **_posterior vaginal fornix_**. Shedding of the ectopic tissue causes **_dysmenorrhea_** (painful menses). Diagnosis

Answer 31

Endometriosis