Female Pathology Flashcards
(148 cards)
1
Q
The two most important etiologies of PCOS are _ and _
A
The two most important etiologies of PCOS are increase in adipose tissue and increased LH
2
Q
What is the consequence of increased adipose tissue in PCOS?
A
Increased adipose –> Increased estrogen –> Increased insulin resistance
3
Q
What is the consequence of high LH in PCOS?
A
High LH –> disrupts the LH/FSH balance –> anovulation –> cyst formation
4
Q
PCOS is also associated with an increase in androgen production by _ cells
A
PCOS is also associated with an increase in androgen production by ovarian theca interna cells
5
Q
Explain how PCOS causes an increase in the free estrogens and androgens
A
PCOS is associated with insulin resistance –> this disrupts normal liver function –> decrease in sex hormone binding globulin –> increase in free estrogens and androgens
6
Q
PCOS is associated with _ levels of estrogen and _ levels of progesterone
A
PCOS is associated with high estrogen and low progesterone
7
Q
High estrogen and low progesterone causes _ to occur in PCOS
A
High estrogen and low progesterone causes endometrial hyperplasia to occur in PCOS
8
Q
What is the “triad” of PCOS sx?
A
- Insulin resistance: obesity, acanthosis nigricans
- Increased estrogen, low progesterone: amenorrhea/oligomenorrhea, enlarged ovaries, infertility
- Increased androgens: hirsutism, acne
9
Q
Though both LH and FSH are elevated in PCOS, (LH/FSH) are highest
A
Though both LH and FSH are elevated in PCOS, LH levels are highest
10
Q
PCOS lab findings:
A
PCOS lab findings:
* High LH (very)
* High FSH
* High estrogen
* High testosterone
11
Q
PCOS will appear as _ on ultrasound
A
PCOS will appear as enlarged ovaries with multiple cysts on ultrasound
* “String of pearls”
12
Q
Hormonal contraceptives are often prescribed in the setting of PCOS for the purpose of _
A
Hormonal contraceptives are often prescribed in the setting of PCOS for the purpose of establishing estrogen/progesterone balance
* Prevent endometrial hyperplasia due to unopposed estrogen
13
Q
Weight loss and metformin may be prescribed in the setting of PCOS to _
A
Weight loss and metformin may be prescribed in the setting of PCOS to decrease adipose tissue
14
Q
Why is spironolactone used in for PCOS?
A
Spironolactone can be used as a steroid receptor antagonist –> androgen blocking effects
15
Q
Finasteride inhibits _ which decreases the conversion of testosterone to DHT
A
Finasteride inhibits 5-alpha-reductase which decreases the conversion of testosterone to DHT
16
Q
Letrozole is used for PCOS because it blocks the conversion of _ to _
A
Letrozole is used for PCOS because it blocks the conversion of androstenedione to estrone
17
Q
Flutamide works as a _ and can be used in PCOS
A
Flutamide works as a androgen receptor antagonist and can be used in PCOS
* Can treat hirsutism
18
Q
_ is a drug that promotes ovulation and may be used in the setting of PCOS
A
Clomiphene is a drug that promotes ovulation and may be used in the setting of PCOS
* Selective estrogen receptor modulator
19
Q
Adenomyosis is _
A
Adenomyosis is hyperplasia of the endometrial basalis layer
20
Q
The endometrium is composed of two “layers” the _ and the _
A
The endometrium is composed of two “layers” the stratum basalis and the stratum functionalis
21
Q
Adenomyosis occurs when there is hyperplasia of the basalis layer that leads to invasion of endometrial tissue into the _
A
Adenomyosis occurs when there is hyperplasia of the basalis layer that leads to invasion of endometrial tissue into the myometrium
22
Q
Adenomyosis is most likely to occur in women who have high _ levels
A
Adenomyosis is most likely to occur in women who have high estrogen levels
* Ex: PCOS, hormone replacement therapy, ovarian producing tumors
* Women aged 30-50
23
Q
Describe the uterus in adenomyosis
A
Describe the uterus in adenomyosis:
soft, boggy, uniformly enlarged globular uterus
* May or may not present with tenderness
24
Q
Adenomyosis may present with _ (painful periods) or _ (heavy or prolonged bleeding)
A
Adenomyosis may present with dysmenorrhea (painful periods) or menorrhagia (heavy or prolonged bleeding)
25
Adenomyosis can be treated with medication like _ or hysterectomy
Adenomyosis can be treated with medication like **GnRH agonists (leuprolide)** or hysterectomy
26
When high levels of estrogen cause enlargement of the endometrial glandular tissue we call this _
When high levels of estrogen cause enlargement of the endometrial glandular tissue we call this **endometrial hyperplasia**
* Increased estrogen relative to progesterone
* More common after menopause
* Causes AUB
* Diagnose with US and endometrial biopsy
27
What are the etiologies of endometrial hyperplasia?
Endometrial hyperplasia is caused by high-estrogen states:
* PCOS
* Estrogen supplementation
* Nulliparity
* Late menopause
* Estrogen producing tumors
28
Endometrial hyperplasia may present as _
Endometrial hyperplasia may present as **abnormal uterine bleeding** or **post menopausal bleeding**
29
Endometrial hyperplasia can be identified as _ on histology
Endometrial hyperplasia can be identified as **proliferation of glandular cells with atypical cells showing extensive loss of cell polarity**
30
Endometrial hyperplasia can be medically managed with _ or hysterectomy if evidence of cellular atypia on biopsy
Endometrial hyperplasia can be medically managed with **progesterone (progestin) supplementation** or hysterectomy if evidence of cellular atypia on biopsy
* The idea behind giving progesterone is to improve hormone balance
31
Asherman syndrome is _
Asherman syndrome is **failure of the endometrium to regenerate following uterine trauma**
32
Explain the pathogenesis of Asherman syndrome
Uterine trauma --> destruction of the endometrial basalis layer --> adhesions/fibrosis --> failure of endometrial regeneration
33
Asherman syndrome may present as _
Asherman syndrome may present as **amenorrhea, infertility, abnormal uterine bleeding, pelvic pain, recurrent pregnancy loss**
34
The deepest layer of the endometrium is the _ , the more superficial layer of the endometrium before the myometrium is the _
The deepest layer of the endometrium is the **stratum functionalis (gets shed)** , the more superficial layer of the endometrium before the myometrium is the **stratum basalis (regenerates)**
35
Endometriosis is _
Endometriosis is **extrauterine endometrial tissue**
36
Overall the most common location for endometriosis is _ ; others include:
Overall the most common location for endometriosis is **the ovaries** ; others include: **uterosacral ligaments, rectouterine pouch peritoneum**
37
A predominant theory for the etiology of endometriosis is _
A predominant theory for the etiology of endometriosis is **retrograde blood/ lymphatic flow**
38
Endometriosis may present with _ (painful periods), _ (pain with sex), _ (difficulty pooping), and cyclic pelvic pain
Endometriosis may present with **dysmenorrhea** (painful periods), **dyspareunia** (pain with sex), **dyschezia** (difficulty pooping), and cyclic pelvic pain
* Can also cause infertility, abnormal uterine bleeding
39
Endometriosis can be visualized on ultrasound and may show a normal sized retroverted uterus with _
Endometriosis can be visualized on ultrasound and may show a normal sized retroverted uterus with **nodular adnexa**
40
Surgical pathology may reveal _ lesions of the peritoneum from endometriosis
Surgical pathology may reveal **yellow-brown "powder burn" lesions** of the peritoneum from endometriosis
41
Cystic, fluid filled lesions may result from endometriosis; we call this _
Cystic, fluid filled lesions may result from endometriosis; we call this **endometrioma**
42
Blood filled "chocolate cysts" on the ovaries is indicative of _
Blood filled "chocolate cysts" on the ovaries is indicative of **endometrioma (endometriosis)**
43
How do we manage endometriosis?
How do we manage endometriosis?
* **NSAIDs** (pain control)
* **OCPs** (inhibit LH surge --> decrease hormone fluctuation)
* **GnRH agonists** ie leuprolide (decrease LH/FSH)
* **Progestins** (suppress growth and implantation of ectopic endometrium)
* **Danazol** (inhibit LH/FSH surge)
* **Surgical removal**
44
Endometritis is _
Endometritis is **inflammation/ infection of the endometrial lining from retained uterine contents**
* Often occurs postpartum, after miscarriage, abortion, IUD, multiple cervical exams
45
Endometritis may present with:
Endometritis may present with:
* Fever, vaginal discharge, abdominal pain, uterine tenderness, foul smelling lochia (postpartum discharge)
46
Complications of endometritis include:
Complications of endometritis include: **sepsis, surgical site infection, peritonitis**
47
Acute endometritis is often caused by _ (pathogen)
Acute endometritis is often caused by **group B streptococcus**
48
Chronic endometritis is often caused by growth of _ or _
Chronic endometritis is often caused by growth of **N. gonorrhoeae** or **A. israelii**
* Also caused by chlamydia, IUD, TB
49
Endometriosis is the presence of estrogen-sensitive _ and _ outside of the uterine corpus
Endometriosis is the presence of estrogen-sensitive **glands** and **stroma** outside of the uterine corpus
* It responds to physiologic estrogen and continues to grow and bleed resulting in chronic inflammatory disorder
50
How does endometriosis present clinically?
Endometriosis may present with:
* Adnexal mass
* Infertility
* Dysmenorrhea
* Dyspareunia
* Dyschezia
* Chronic pelvic pain
51
Endometritis can be diagnosed via:
* Clinical suspicion: pelvic pain, fever
* Blood cultures
* Endometrial biopsy: inflammatory cells in the endometrium
52
On endometrial biopsy, acute endometritis will reveal _ cells
On endometrial biopsy, acute endometritis will reveal **neutrophils**
53
On endometrial biopsy, chronic endometritis will reveal _ cells
On endometrial biopsy, chronic endometritis will reveal **plasma cells**
54
Endometrial hyperplasia has a risk for progression to _
Endometrial hyperplasia has a risk for progression to **endometrial cancer**
55
Endometrial hyperplasia is associated with a gland: stroma ratio _
Endometrial hyperplasia is associated with a **gland: stroma ratio > 1:1**
56
The most common benign tumor of the urogenital tract is _
The most common benign tumor of the urogenital tract is **leiomyoma**
* Most common in premenopausal patients
57
Leiomyomas may present with:
Leiomyomas may present with:
* Abnormal menstruation
* Mass effect
* Urinary tract symptoms
* Infertility
58
Medical management of leiomyomas:
59
A benign "well circumscribed white tan firm mass with whorled appearance" describes _
A benign "well circumscribed white tan firm mass with whorled appearance" describes **leiomyomas**
60
Microscopically, leiomyomas have bland smooth muscle arranged in bundles with _ nuclei
Microscopically, leiomyomas have bland smooth muscle arranged in bundles with **cigar-shaped nuclei**
61
_ is the most common cancer of the female reproductive tract
**Endometrial cancer** is the most common cancer of the female reproductive tract
* 75% of cases are postmenopausal patients
62
Risk factors for endometrial cancer involve _
Risk factors for endometrial cancer involve **chronic estrogen exposure**
* Early menarche
* Late menopause
* Estrogen replacement therapy without compensatory progesterone
* Obesity
* Nulliparity
63
75% of endometrial cancers are type 1 which are _
75% of endometrial cancers are type 1 which are **endometrioid adenocarcinomas**
64
(Type 1/ Type 2) endometrial cancer is well-differentiated with favorable prognosis and often caught at a lower stage
**Type 1** endometrial cancer is well-differentiated with favorable prognosis and often caught at a lower stage
65
Type 1 endometrial cancers are often caused by unopposed estrogen and mutations in _ or _ tumor suppressor genes
Type 1 endometrial cancers are often caused by unopposed estrogen and mutations in **PTEN** or **KRAS** tumor suppressor genes
66
The most common Type 2 endometrial cancers are _ and _
The most common Type 2 endometrial cancers are **serous** and **clear cell**
* Type 2 only make up 20% of all endometrial cancers
67
Type 2 endometrial cancers are more aggressive, higher stage/grade and associated with _ mutations
Type 2 endometrial cancers are more aggressive, higher stage/grade and associated with **TP53 mutations**
68
(Leiomyosarcoma/ Leiomyoma) is more common in post-menopausal women
**Leiomyosarcoma** is more common in post-menopausal women
69
Risk factors of cervical cancer:
Risk factors of cervical cancer:
* HPV infection
* Diethystillbestrol (DES) exposure
* Smoking
* Immunocompromised state
*Pap screening allows detection of dysplasia before progression to cancer*
70
How are abnormal cells on pap test graded?
**ASCUS**: atypical squamous cells of undetermined significance
**LSIL**: low-grade squamous intraepithelial lesion
**HSIL**: high-grade squamous intraepithelial lesion
71
HPV high risk testing is screening for subtypes _ and _
HPV high risk testing is screening for **subtypes 16,18**
* Both of these make E6 and E7 gene products
72
E6 inhibits _
E7 inhibits _
E6 inhibits **TP53**
E7 inhibits **pRb**
73
High-grade squamous intraepithelial lesion (HSIL) has _ abnormalities due to increased DNA from HPV integration
High-grade squamous intraepithelial lesion (HSIL) has **high nuclear to cytoplasm ratios** abnormalities due to increased DNA from HPV integration
74
75
The vaccine used in the US to protect against HPV is _
The vaccine used in the US to protect against HPV is **Gardasil 9**
* HPV 6, 11, 16, 18, 31, 33, 45, 52, 58
76
LEEP procedure is _
LEEP procedure is **loop electrosurgical excision procedure**
* This is a local procedure
77
Follicular cysts are common ovarian cysts which arise from _ cells
Follicular cysts are common ovarian cysts which arise from **sex cord/stromal cells** (ie the granulosa/theca cells)
* Most common type
* Unruptured follicle
78
Epithelial cysts are ovarian cysts that arise from the _
Epithelial cysts are ovarian cysts that arise from the **surface epithelium**
79
_ cysts are caused by large amounts of hCG
**Theca lutein cysts** are caused by large amounts of hCG
* Cyst wall is composed of luteinized theca cells (no granulosa cells)
* Elevated androgen levels
* Tend to be bilateral
80
Neoplastic cysts are malignant or benign ovarian tumors most commonly of _ origin
Neoplastic cysts are malignant or benign ovarian tumors most commonly of **surface epithelial origin**
81
Corpus luteum cyst
Epithelial ovarian cyst
82
_ is a benign cystic ovarian epithelial neoplasm with smooth external surface
**Cystadenoma** is a benign cystic ovarian epithelial neoplasm with smooth external surface
* The most common ovarian neoplasm in all ages
83
Cancer antigen marker _ is used in postmenopausal patients to evaluate for ovarian cancer (recurrence)
Cancer antigen marker **CA-125** is used in postmenopausal patients to evaluate for ovarian cancer (recurrence)
84
PCOS is defined as having at least 2/3 of the following:
PCOS is defined as having at least 2/3 of the following:
1. Polycystic ovaries (follicular cysts)
2. Irregular menstruation/ infertility
3. Elevated androgen levels
85
PCOS pathophysiology
86
Ovarian cancer may present with non-specific symptoms like:
Ovarian cancer may present with non-specific symptoms like:
* Constipation
* Abdominal/pelvic pain
* Bloating
87
Three categories/ "layers" of ovarian tumors:
Three categories/ "layers" of ovarian tumors:
1. **Epithelial**
2. **Sex cord stromal**
3. **Germ cell**
88
The vast majority (95%) of ovarian neoplasms are of _ origin
The vast majority (95%) of ovarian neoplasms are of **epithelial** origin
89
_ is the most common histological subtype of epithelial neoplasms
**Serous** is the most common histological subtype of epithelial neoplasms
90
Serous carcinoma is associated with _ gene mutations
Serous carcinoma is associated with **TP53, BRCA1, BRCA2**
91
Benign ovarian epithelial tumors are called _
Malignant tumors are called _
Benign ovarian epithelial tumors are called **cystadenoma**
Malignant tumors are called **cystadenocarcinoma**
92
Serous (ovarian epithelial) tumors are characterized by _
Serous (ovarian epithelial) tumors are characterized by secretion of **thin serous fluid** and **CA-125**
93
Serous cystadenocarcinoma
94
Mucinous (ovarian epithelial) tumors are characterized by _
Mucinous (ovarian epithelial) tumors are characterized by **thick mucus** and secretion of **carcinoembryonic antigen (CEA)**
95
**Mucinous ovarian tumor**
96
Clear cell carcinoma
* Almost always malignant
97
Sex cord tumors come from _ cells
Sex cord tumors come from **granulosa cells**
98
Stromal tumors come from _ cells
Stromal tumors come from **fibroblasts and theca cells**
99
(Fibromas/thecomas) produce estrogen
**Thecomas** produce estrogen
* Thecomas are a benign sex cord stromal tumor in postmenopausal women
100
Meigs syndrome (3) elements
Meigs syndrome (3):
1. Ovarian fibroma
2. Ascites
3. Pleural effusion
101
Granulosa cell tumors are malignant and will overproduce _ and _
Granulosa cell tumors are malignant and will overproduce **estrogen** and **inhibin**
* Postmenopausal bleeding in women in 50s
102
Sertoli-leydig tumors secrete _
Sertoli-leydig tumors secrete **testosterone** --> abrupt and rapid virulization
103
Germ cell tumors arise from cells that make up the _
Germ cell tumors arise from cells that make up the **ovum**
* Teratomas
* Dysgerminomas
* Yolk sac tumors
* Choriocarcinomas
104
_ is a germ cell tumor that occurs most often in adolescent patients, increases serum LDH, and has fried egg appearance on histology
**Dysgerminoma** is a germ cell tumor that occurs most often in adolescent patients, increases serum LDH, and has fried egg appearance on histology
105
Yolk sac tumors secrete _ and are characterized by _ bodies on histology
Yolk sac tumors secrete **alpha-fetoprotein** and are characterized by **Schiller-Duval bodies** on histology
106
Teratoma
107
(Mature/Immature) teratomas are benign
**Mature** teratomas are benign --> called "dermoid cyst"
* Immature are malignant
108
Teratomas are _
Teratomas are **differentiated cells of one or more 3 germ layers**
* Endoderm, mesoderm, ectoderm
109
_ is a mature cystic teratoma that contains predominantly thyroid tissue
**Struma ovarii** is a mature cystic teratoma that contains predominantly thyroid tissue --> hyperthyroidism
110
The most common immature tissue in an immature (malignant teratoma) is _
The most common immature tissue in an immature (malignant teratoma) is **neural**
111
An enlarged, asymmetric, nontender uterus in the setting of abnormal uterine bleeding is indicative of _
An enlarged, asymmetric, nontender uterus in the setting of abnormal uterine bleeding is indicative of **leiomyoma (fibroid)**
* Females aged 20-40
* Multiple discrete tumors with "whorled well-demarcated smooth muscle bundles"
112
Prolonged estrogen exposure leading to discrete collection of benign endometrial tissue describes _
Prolonged estrogen exposure leading to discrete collection of benign endometrial tissue describes **endometrial (uterine) polyps**
* Most common in post-menopausal women with history of estrogen exposure
113
Explain the pathophysiology of endometrial polyps
High estrogen --> increased growth of the uterine myometrium --> benign smooth muscle tumor
114
_ is a malignant neoplasm of the myometrium which presents as a single tumor with areas of necrosis
**Leiomyosarcoma** is a malignant neoplasm of the myometrium which presents as a single tumor with areas of necrosis
115
Endometrial carcinoma can be distinguished into two histological subtypes _ and _
Endometrial carcinoma can be distinguished into two histological subtypes **endometriod type** and **serous type**
116
Endometrial atrophy that undergoes transformation describes (endometrioid/serous) type endometrial carcinoma
Endometrial atrophy that undergoes transformation describes **serous type** endometrial carcinoma
117
Histology of serous type endometrial carcinoma will show _
Histology of serous type endometrial carcinoma will show **papillae, tufts +/- psammoma bodies**
118
Endometrioid type endometrial carcinoma is caused by unopposed estrogen + loss of _
Endometrioid type endometrial carcinoma is caused by unopposed estrogen + loss of **PTEN/ mismatch repair protein**
* Histology will show abnormally arranged endometrial cells
119
Overaggressive dilation and curettage (D&C) can cause loss of the basalis layer leading to secondary amenorrhea called _ syndrome
Overaggressive dilation and curettage (D&C) can cause loss of the basalis layer leading to secondary amenorrhea called **Asherman syndrome**
120
Tamoxifen can cause endometrial polyps due to its _ effects on the endometrium
Tamoxifen can cause endometrial polyps due to its **pro-estrogenic** effects on the endometrium
* *Tamoxifen treats breast cancer due to its anti-estrogenic effects on the breast, however, it has pro-estrogenic effects on the endometrium*
121
Endometriosis carries an increased risk of carcinoma, especially in _ site
Endometriosis carries an increased risk of carcinoma, especially in **ovaries**
* Ovaries are the most common site of involvement
122
The most important predictor for progression of endometrial hyperplasia to carcinoma is _
The most important predictor for progression of endometrial hyperplasia to carcinoma is **presence of cellular atypia**
123
The most common invasive carcinoma of the female genital tract is _
The most common invasive carcinoma of the female genital tract is **endometrial carcinoma**
124
Endometrial carcinoma arises via two different pathways _ and _
Endometrial carcinoma arises via two different pathways **hyperplasia** and **sporatic**
* 75% of the time it is the hyperplasia pathway
125
Endometrial hyperplasia --> endometrial carcinoma will normally have _ histology
Endometrial hyperplasia --> endometrial carcinoma will normally have **endometrioid** histology
126
In the sporatic pathway, endometrial carcinoma arises in an atrophic endometrium with no precursor lesions; histology will be _
In the sporatic pathway, endometrial carcinoma arises in an atrophic endometrium with no precursor lesions; histology will be **serous**
* Characterized by *papillary structures*
127
Serous endometrial carcinoma is often associated with _ mutations
Serous endometrial carcinoma is often associated with **p53** mutations
128
Increased LH in PCOS induces excess androgen production, resulting in _
Increased LH in PCOS induces excess androgen production, resulting in **hirsutism**
129
The most common type of ovarian tumor is a _
The most common type of ovarian tumor is a **surface epithelial tumor**
130
The two most common type of surface epithelial tumors are _ and _
The two most common type of surface epithelial tumors are **serous** and **mucinous**
* Can be benign or malignant
* Less common subtypes are endometrioid and brenner
131
_ are surface epithelial ovarian tumors composed of bladder-like epithelium and are usually benign
**Brenner tumors** are surface epithelial ovarian tumors composed of bladder-like epithelium and are usually benign
* Coffee bean nuclei
132
Epithelial ovarian carcinomas tend to be aggressive and spread locally, especially to the _
Epithelial ovarian carcinomas tend to be aggressive and spread locally, especially to the **peritoneum**
133
_ is a germ cell tumor that mimics fetal tissue
**Teratoma** is a germ cell tumor that mimics fetal tissue
* Often benign but can contain immature tissue (neural) or somatic malignancy (squamous cell carcinoma of skin) --> malignant
134
The female equivalent of a seminoma is a _
The female equivalent of a seminoma is a **dysgerminoma**
* Most common malignant germ cell tumor in adolescents
135
_ is a tumor composed of large cells with clear cytoplasm and central nuclei that resemble oocytes
**Dysgerminoma** is a tumor composed of large cells with clear cytoplasm and central nuclei ("fried egg") that resemble oocytes
* May have increased LDH levels
136
_ is a germ cell tumor that mimics the yolk sac and is most common form in children
**Endodermal sinus tumor** is a germ cell tumor that mimics the yolk sac and is most common form in children
137
Yolk sac tumors will often have elevated _
Yolk sac tumors will often have elevated **serum AFP**
138
Yolk sac tumors classically show glomerulus-like structures called _ on histology
Yolk sac tumors classically show glomerulus-like structures called **Schiller-Duval bodies** on histology
139
_ is a malignant tumor composed of cytotrophoblasts and syncytiotrophoblasts that mimics placental tissue
**Choriocarcinoma** is a malignant tumor composed of cytotrophoblasts and syncytiotrophoblasts that mimics placental tissue
* Vili are absent
140
Choriocarcinomas are often associated with high _ levels
Choriocarcinomas are often associated with high **beta-hcg** levels
141
Name three types of sex cord-stromal tumors that can occur in females:
Name three types of sex cord-stromal tumors that can occur in females:
1. Granulosa-theca cell tumor
2. Sertoli-Leydig cell tumor
3. Fibroma
142
Granulosa-theca cell tumors cause high _ levels and will have a presentation consistent with this
Granulosa-theca cell tumors cause **high estrogen levels** and will have a presentation consistent with this
* Prior to puberty- precocious puberty
* Reproductive age- menorrhagia
* Postmenopause- endometrial hyperplasia + AUB
143
Sertoli-Leydig cell tumors in a female may result in _
Sertoli-Leydig cell tumors in a female may result in **excess androgen, hirsutism, virilization**
144
A _ is a benign tumor of fibroblasts
A **fibroma** is a benign tumor of fibroblasts
* Type of sex cord-stromal tumor
* "Bundles of spindle-shaped fibroblasts"
145
Fibromas are associated with _ and _ ; this is called Meigs syndrome
Fibromas are associated with **pleural effusions** and **ascites**; this is called Meigs syndrome
146
Theca-lutein cysts are associated with _ malignancy
Theca-lutein cysts are associated with **choriocarcinoma**
147
Dysgerminoma tumors markers are _ and _
Dysgerminoma tumors markers are **hCG** and **LDH**
148
Call-Exner bodies may be seen in _ sex cord stromal tumors
Call-Exner bodies may be seen in **granulosa cell tumors**
