Flashcards in Repro - Pathology (Ovarian pathology & Vaginal tumors) Deck (80)
What is premature ovarian failure? What is the presentation that defines this?
Premature atresia of ovarian follicles in women of reproductive age; Patients present with signs of menopause after puberty but before age 40
What hormone changes are associated with premature ovarian failure?
Decreased estrogen, Increased LH, FSH
What are the 11 most common causes of anovulation?
(1) Pregnancy (2) Polycystic ovarian syndrome (3) Obesity (4) HPO axis abnormalities (5) Premature ovarian failure (6) Hyperprolactinemia (7) Thyroid disorders (8) Eating disorders (9) Female athletes (10) Cushing syndrome (11) Adrenal insufficiency
What is another name for polycystic ovarian syndrome? What is its definition?
Stein-Leventhal syndrome; Hyperandrogenism due to deranged steroid synthesis by theca cells, hyperinsulinemia.
What are 3 major hormone mechanisms associated with polycystic ovarian syndrome?
(1) Estrogen increases steroid hormone-binding globulin (SHBG) and decreases LH, ultimately resulting in decreased free testosterone; (2) insulin and testosterone decrease SHBG --> increased free testosterone; (3) Increased LH due to pituitary/hypothalamus dysfunction.
What imaging finding is associated with polycystic ovarian syndrome?
Results in enlarged, bilateral cystic ovaries
How does polycystic ovarian syndrome present?
Presents with amenorrhea/oligomenorrhea, hirsuitism, acne, infertility
What condition is associated with polycystic ovarian syndrome? For what other condition does PCOS increase the risk, and why?
Asociated with obesity. Increased risk of endometrial cancer secondary to increased estrogens from the aromatization of testosterone and absence of progesterone
What is the treatment for the different symptoms of polycystic ovarian syndrome?
TREATMENT FOR HIRSUITISM, ACNE: weight reduction, OCPs (estrogen increases SHBG and decreases LH --> decreased free testosterone), antiandrogens; FOR INFERTILITY: clomiphene citrate (blocks negative feedback of circulating estrogen, increasing FSH, LH), metformin (increase insulin sensitivity, decrease insulin levels, results in decreased testosterone; enables LH); FOR ENDOMETRIAL PROTECTION: cyclic progesterones (antagonizes endometrial proliferation)
What hormone changes are associated with polycystic ovarian syndrome?
Increased LH, Increased FSH (LH:FSH, 3:1), Increased testosterone, Increased estrogen (from aromatization)
What is the most common cause of infertility in women?
Polycystic ovarian syndrome
What defines/causes a follicular cyst?
Distension of unruptured graafian follicle
What are 2 conditions with which follicular cyst is associated?
May be associated with (1) hyperestrogenism and (2) endometrial hyperplasia.
What is the most common ovarian mass in young women?
What defines/causes a corpus luteum cyst?
Hemorrhage into persistent corpus luteum.
How is a corpus luteum cyst commonly resolved?
Commonly regresses spontaneously
What causes a theca-lutein cyst?
Due to gonadotropin stimulation
How does a theca-lutein cyst present in the body?
What are 2 conditions with which theca-lutein cysts are associated?
Associated with choriocarcinoma and moles
What defines/causes a hemorrhagic cyst?
Blood vessel rupture in cyst wall.
What causes a hemorrhagic cyst to grow? How does it usually resolve?
Cyst grows with increased blood retention; usually self-resolves.
What is a dermoid cyst? What does it contain?
Mature teratoma. Cystic growths filled with various types of tissue such as fat, hair, teeth, bits of bone, and cartilage.
What defines/causes an endometrioid cyst?
Endometriosis within ovary with cyst formation
What produces variations in endometrioid cysts?
Varies with menstrual cycle.
What is a classical finding of endometrioid cysts in the ovaries?
When filled with dark, reddish-brown blood it is called a "chocolate cyst"
What is the most common adnexal mass in women > 55 years old? Is it benign, malignant, or both?
Ovarian neoplasms; Can be benign or malignant
From where can ovarian neoplasms arise? From where do the majority of malignant tumors arise?
Arise from surface epithelium, germ cells, and sex cord stromal tissue; Majority of malignant tumors arise from epithelial cells. Majority (95%) are epithelial (serous cystadenocarcinoma most common)
What are 5 factors/conditions that increase risk for ovarian neoplasms?
Risk increased with (1) advanced age, (2) infertility, (3) endometriosis, (4) PCOS, (5) genetic predisposition (BRCA-1 or BRCA-2 mutation, HNPCC, strong family history)
What are 4 factors/conditions that decrease risk for ovarian neoplasms?
Rick decreased with (1) previous pregnancy, (2) history of breastfeeding, (3) OCPs, and (4) tubal ligation