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ENRP Exam I > Female Repro Tract Pathology (Hillard) > Flashcards

Female Repro Tract Pathology (Hillard) Flashcards

1
Q

Mayer-Rokitansky -Kuster-Hauser Syndrome

A

mullerian ageneis; missing fallopian tubes, uterus, and upper third of the vagina, presents with amenorrhea; but normal breast, pubic hair and vulvar development

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2
Q

Bartholin Cyst

A

benign vulvar lesion; results from obstruction of the Bartholin glands; cysts are non tender, unilateral, soft mass (3-5 cm) in the posterior aspect of the vaginal introitus; fluid is white or clear

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3
Q

Infected Bartholin Cyst

A

benign vulvar lesion; abscess; fluid is green or yellow; lesion is painful, warm, +/- surrounding edema and cellulitis; most common bug is E. coli

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4
Q

Lichen Sclerosus

A

benign vulvar and anogenital skin lesion; inflammatory disorder with activated T cells; most common in postmenopausal women; pruritis, dyspareunia, dysuria; white plaques; risk for TP53 positive keratinizing squamous cell carcinoma; histo thinning (atrophy), edematous band with lymphocytic infiltrate

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5
Q

Dyspareunia

A

painful sexual intercourse

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6
Q

Lichen Sclerosus has increased risk for what?

A

TP53 positive keratinizing squamous cell carcinoma

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7
Q

Histology of Lichen Sclerosus

A

thinning (atrophy), edematous band with lymphocytic infiltrate

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8
Q

Squamous Cell Hyperplasia (Lichen Simplex Chronicus)

A

thickening of skin (vulva) due to chronic, uncontrolled rubbing or scratching, appears as thickened reddened surface which can whiten over time. Associated with contact dermatitis, lichen sclerosis, and squamous cell carcinoma

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9
Q

Squamous Cell Hyperplasia (Lichen Simplex Chronicus) can be associated with other disorders?

A

contact dermatitis, psoriasis, lichen sclerosis, and squamous cell carcinoma

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10
Q

Condyloma Acuminatum

A

anogenital wart caused by HPV (6,11); sexual intercourse; laten phase can last weeks to months; skin-colored exophytic plaques; cauliflower-like appearance

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11
Q

Fleshy, skin-colored papules and plaques with a cauliflower appearance around the anogenital region should make you consider what?

A

Condyloma Acuminatum caused by HPV (6,11); low risk for progression to SCC

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12
Q

Histological findings of Condyloma Acuminatum?

A

hyperplastic papillary projections compromised of squamous cells with parakeratosis (surface keratinocytes with nuclei); some cells are kolicytic atypia (enlarged hyperchromic nuclei with a surrounding cleared-out halo space)

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13
Q

Vulvar carcinoma

A

SCC is the most common. 2 types:
1. Basaloid/Warty SCC
2. Keratinizing SCC

both arise from Vulvar intraepithelial neoplasia (VIN)

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14
Q

HPV related SCC of the vulva arises from what?

A

Vulvar intraepithelial neoplasia (VIN)

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15
Q

Basaloid / Warty Squamous Cell Carcinoma

A

Avg age 60 yrs; “Classic VIN”, associated with HPV (16 and 18)

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16
Q

Keratinizing Squamous Cell Carcinoma

A

Avg age 76 yrs; “Differentiated VIN”; caused by chronic irritation (lichen sclerosus or squamous cell hyperplasia); freq with TP53 mutations

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17
Q

Keratinizing Squamous Cell Carcinoma has a high frequency with what mutation?

A

TP53 mutations; causes an abnormal p53 tumor suppressor protein

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18
Q

Classic VIN

A

high risk HPV driven Basaloid / Warty SCC; full thickness atypia; lots of mitotic figures on histo; can progress to invasive SCC

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19
Q

Differentiated VIN

A

Non-HPV related vulvar SCC; basal/parabasal atypia; can lead to keratinizing SCC; with KSCC will show invasive nest of squamous cells showing keratinization

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20
Q

Papillary Hidradenoma

A

benign neoplasm; solitary, well-circumscribed vulvar dermal or subcutaneous nodule; columnar and myoepithelial cells with apocrine (sweat gland) differentiation; arises from the mammary-type glands along the primitive milk-line

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21
Q

What embryonic structure does papillary hidradenoma of the vulvar arise?

A

arises from the mammary-type glands along the primitive milk-line

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22
Q

What identical lesion of the papillary hidradenoma is seen in the breast?

A

intraductal papilloma

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23
Q

Extramammary Paget’s Disease (EMPD)

A

intraepithelial adenocarcinoma; sweat gland and keratinocyte differentiation; pruritic, ill-defined, erythematous +/- white crusted lesion with a “map-like” quality; immunostain CK7 positive

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24
Q

A pruritic, ill-defined, erythematous +/- white crusted lesion with a “map-like” quality in the anogenital region should make you think of what?

A

Extramammary Paget’s Disease (EMPD)

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25
Q

Lesion that is immunostain CK7 positive

A

Extramammary Paget’s Disease (EMPD)

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26
Q

What are Gartner duct cyst derived from?

A

Wolffian (mesonephric) remnants

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27
Q

What are Mullerian cyst derived from?

A

Mullerian (paramesonephric) duct

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28
Q

Gartner duct cyst and Mullerian cyst

A

submucosal cyst in reproductive age women; found on the anterior lateral walls of the vagina, can protrude into the orifice; asymptomatic, when symptomatic can cause vaginal pressure and painful intercourse

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29
Q

Diethylstilbestrol (DES) exposure

A

in utero exposure to DES predisposes women to vaginal clear cell adenocarcinoma; females exposed have increased patches of vaginal adenosis that turns into clear cell adenocarcinoma

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30
Q

Why was DES used?

A

nonsteroidal estrogen that addressed issues in pregnancy including miscarriage, preterm delivery, and post-partum lactation suppression

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31
Q

Why was DES discontinued?

A

discontinued in 1971 because linked to vaginal clear cell carcinoma in daughters of women who used the drug during pregnancy

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32
Q

Vaginal Embryonal Rhabdomyosarcoma (Sarcoma Botryoides)

A

uncommon tumor found in infants and young girls, protruding bulky; polypoid, grape-like mass; invasion can result in death; embryonal rhabdomyoblasts

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33
Q

Histogenesis of Vaginal Embryonal Rhabdomyosarcoma (Sarcoma Botryoides)?

A

Malignant cells are embryonal rhabdomyoblasts

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34
Q

Vaginal Squamous Cell Carcinoma and VAIN

A

starts with premalignant lesions VAIN; high-risk HPV (16 and 18); metastasizes in lymphatic pattern

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35
Q

Premalignant lesion of vaginal squamous cell carcinoma

A

Vaginal intraepithelial neoplasia (VAIN); caused by high risk HPV (16 and 18)

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36
Q

VAIN

A

Vaginal intraepithelial neoplasia (VAIN); caused by high risk HPV (16 and 18); Premalignant lesion of vaginal squamous cell carcinoma

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37
Q

Lymphatic spread of vaginal SCC of lower 2/3rd of vagina?

A

inguinal and femoral lymph nodes

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38
Q

Lymphatic spread of vaginal SCC of upper vagina?

A

regional iliac lymph nodes to periaortic lymph nodes

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39
Q

Which type of HPV is the most common cause of carcinoma?

A

HPV 16

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40
Q

HPV

A

Human papillomavirus; DNA virus; causes almost all cervical and vaginal carcinomas; most common cause is HPV 16; second runner up is HPV 18

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41
Q

Pathogenesis of HPV?

A

High-risk HPV integrates into the squamous cell genome of E6 and E7 oncogenes and promotes oncogenesis.

E6: increases telomerase (no division limit)
E6: degrades p53 (removes the brakes)
E7: drives cell proliferation by inactivating p21 and binding to RB

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42
Q

How does HPV affect E6?

A

E6: increases telomerase (no division limit)
E6: degrades p53 (removes the brakes)

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43
Q

How does HPV affect E7?

A

E7: drives cell proliferation by inactivating p21 and binding to RB

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44
Q

HPV has a predilection for which zone in the cervix?

A

transformation zone (T zone)

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45
Q

Progression of cervical dysplasia

A

normal squamous epithelium to low grade dysplasia (LSIL/CIN I) to moderate dysplasia (CIN II) and then severe dysplasia / carcinoma in situ (HSIL/CIN III)

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46
Q

CIN I

A

low-grade squamous cervical intraepithelial neoplasia (CIN) lesion, lack of maturation in the lower third of epithelium with koilocytes seen in upper layers; LSIL

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47
Q

LSIL

A

Low-grade squamous intraepithelial lesion; 60% regress, 30% persist and 10% progress to high-grade SIL; CIN I

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48
Q

HSIL

A

High-grade squamous intraepithelial lesion; 30% regress, 60% persist, and 10% progress to carcinoma! (CIN II and III)

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49
Q

What is the screening tool for cervical dysplasia?

A

a pap test; sample is taken from the cervix at the transformation zone, sample is stained with a Papanicolaou stain - specifically used to stain for squamous cells

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50
Q

Molecular screening techniques for cervical neoplasms

A

Real-time PCR-based assays or Hybrid capture are used to check for high risk HPV (16 and 18); is it a true dysplastic atypia?

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51
Q

What are the screening guidelines for Pap Testing

A

Start at age 21yrs; cytology every 3 yrs until 30 yrs; 30-60 yrs every 5 yrs w/ molecular test; stop screening at >65 yrs

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52
Q

Colposcopy

A

if pap test picks up abnormality cervix can be visualized through a coloscope; acetic acid is applied, causing coagulation and dysplasia turn acetowhite.

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53
Q

Low grade lesions vs high grade lesions on colposcopy

A

low-grade lesions show faint or fine punctation;
high-grade lesions show more coarse punctation

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54
Q

Punctation

A

refers to a dotted or stippling vascular pattern seen on colposcopy of the cervix

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55
Q

Treatment for high-grade dysplasia of the cervix

A

Cervical conization -cone-shaped piece of tissue is cut out from the cervix;
or LEEP (loop electrosurgical excision) - electric current runs through wire loop and cuts away abnormal tissue

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56
Q

Cervical adenocarcinoma in situ (AIS)

A

most cervical cancers are squamous but sometimes ENDOcervix is infected and causes glandular lesions; causing AIS; characterized by hyperchromatic nuclear enlargement with pseudostratification; can progress to invasive adenocarcinoma

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57
Q

Average age for cervical cancer?

A

45-50 yrs

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58
Q

Most common type of cervical cancer?

A

SCC (80%) and adenocarcinoma (15%)

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59
Q

Vaccination for cervical cancer?

A

three vaccines; recommended for both males and females age 11 or 12

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60
Q

Endocervical polyps

A

common benign growth in the ENDOcervix that protrudes beyond the epithelial surface of the cervix; occurs during reproductive years; can present with spotting; simple excision (polypectomy) is curative

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61
Q

Histology of proliferative phase endometrium in the menstrual cycle?

A

cellular blue stroma; tubular glands with pseudostratification; mitotic figures

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62
Q

Histology of secretory phase endometrium in the menstrual cycle?

A

tortuous, serrated glands with secretory material; decidualized stroma; “piano key” vacuoles

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63
Q

“piano key” vacuoles on histology

A

The early secretory phase of the menstrual cycle; subnuclear vacuoles that mimic the appearance of piano keys

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64
Q

Anovulatory

A

lack of ovulation

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65
Q

What are the 3 most common causes of AUB caused by hormonal imbalances during menarche and during the perimenopausal period?

A
  1. Ovarian lesion (PCOS - polycystic ovarian syndrome
  2. Metabolic disorder - obesity
  3. Endocrine disorders - thyroid, adrenal, pituitary
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66
Q

Acute endometritis

A

acute infection of the endometrium; common cause of post-partum fever, uterine tenderness, and abdominal pain; infiltrate of neutrophils (microabscesses); commonly caused by Group A Strep after delivery; can also be associated with chlamydia

67
Q

What is the common bacterial agent that causes acute endometritis?

A

Group A Strep or staphylococci after delivery

68
Q

Chronic endometritis

A

characterized by the presence of plasma cells; eccentrically placed nucleus and a perinuclear hof (or cleared halo); variety of causes - retained products of conception, chronic pelvic inflammatory disease, and IUD (Actinomyces)

69
Q

What is the histological hallmark of chronic endometritis?

A

Plasma cells within the stroma

70
Q

What are the 3 most common causes of chronic endometritis?

A
  1. Retained products of conception
  2. Chronic Pelvic Inflammatory Disease (PID)
  3. IUD (Actinomyces)
71
Q

Long-standing intrauterine devices can cause what?

A

infections by the fungus-like bacteria actinomyces; chronic endometritis

72
Q

Endometriosis

A

“ectopic” endometrial tissue OUTSIDE of the uterus; commonly ovaries and pelvic tissues; severe dysmenorrhea (painful menses) and ovarian mass.

73
Q

What structures are commonly affected by endometriosis?

A

ovaries and pelvic tissue

74
Q

Pathogenesis of endometriosis?

A

persistence and survival of endometrial tissue via release of proinflammatory and inflammatory factors; increase aromatase enzyme production causing increase in estrogen; mutations in tumor suppressors and oncogenes

75
Q

Histological findings of endometriosis?

A

red-brown to blue-black “powder burn” lesions; if involves ovaries (ovarian endometrioma) - “chocolate cysts”

need 2 of the 3 findings:
1. endometrial glands
2. endometrial stroma
3. evidence of hemorrhage (hemosiderin laden macrophages)

76
Q

Adenomyosis

A

endometriotic tissue in the muscle of the uterus (myometrium); presents with dysmenorrhea, pelvic pain, dyspareunia, and infertility; uterus will show multiple foci of hemorrhagic spaces

77
Q

Endometrial polyps

A

benign exophytic, hyperplastic polypoid neoplastic-like mass; benign glands and stroma; can be caused by use of tamoxifen

78
Q

Tamoxifen can cause what pathology?

A

endometrial polyps

79
Q

Endometrial hyperplasia

A

increase in the number of endometrial glands relative to the stroma; premalignant condition; two types:
1. Typical hyperplasia (low-risk to carcinoma)
2. Atypical hyperplasia (high-risk to carcinoma)

80
Q

What are the 5 risk factors to hyperplasia/carcinoma?

A
  1. Obesity
  2. Polycystic ovarian syndrome (PCOS)
  3. Estrogen replacement therapy
  4. Tamoxifen therapy
  5. Estrogen-producing tumors (granulosa cell tumor and thecoma of ovary)

** early menarche, late menopause and nulliparity also increase risk

81
Q

What is the most common finding in endometrial cancer?

A

abnormal uterine bleeding; most often seen in post menopausal women

82
Q

What are the three types of endometrial cancer?

A
  1. Endometrioid Carcinoma of the uterus
  2. Serous Carcinoma of the uterus
  3. Malignant Mixed Mullerian Tumor (MMMT)
83
Q

Endometrioid Carcinoma of the uterus

A

most common (85%); mimics normal endometrium; slow progression; mutations of PTEN and KRAS

84
Q

Serous Carcinoma of the uterus

A

(15% of cancers); postmenopausal atrophic; blacks; papillary growth pattern with marked cytologic atypia; TP53 mut; aggressive tumor, poor prognosis

85
Q

Malignant Mixed Mullerian Tumor (MMMT)

A

rare tumor; postmenopausal atrophic; blacks; BOTH malignant glandular and malignant stroma; TP53 mut; aggressive tumor, poor prognosis with heterologous component (chondrosarcoma or rhabdomyosarcoma)

86
Q

Lynch Syndrome

A

AD with mismatch repair gene mut (MLH1 or MSH2) leading to microsatellite instability (MSI); also increases risk for colon, endometrial and ovarian cancers

87
Q

Mutations in mismatch repair genes MLH1 and MSH2

A

Lynch Syndrome; increased risk for colon, endometrial and ovarian cancers

88
Q

Adenosarcoma

A

rare, low grade malignancy; benign glands and malignant stroma (sarcoma); compare to MMMT (malignant glands AND stroma); can be mistaken for benign polyps

89
Q

Low Grade Endometrial Stromal Sarcoma

A

rare malignant tumor of endometrial stroma; invades myometrium and/or has lymph/vascular invasion; JAZF1 gene translocation

90
Q

Pathology with JAZF1 gene translocation?

A

Low Grade Endometrial Stromal Sarcoma; rare malignant tumor of endometrial stroma; invades myometrium and/or has lymph/vascular invasion

91
Q

Leiomyoma

A

Fibroids; benign smooth muscle tumors, bland, spindled cells; multiple white to tan circumscribed nodules; can cause uterine bleeding and infertility; MED12 mutation

92
Q

What mutation is associated with leiomyomas?

A

MED12 mutation (70%)

93
Q

Leiomyosarcoma

A

uncommon malignant neoplasm of smooth muscle origin (similar to leiomyoma - both have MED12 mut); aggressive (50% metastasize); 3 features that separate it from leiomyomas:
1. atypia
2. increased mitosis
3. tumor necrosis

94
Q

What are the three characteristics that separate leiomyosarcomas from leiomyomas?

A
  1. atypia
  2. increased mitosis
  3. tumor necrosis
95
Q

Paratubal cysts of the fallopian tube

A

very common benign cysts derived from embryological ducts or mesothelium; asymptomatic

subtype: hydatid cyst of Morgagni; larger and derived from Mullerian remnants near fimbriae

96
Q

Name of the ovarian cyst derived from Mullerian remnants near fimbriae?

A

Hydatid cyst of Morgagni; subtype of paratubal cysts

97
Q

Follicular cysts are derived from what and contain what type of cells?

A

Ovarian follicle; both follicular and granulosa cells

98
Q

Luteal cysts are derived from what and contain what type of cells?

A

when the corpus luteum fails to regress; luteinized granulosa cells and theca cells

99
Q

Adenomatoid Tumor

A

most common tumor of the fallopian tube; well-circumscribed benign tumor of mesothelial origin

100
Q

Polycystic Ovarian Syndrome (PCOS)

A
  1. Hyperandrogenism (testosterone) - look for hirsutism/ male pattern balding
  2. Hormonal imbalance (LH/FSH) - chronic anovulation, decreased fertility, increased estrogen
  3. Insulin resistance (DM2) - obesity
  4. Polycystic ovaries
101
Q

What are the 5 ovarian epithelial tumors?

A
  1. Serous
  2. Mucinous
  3. Endometrioid
  4. Clear Cell
  5. Brenner tumor (transitional tumor)
102
Q

What are the 4 ovarian germ cell tumors?

A
  1. Teratoma
  2. Dysgerminoma
  3. Yolk sac tumor
  4. Choriocarcinoma
103
Q

What are the 3 ovarian sex-cord tumors?

A
  1. granulosa cell tumor
  2. fibroma/thecoma
  3. Sertoli-Leydig cell tumor
104
Q

What are the 2 ovarian metastatic tumors?

A
  1. Krukenberg tumor
  2. Pseudomyxoma peritonei
105
Q

What is the most common ovarian malignancy?

A

Serous carcinoma (epithelial tumor)

106
Q

What is the one exception ovarian tumor that is unilateral?

A

Mucinous tumors (unilateral); all else are bilateral

107
Q

Name some clinical features of ovarian tumors.

A

Can be asymptomatic or have vague symptoms: adnexal mass on palpation (can lead to urinary urgency), vaginal bleeding, abdominal pain/distention

if malignant - weight loss and ascites

108
Q

What are the 3 ovarian epithelial tumor classifications?

A
  1. benign
  2. borderline
  3. malignant
109
Q

Pathogenesis of type I ovarian tumors?

A

benign precursor lesion and then to a borderline tumor and finally to a low grade carcinoma

110
Q

What are the 5 type I ovarian tumors?

A

All of the epithelial ovarian tumors:
1. LOW-GRADE serous
2. Mucinous
3. Endometrioid
4. Clear Cell
5. Brenner

111
Q

Pathogenesis of type II ovarian tumors?

A

derived from tubal/ovarian surface and associated with p53 mutation

112
Q

What is the ONE type II ovarian tumor to know?

A

HIGH-GRADE serous carcinoma; derived from fallopian tubal precursor termed Serous tubal intraepithelial carcinoma (STIC); associated with p53 mut

113
Q

The two types of ovarian serous tumors?

A

type I LOW-GRADE serous tumor; cystic tumor with tubal-like epithelium with a papillary growth pattern

type II HIGH-GRADE serous tumor; solid tumor with marker atypia; p53 mutation; associated with BRCA1 and BRAC2 mut (breast cancer)

114
Q

What mutations are associated with type II ovarian tumors?

A

pathogenesis involves p53 mutation and is associated with BRCA1 and BRAC2 mut (breast cancer)

115
Q

LOW-GRADE ovarian serous tumor

A

type I serous tumor; can be benign, borderline, or malignant; cystic tumor with tubal-like epithelium with a papillary growth pattern

116
Q

HIGH-GRADE ovarian serous tumor

A

type II serous tumor; malignant; solid tumor with marker atypia; p53 mutation; associated with BRCA1 and BRAC2 mut (breast cancer)

117
Q

Ovarian mucinous tumors

A

UNILATERAL (exception); columnar epithelium; large cystic lesion with mucinous fluid; KRAS mutation

118
Q

What mutation is strongly associated with ovarian mucinous tumors?

A

KRAS mutation

119
Q

Endometrioid ovarian tumors

A

most are carcinomas; similar to endometrial endometrioid carcinomas; endometriosis is a precursor in some cases

120
Q

Clear cell ovarian tumors

A

vast majority are malignant; variant of endometrioid tumor; large epithelial cells with clear cytoplasm (cytoplasmic clearing)

121
Q

What are the 3 types of ovarian teratoms?

A
  1. Mature Cystic Teratoma (Dermoid Cyst)
  2. Immature malignant teratoma
  3. Monodermal (Specialized) Teratoma
122
Q

Mature cystic teratoma

A

AKA Dermoid Cyst
benign; comprised of all three germ layers; 46XX karyotype; most common germ cell tumor; unilateral cystic mass

123
Q

What is the most common ovarian germ cell tumor

A

Mature cystic teratoma (Dermoid Cyst)

124
Q

Immature malignant teratoma

A

malignant (watch for extra ovarian spread); prepubertal female adolescents and young women; key feature is presence of malignant immature neuroepithelium

125
Q

What key feature is required for the diagnosis of an ovarian immature malignant teratoma?

A

presence of malignant immature neuroepithelium

126
Q

Monodermal (Specialized) Teratoma

A

composed predominately or solely of ONE tissue type; two types:
1. Struma ovarii - mature thyroid tissue; unique presentation of hyperthyroidism symptoms
2. Carcinoid tumor - carcinoid syndrome; flushing, diarrhea, hypotension

127
Q

What are the two types of ovarian monodermal (Specialized) teratomas?

A
  1. Struma ovarii - mature thyroid tissue; unique presentation of hyperthyroidism symptoms
  2. Carcinoid tumor - carcinoid syndrome; flushing, diarrhea, hypotension
128
Q

Struma ovarii

A

type of ovarian monodermal (Specialized) teratoma; composed predominately or solely of ONE tissue type; mature thyroid tissue; unique presentation of hyperthyroidism symptoms (tachycardia, heat intolerance, tremor, LOW TSH)

129
Q

Carcinoid tumor

A

type of ovarian monodermal (Specialized) teratoma; composed predominately or solely of ONE tissue type; causes carcinoid syndrome; flushing, diarrhea, hypotension

130
Q

Dysgerminoma

A

most common malignant ovarian germ cell tumor; ovarian counterpart to testicular seminoma; KIT mutation

131
Q

What mutation is associated with a dysgerminoma?

A

KIT mutation

132
Q

Ovarian yolk sac tumor

A

second most common malignant ovarian germ cell tumor; alpha-fetoprotein (AFP); hallmark is Schiller-Duval body and hyaline droplets

133
Q

What pathology as the histological hallmark of hallmark is Schiller-Duval body and hyaline droplets?

A

Ovarian yolk sac tumor; alpha-fetoprotein (AFP) positive

134
Q

Ovarian choriocarcinoma

A

aggressive, malignant germ cell tumor; placental (trophoblastic) differentiation; secretes high levels of beta-hCG

135
Q

Which ovarian tumor can mimic an ectopic pregnancy?

A

Ovarian choriocarcinoma; secretes high levels of beta-hCG

136
Q

What are the two types of a granulosa cell tumors?

A
  1. Adult granulosa cell tumor - peri & postmenopausal women (endometrial hyperplasia/carcinoma)
  2. Juvenile granulosa cell tumor - younger (precocious puberty)
137
Q

A granulosa cell tumor stains strongly for what?

A

inhibin; brown is positive

138
Q

Granulosa cell tumor characterisitcs?

A

tumor cells in developing follicles; low-grade malignancy; can release estrogen and cause endometrial hyperplasia/carcinoma in adults and precocious puberty in juveniles; histo - coffee bean nuclei and Call-Exner bodies

139
Q

What color are hormonally active granulosa cell tumors?

A

yellow; they release large amounts of estrogen

140
Q

Fibroma

A

benign tumor of fibroblasts; clinical features - Meigs Syndrome: Triad
1. Ascites
2. Pleural effusion
3. Benign ovarian tumor

141
Q

Meigs Syndrome

A

Clinical presentation of fibroma; triad
1. Ascites
2. Pleural effusion
3. Benign ovarian tumor

142
Q

Thecoma

A

tumor of theca-like cells; can release estrogen; can cause endometrial hyperplasia/carcinoma and precocious puberty

143
Q

Sertoli-Leydig Cell Tumor

A

tumor of cells normally seen in male testis; secretes testosterone; DICER1 mut; clinical effects of defeminization and severe virilization; more severe than PCOS; association with Reinke crystals (rod-like pink crystals)

144
Q

Krukenberg Tumor

A

malignant non-ovarian origin tumor; typically GI origin; bilateral metastases; mucin-rich signet ring cells

145
Q

Pseudomyxoma Peritonei

A

tumor of non-ovarian origin tumor; almost always appendiceal mucinous tumor; gelatinous, mucinous ascites termed “jelly belly”; nonspecific symptoms

146
Q

1 risk factor for ectopic pregnancy

A

pelvic inflammatory disease (PID); fallopian tube is the most common site

147
Q

Clinical findings seen in ectopic pregnancy

A

abdominal pain; bleeding 6-8 weeks after last period; if rupture life threatening EMERGENCY; severe hemorrhagic shock

148
Q

Definition of spontaneous abortion

A

AKA miscarriage; pregnancy loss before 20 weeks

149
Q

Dizygotic fraternal twins always result in what type of placenta in utero?

A

“Di-Di”
dichorionic diamniotic placenta

150
Q

Twin-to-Twin Transfusion Syndrome

A

ONLY occurs in monochorionic twins; just one chorion; arteriovenous anastomoses occurs; one twin becomes under perfused and the other becomes fluid overloaded

151
Q

Placenta Accreta Spectrum

A

no placenta decidua so fetal villi directly adhere/invade the myometrium; failure of placenta to separate and leads to post-partum hemorrhage; different types - remember AIP (accreta, increta, percreta)

152
Q

Placenta Previa

A

placenta implantation in the lower uterine segment of cervix and covers internal os; 3rd trimester bleeding;
C-section required

153
Q

Preeclampsia

A

HTN (>140/90) and proteinuria in pregnancy; occurs >20 weeks of pregnancy; if severe can display headache and visual changes

154
Q

Eclampsia

A

preeclampsia plus the appearance of a grand mal seizure (complete loss of consciousness and violent muscle contractions)

155
Q

Three main symptoms of preeclampsia?

A
  1. HTN
  2. swollen hands and feet
  3. protein in urine
156
Q

Pathogenesis of preeclampsia

A
  1. abnormal placenta vasculature (placenta ischemia)
  2. maternal vasoconstriction (HTN)
  3. hypercoagulable state (increased fibrin thrombi - can lodge in organs such as kidneys, liver or brain)
157
Q

HELLP Syndrome

A

H Hemolysis, microangiopathic anemia (schistocytes)
EL Elevated Liver Enzymes
LP Low Platelets

158
Q

Complete molar pregnancy

A

abnormal pregnancy; subtype of a hydatiform mole; multi-cystic mass lesion “snow storm” on US; NO FETAL PARTS; increased risk for both choriocarcinoma and invasive mole; PATERNALLY derived (46 XX) most common

159
Q

What karyotype is most common in a complete molar pregnancy?

A

PATERNALLY derived (all generic material); 46 XX most common karyotype; p57 negative

160
Q

Partial molar pregnancy

A

abnormal pregnancy; subtype of a hydatiform mole; fetal parts/abnormal fetus present; small risk for invasive mole; genetic material from BOTH parents; 69 XXX / 69 XXY / 69 XYY karyotypes

161
Q

Karyotypes associated with a partial molar pregnancy?

A

genetic material from BOTH parents; 69 XXX / 69 XXY / 69 XYY karyotypes; p57 positive

162
Q

Gestational Choriocarcinoma

A

malignant trophoblastic tumor; greatest risk factor is previous complete mole; INCREASED beta - hCG; very high cure rate with chemotherapy (contrast to ovarian choriocarcinoma)

163
Q

Trophoblastic tumor

A

rare tumor of intermediate trophoblast; presents with uterine mass with abnormal uterine bleeding or amenorrhea; increased beta-hCG

ENRP Exam I (24 decks)

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