[PATHO] REVISION 2 Flashcards
1
Q
purulent inflammation 2ry to introduction of bacteria from uterine cavity to tubal lumen
A
acute salpingitis
2
Q
MC causative agent of acute salpingitis
A
Neisseria gonorrhea
3
Q
acute salpingitis gross picture
A
tube is swollen congested
lumen filled w/ pus
4
Q
acute salpingitis microscopic picture
A
acute inflammatory process
polymorphs & pus cells
5
Q
chronic non specific salpingitis gross picture (4)
A
1-tube is irregular, distended
2-fibrous adhesion over serosal surface
3-permanent bridging b/w plicae
4-wall infiltrated by lymphocytes + plasma cells
6
Q
salpingitis complications (5)
A
1-extension–> pelvic peritonitis
2-extension–>tubo-ovarian abscess
3-chronicity—> hydrosalpinx/ pyosalpinx
4-if bilateral–>sterility
5-ectopic pregnancy
7
Q
if chronicity of salpingitis is mild this leads to
A
hydrosalpinx
8
Q
if chronicity of salpingitis is severe this leads to
A
pyosalpinx
9
Q
TB salpingitis gross picture (3)
A
1-serosal tubercles
2-tube is elongated, nodular, irregularly distended
3-adhesions to nearby organs
10
Q
TB salpingitis microscopic picture
A
caseating granuloma
11
Q
tubal pregnancy gross picture
A
tube distended by hemorrhagic clot enmeshing chorionic villi
12
Q
tubal pregnancy fate
A
1-abortion
2-rupture & intraperitoneal bleeding
13
Q
tubal pregnancy pathogenesis
A
1-factors ↑ tubal receptibility (endometriosis)
2-factors blocking zygote passage to uterine cavity (chronic salpingitis/ congenital tubal diverticulae)
14
Q
purulent inflammatory process following introduction of neisseria gonorrhea from uterine cavity to tubal lumen
A
acute salpingitis
15
Q
obliteration of fimbriated end w/ dilatation of tube
wall is whitish, thin, translucent
tube contains clear serous fluid
A
hydrosalpinx
16
Q
uterus is enlarged
mass of grapelike structures of translucent white cysts
no fetal parts
weighs > 200g
hydropic swelling of chorionic villi
chorionic villi filled w/ avascular loose myxoid stroma
hyperplastic sheets of cytotrophoblasts & syncytiotrophoblasts
cytologic atypia is present
A
complete hydatidiform mole
17
Q
obliteration of fimbriated end w/ dilatation of tube
wall is thick & opaque
lumen distended w/ pus
A
pyosalpinx
18
Q
tubes are swollen & congested
lumen is filled w/ pus
tubes show polymorphs & pus cells
A
acute salpingitis
19
Q
tube is distended, irregular
fibrous adhesions on serosal surface
healing & organization
permanent bridging b/w plicae
lymphocytes & plasma cells
A
chronic salpingitis
20
Q
blood borne organism lodged in tubes
tube is elongated, nodular, irregularly distended
adhesions to nearby organs
serosal tubercles
caseating granuloma
A
TB salpingitis
21
Q
MC routes of lymphatic spread in TB salpingitis
A
intestinal
bladder
22
Q
tube is distended w/ hemorrhagic clot enmeshing chorionic villi
A
tubal pregnancy
23
Q
uterus may be enlarged
few vesicles
few fetal parts seen
villous edema of some villi
trophoblastic proliferation is focal & slight
A
partial hydatidiform mole
24
Q
gross picture of complete hydatidiform mole (4)
A
1-usually uterus is enlarged
2-grape-like structures of thin translucent cysts
3-NO fetal parts
4-weighs> 200g
25
complete hydatifirom mole microscopic picture (4)
1-hydropic swellings of chorionic villi
2-chorionic villi filled w/ avascular loose myxoid stroma
3-hyperplastic sheets of cyto & syncytiotrophoblasts
4-cytologic atypia
26
complete hydatiform complications
choriocarcinoma
invasive mole
27
invasive mole micro picture
chorionic villi show active proliferation of both cyto & syncytiotrophoblasts
28
grape like clusters in uterine cavity
complete hydatidiform mole
29
hyperplastic sheets of cyto & synctiotrophoblasts
complete hydatidform mole
30
uterine bleeding
possible rupture of uterus
abortion
↑ hCG
complete mole
penetrates myometrium & can perforate uterine wall
villi show active proliferation to cyto & syncytiotrophoblasts
invasive mole
31
large hemorrhagic necrotic mass destroying uterine wall
invades uterine wall, BV, lymphatics
no stroma
no BV
no chorionic villi formed
extravasated blood & necrosis
contains cytotrophoblasts & synyctial cells
invades
choriocarcinoma
32
choriocarcinoma spread
lungs
liver
vulva
vagina
33
polymorphs & pus cells seen in
acute salpingitis
34
lymphocytes & plasma cells seen in
chronic salpingitis
35
cytotrophoblasts & syncytiotrophoblasts seen in
1-complete mole
2-partial mole
3-invasive mole
36
cytotrophoblasts & syncytial cells seen in
choriocarcinoma
37
cannon ball appearance seen in
choriocarcinoma spread to lungs
38
coffee bean nucleus seen in
cuboidal cells of granulosa cell tumor
39
tuboovarian abscess gross picture (2)
fibrotic wall
cavity containing purulent material
40
wall of ovary is fibrotic
cavity filled w/ purulent material
necrosis
granulation tissue
inflammatory cell infiltration
fallopian tube bound to ovary in distorted mass
tubo-ovarian abscess
41
tubo-ovarian abscess micro picture (3)
necrosis
granulation tissue
inflam cell infiltration
42
chronic granulomatous oophritis caused by
TB
Bilharziasis
43
MC cause of enlarged ovaries
cysts
44
palpable ovarian mass
pelvic pain
menstrual abnormalities
↑estrogen
unilocular cyst 1-5cm
outer surface is smooth
thin wall
cyst contains clear serous fluid
cyst lined by granulosa cells surrounded by theca internal cells
follicular cysts
45
follicular cyst gross picture (7)
1-unilocular
2-1-5 cm
3-unilateral/ bilateral
4-single/multiple
5-smooth outer surface
6-thin wall
7-filled w/ clear serous fluid
46
follicular cyst micro picture
lined by granulosa cells surrounded by theca interna cells
47
follicular cysts originate from
unruptured graafian follicle
or
follicle which had ruptured & immediately sealed
48
corupus luteum cyst orignates from
delayed resolution of corpus luteum
49
corpus luteum gross picture (2)
1-unilocular 3-6 cm
2-yellow festooned lining
50
corpus luteum cyst micro picture
lined by luteinizing granulosa cells
that may be hemorrhagic
51
estrogen secreting cyst
follicular cyst
52
progesterone secreting cyst
corpus luteum
53
menstrual irregularities
↑ progesterone
cyst diameter: 3-6cm
cyst lined w/ luteinizing granulosa cells
unilocular cysts w/ yellow festooned lining
corpus luteum cyst
54
patient taking gonadotropin therapy for infertility/pregnant/ pt w/ choriocarcinoma/ pt w/ hydatidiform mole
hyperplastic luteinized theca interna cells
Hg & rupture
may require surgical intervention
theca lutein cyst
55
theca lutein cyst forms due to
↑ gonadotropins
56
PCOS gross picture (3)
1-both ovaries enlarged 2-5x their original size
2-capsule is thickened
3-capsule is studded w/ multiple small cysts
57
PCOS micro picture(4)
1-thickened T.albuginea
2-cysts lined w/ granulosa cells & hyperplastic luteinizing theca interna cells
3- no corpora luteum
4-no T. albicantia
58
Cl/P of PCOS
1-hyperoestronism
2-Stein-leventhal $
3-virilism
59
hyperoestronisim
↑estrogen + irregular bleeding
60
stein leventhal $
2ry amenorrhea
sterility
PCOS
61
virilism
progressive hirustism
voice changes
breast atrophy
62
ovarian endometriosis gross picture (4)
1-punctate red-brown spots or patches w/ dense fibrous adhesions
2-thick fibrotic cyst wall
3-shaggy/smooth red-brown inner lining
4-cyst filled w/ red-brown chocolate material
63
ovarian neoplasm can be lethal dt
late symptoms & detection
64
ovarian neoplasms RF
nulliparity
family history
genetic mutation in BRACA 1&2
65
genetic mutation possibly leading to ovarian neoplasms
BRACA 1&2 mutation
(suppressor genes)
66
punctate red brown spots
patches w/ dense fibrous adhesions
thick fibrotic cyst wall
smooth/ shaggy red-brown inner lining
cyst contains red brown chocolate material
ovarian endometriosis
67
type I ovarian tumors progression
benign neoplasms-->borderline tumors-->low grade carcinoma
68
Type II ovarian tumors progression
inclusion cysts from ovary/fallopian tube via STIC -->high grade serous tumors
69
STIC
serosal tubal intraepithelial carcinoma
70
surface epithelial tumors derived from
coelomic mesothelium
71
surface epithelial tumors form dt
repeated ovulation-->surface scarring-->mesothelium pulled into ovarian cortex-->epithelial cysts--->metaplasia & neoplastic transformation---> surface epi tumors
72
serous tumors types
benign
borderline
malignant
73
benign serous cystadenoma gross picture (5)
1-thin walled distended unilocular cysts
2-clear straw colored fluid
3-unilateral
4-smooth outer+inner surfaces
5-may be: serous cystadenofibroma/ papillary serous cystadenoma
74
benign serous cystadenoma w/ stromal fibrous component=
serous cystadenofibroma
75
benign serous cystadenoma w/ exophytic/ endophytic papillae
papillary serous cystadenoma
76
benign serous cystadenoma micro picture
cyst lined w/ cuboidal epi/columnar partially ciliated epithelium resembling fallopian tubes
77
borderline serous cystadenoma micro picture
cytological atypia
NO stromal invasion
78
malignant serous cystadenoma micro picture
cytologic atypia + stromal invasion
PSAMMOMA BODIES
79
mucinous tumors gross picture (7)
1-ovoid/lobulated
2-outer surface is smooth
3-thick fibrotic wall
4-unilateral
5-multilocular
6-variable sized locules separated by fibrous tissue septa
7-filled w/ mucinous fluid
80
mucinous tumor types
benign
borderline
malignant
81
benign mucinous tumor micro picture
1-lined by tall columnar cells
2-basal nuclei
3-basophilic mucin containing cytoplasm
resembling endocervical mucosa
82
tumor lined by cells resembling endocervical mucosal cells
benign mucinous tumor
83
tumor lined by cells resembling fallopian tubes cells
benign serous cystadenoma
84
tumor lined by cuboidal cells/columnar partially ciliated cells
benign serous cystadenoma
85
tumor lined by tall columnar cells w/ basal nuclei + basophilic mucin containing cytoplasm
benign mucinous tumor
86
borderline mucinous tumor micro pic
cytologic atypia
NO stromal invasion
87
malignant mucinous tumor micro pic
cytologic atypia + stromal invasion
88
endometrioid tumors of ovary are usually
malignant
89
brenner's tumor gross picture (4)
1-unilateral
2-up to 20 cm in diameter
3-solid, circumscribed, firm-rubbery
4- may have cystic component (not common)
90
brenner's tumor micro picture
transitional epithelium nests in fibrous stroma
91
thin walled unilocular cysts
dilated w/ clear straw-colored fluid
unilateral
lined by cells resembling fallopian tube cells
may have stromal fibrous components or show papillae on external/internal cyst surface
lined by cuboidal epithelium/ columnar partially ciliated epithelium
benign serous cystadenoma
92
ovoid lobulated tumor
outer surface is smooth
thick fibrotic wall
unilateral
multilocular
variably sized lobules supported by fibrous tissue septa
filled w/ mucinous fluid
mucinous tumors
93
rare unilateral tumor 20 cm
arising from surface epithelium
solid circumscribed
firm-rubbery
may have cystic component (not common)
surface epithelium underwent metaplasia-->transitional urothelium
brenner's tumor
94
malignant surface epi tumors gross picture (4)
1-cystic, solid or partly cystic/partly solid
2-endophytic/exophytic papillary growths
3-areas of necrosis + Hg
4-cystic spaces content: serous/mucoid and/or hemorrhagic
95
malignant surface epi tumors micro pic
adenocarcinoma w/ different differentiation grades :serous
mucinous
endometrioid
clear cell
96
postmenopausal women
abnormal bleeding
possibility of endometrial hyperplasia/carcinoma
unilateral tumor
unilocular/mutlilocular
solid/ partly cystic
can grow to fill pelvis
cuboidal cells w/ longitudinal nuclear groove
granulosa cell tumors
97
granulosa cell tumor gross picture (4)
1-unilateral
2-unilocular/multilocular
3-can grow to fill pelvis
4-solid/partly cystic /totally cystic
98
granulosa cell tumor micro picture
cuboidal cells w/ coffee bean nucleus arranged in following patterns:
-trabecular
-insular
-microfollicular
- diffuse sarcomatoid
99
Cl/P granulosa cell tumor in pre-menarchal age
precocious puberty
100
Cl/P granulosa cell tumor in reproductive age (5)
1-abnormal bleeding
2-leiomyomas
3-endometrial hyperplasia
4-fibrocystic disease
5-carcinoma of breast
101
Cl/P granulosa cell tumor in postmenopausal age (3)
1-abnormal bleeding
2-endometrial hyperplasia
3-carcinoma
102
biological behavior of granulosa cell tumor
unpredictable
sometimes behaves benign & sometimes malignant
103
thecoma gross picture (3)
1-unilateral
2-solid firm rubbery
3-grey-ish white w/ yellow tinge
104
thecoma microscopic picture (2)
1-spindle shaped theca cells arranged in fibroma-like pattern
2-foci of luteinization
105
sertoli cell tumor gross picture (3)
1-lobulated
2-solid firm
3-yellow-orange
106
sertoli cell micro picture
tubules lined by cells w/ clear cytoplasm & basal nuclei
107
estrogen producing tumor
solid firm rubbery
grey-ish white w/ yellow tinge
cells are spindle-shaped arranged in a fibroma like pattern
foci of luteinization is seen
thecoma cell tumor
108
testosterone-producing tumor
lobulated
solid firm
yellow-orange colored
tubules lined w/ cells w/ clear cytoplasm & basal nuclei
sertoli cell tumors
109
leydig cell tumor gross picutre
small solid w/ yellow tinge
110
Leydig cell tumor micro picture
sheets of Leydig cells w/ eosinophilic vacuolated cytoplasm
111
secrete testosterone
rarely malignant
defeminizing
amenorrhea
breast atrophy
hirustism
clitoris enlaregement
male voice
sertoli & Leydig cell tumors
112
large tumor
pink-grey color
immature cells
central nuclei
prominent nucleoli that's arranged in cords/groups
supported by fibrous stroma
infiltrated by lymphocytes
dysgerminoma
113
malignant cell tumor w/ extra-embryonic differentiation
yolk sac tumor (endodermal sinus tumor)
114
tumor infiltrated by lymphocytes
dysgerminoma
115
large tumor
10-20 yo
extra-embryonic differentiation
nodular cut surface
firm rubbery
grey-white
microcystic pattern of flat/cuboidal cells
Schiller-Duvan bodies
↑AFP
yolk sac tumor
116
yolk sac tumor microscopic picture
1-microcystic pattern of flat/cuboidal cells
2-Schiller-Duval body
3-↑AFP
117
pathognomic sign of yolk sac tumors
schilelr-duval body
118
AFP is increased in
yolk sac tumors
119
central BV enveloped by germ cells resembling glomerulus
Schiller-Duval body
120
solid grey white tumor
necrosis & Hg in large tumors
solid aggregates of epithelial cells
nucleus: hyperchromatic/vesicular
prominent nucleoli
contain choriocarcinoma/ yolk sac tumor elements
embryonal carcinoma
121
Meig's $
1-fibroma
2-ascites
3-hydrothorax
122
metastatic tumors of ovary
originating from GIT/breasts
bilateral
enlarged ovary
multinodular surface
signet ring cell appearance in hypercellular stroma
Krukenberg tumor
123
Krukenberg tumor stains pink by
Mucin stain
124
Krukenberg tumor mico picture
signet ring cells in hypercellular stroma
125
implantation of mucinous tumor cells from borderline/malignant mucinous tumors in peritoneum w/ ↑mucin production
pseudomyxoma peritonii
126
pseudomyxoma peritonii MC caused by
metastasis from appendix
127
CA-125 elevated in
epithelial ovarian cancer
128
CEA elevated in
mucinous ovarian cancer
129
inhibin elevated in
granulosa cell tumor
130
AFP elevated in
yolk sac tumor
embryonal carcinoma
131
HCG elevated in
choriocarcinoma
embryonal carcinoma
132
psammoma bodies seen in
malignant serous cystadenoma
