Lecture 31 - Ovarian, Fallopian Tube, and Gestational Trophoblastic Diseases

Question 1

Endometriomas are endometriosis of the ______. Because they form cysts, blood pools within them in congruence with the menstrual cycle (“chocolate fluid” collects within them).

Answer 1

Ovary

Question 2

Polycystic Ovary Syndrome (PCOS) results from inappropriate _______ (particularly LH –> steady levels without surge for ovulation). These women tend to be obese and exhibit hyper________ and insulin resistance.

Obese patients with PCOS need to be monitored for development of endometrial hyperplasia and/or carcinoma. Why?

Answer 2

Gonadotropin

Hyperandrogenemia

With increased fat –> increased aromatase activity –> increased peripheral conversion of androgens to Estrone –> unopposed Estrogen –> potential for hyperplasia/carcinoma.

Question 3

Rank the type of Ovarian Neoplasms in order from most common to least common in Adults:

Germ cell

Epithelial

Stromal

Is this the same for adolecents?

Answer 3

1. Epithelial
2. Germ cell
3. Stromal

No, Germ cell is most common in adolecents, then Epithelial, and last Stromal.

Question 4

Serous tumors are among the most common _____ tumors of the ovary.

Most are benign, about 1/4 are malignant, and few have low malignant potential.

______ bodies (small calcified spots) can be commonly seen in these tumors.

Answer 4

Epithelial

Psammoma bodies

Question 5

Mucinous tumors of the ovary are most often benign and can be VERY large. Being mucinous, they resemble ______ (endo or exocervix?).

They have an association with ______ ______ (“jelly belly”). This results from large, loculated mucinous tumors, likely from the ______ that have spread to the ovary.

Answer 5

Endocervix

Pseudomyxoma peritonei

Appendix

Question 6

Ovarian Dermoids (aka benign teratomas) are comprised of which germ cell layers?

Struma ovarii is a subset of these that are comprised mostly of ______ tissue.

Answer 6

All three! Endoderm, Mesoderm, and Ectoderm.

Thyroid

Question 7

______ teratomas of the ovary are malignant, unlike dermoid.

Answer 7

Immature (keep in mind dermoid are “mature”)

Question 8

Stromal tumors can arise from granulosa, theca, and other ovarian stromal cells. They are highly hemorrhagic and usually ______ (unilateral or bilateral?).

Which stain is used to identify Ovarian Stromal tumors of any cellular origin?

Answer 8

Unilateral

Inhibin

Question 9

Fibrothecal ovarian stromal tumors are usually benign and occur most often during _______. They can result in Meig’s syndrome which involves ____-sided hydrothorax and ______.

Answer 9

Menopause

Right-sided Hydrothorax

Ascites

Question 10

A Kreukenberg tumor of the ovary is a metastatic tumor from basically any site in the body, but it is a mucinous tumor with characteristic _____ ring cells (cells with mucinous globs that marginalize the nucleus).

Keep in mind mets to the ovary will usually be ______ (unilateral or bilateral?).

Answer 10

Cignet ring cells

Bilateral (unlike primary tumors like Granulosa and Fibrothecal stromal tumors)

Question 11

Fallopian tube infection can lead to PID (pelvic inflammatory disease). This can lead to ______, leaking of pus from the fallopian tube.

Answer 11

Pyosalpinx

Question 12

If fallopian tube infection resolves, but fimbriae remain closed, it can result in _____, depicted in the image.

Answer 12

Hydrosalpinx

Question 13

The biggest risk of ectopic tubal pregnancy is internal ______ following rupture of the fallopian tube. Remember the fallopian tube is not meant to stretch like the uterus.

Answer 13

Hemorrhage