Repro - Pathology (Ovarian pathology & Vaginal tumors)

Question 1

What is premature ovarian failure? What is the presentation that defines this?

Answer 1

Premature atresia of ovarian follicles in women of reproductive age; Patients present with signs of menopause after puberty but before age 40

Question 2

What hormone changes are associated with premature ovarian failure?

Answer 2

Decreased estrogen, Increased LH, FSH

Question 3

What are the 11 most common causes of anovulation?

Answer 3

(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

Question 4

What is another name for polycystic ovarian syndrome? What is its definition?

Answer 4

Stein-Leventhal syndrome; Hyperandrogenism due to deranged steroid synthesis by theca cells, hyperinsulinemia.

Question 5

What are 3 major hormone mechanisms associated with polycystic ovarian syndrome?

Answer 5

(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.

Question 6

What imaging finding is associated with polycystic ovarian syndrome?

Answer 6

Results in enlarged, bilateral cystic ovaries

Question 7

How does polycystic ovarian syndrome present?

Answer 7

Presents with amenorrhea/oligomenorrhea, hirsuitism, acne, infertility

Question 8

What condition is associated with polycystic ovarian syndrome? For what other condition does PCOS increase the risk, and why?

Answer 8

Asociated with obesity. Increased risk of endometrial cancer secondary to increased estrogens from the aromatization of testosterone and absence of progesterone

Question 9

What is the treatment for the different symptoms of polycystic ovarian syndrome?

Answer 9

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)

Question 10

What hormone changes are associated with polycystic ovarian syndrome?

Answer 10

Increased LH, Increased FSH (LH:FSH, 3:1), Increased testosterone, Increased estrogen (from aromatization)

Question 11

What is the most common cause of infertility in women?

Answer 11

Polycystic ovarian syndrome

Question 12

What defines/causes a follicular cyst?

Answer 12

Distension of unruptured graafian follicle

Question 13

What are 2 conditions with which follicular cyst is associated?

Answer 13

May be associated with (1) hyperestrogenism and (2) endometrial hyperplasia.

Question 14

What is the most common ovarian mass in young women?

Answer 14

Follicular cyst

Question 15

What defines/causes a corpus luteum cyst?

Answer 15

Hemorrhage into persistent corpus luteum.

Question 16

How is a corpus luteum cyst commonly resolved?

Answer 16

Commonly regresses spontaneously

Question 17

What causes a theca-lutein cyst?

Answer 17

Due to gonadotropin stimulation

Question 18

How does a theca-lutein cyst present in the body?

Answer 18

Often bilateral/multiple

Question 19

What are 2 conditions with which theca-lutein cysts are associated?

Answer 19

Associated with choriocarcinoma and moles

Question 20

What defines/causes a hemorrhagic cyst?

Answer 20

Blood vessel rupture in cyst wall.

Question 21

What causes a hemorrhagic cyst to grow? How does it usually resolve?

Answer 21

Cyst grows with increased blood retention; usually self-resolves.

Question 22

What is a dermoid cyst? What does it contain?

Answer 22

Mature teratoma. Cystic growths filled with various types of tissue such as fat, hair, teeth, bits of bone, and cartilage.

Question 23

What defines/causes an endometrioid cyst?

Answer 23

Endometriosis within ovary with cyst formation

Question 24

What produces variations in endometrioid cysts?

Answer 24

Varies with menstrual cycle.

Question 25

What is a classical finding of endometrioid cysts in the ovaries?

Answer 25

When filled with dark, reddish-brown blood it is called a "chocolate cyst"

Question 26

What is the most common adnexal mass in women > 55 years old? Is it benign, malignant, or both?

Answer 26

Ovarian neoplasms; Can be benign or malignant

Question 27

From where can ovarian neoplasms arise? From where do the majority of malignant tumors arise?

Answer 27

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)

Question 28

What are 5 factors/conditions that increase risk for ovarian neoplasms?

Answer 28

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)

Question 29

What are 4 factors/conditions that decrease risk for ovarian neoplasms?

Answer 29

Rick decreased with (1) previous pregnancy, (2) history of breastfeeding, (3) OCPs, and (4) tubal ligation

Question 30

How do ovarian neoplasms present?

Answer 30

Presents with adnexal mass, abdominal distension, bowel obstruction, pleural effusion

Question 31

How are ovarian neoplasms diagnosed? How are they monitored?

Answer 31

Diagnose surgically; Monitor progression by measuring CA-125 levels (not good for screening).

Question 32

What are 7 examples of benign ovarian neoplasms?

Answer 32

(1) Serous cystadenoma (2) Mucinous cystadenoma (3) Endometrioma (4) Mature cystic teratoma (dermoid cyst) (5) Brenner tumor (6) Fibromas (7) Thecoma

Question 33

What is the most common ovarian neoplasm?

Answer 33

Serous cystadenoma

Question 34

What characteristics distinguish serous cystadenoma?

Answer 34

Thin-walled, uni- or multilocular. Lined with fallopian-like epithelium. Often bilateral.

Question 35

What characteristics distinguish mucinous cystadenoma?

Answer 35

Multiloculated, large. Lined by mucus-secreting epithelium.

Question 36

What is an endometrioma?

Answer 36

Mass arising from growth of ectopic endometrial tissue

Question 37

What imaging finding characterizes endometrioma?

Answer 37

Complex mass on ultrasound

Question 38

How does endometrioma present?

Answer 38

Presents with pelvic pain, dysmenorrhea, dyspareunia.

Question 39

What is the most common ovarian tumor in women 20-30 years old?

Answer 39

Mature cystic teratoma (dermoid cyst)

Question 40

What is a mature cystic teratoma (dermatoid cyst)? What can it contain? What are the most common components?

Answer 40

Germ cell tumor; Can contain elements from all 3 germ layers: teeth, hair, sebum are common components

Question 41

What are ways in which a mature cystic teratoma (dermoid cyst) may present?

Answer 41

Can present with pain secondary to ovarian enlargement or torsion.; Can also contain functional thyroid tissue and present as hyperthyroidism (struma ovarii).

Question 42

What is struma ovarii?

Answer 42

Mature cystic teratoma (dermoid cyst) that contains functional thyroid tissue and presents as hyperthyroidism

Question 43

What is the defining characteristic of a Brenner tumor?

Answer 43

Benign ovarian neoplasm that looks like bladder; Think: "B for Brenner & bladder"

Question 44

How does a Brenner tumor appear grossly? What characterizes it on H & E stain?

Answer 44

Solid tumor that is pale yellow-tan in color and appears encapsulated; "Coffee bean" nuclei on H & E stain; Think: "B for Brenner, Bladder, & coffee Bean"

Question 45

How do fibromas appear on histology?

Answer 45

Bundles of spindle-shaped fibroblasts

Question 46

What is Meigs syndrome?

Answer 46

Triad of ovarian fibroma, ascites, and hydrothorax.

Question 47

What is a symptom associated with fibromas?

Answer 47

Pulling sensation in groin

Question 48

What product comes from thecoma? What other tumor has the same product?

Answer 48

Like granulosa cell tumors, may produce estrogen

Question 49

How does a thecoma usually present?

Answer 49

Usually present as abnormal uterine bleeding in a postmenopausal women.

Question 50

What are 8 examples of malignant ovarian neoplasms?

Answer 50

(1) Immature teratoma (2) Granulosa cell tumor (3) Serous cystadenocarcinoma (4) Mucinous cystadenocarcinoma (5) Dysgerminoma (6) Choriocarcionma (7) Yolk sac (endodermal sinus) tumor (8) Krukenberg tumor

Question 51

What are 3 defining features of an immature teratoma?

Answer 51

Aggressive, contains fetal tissue, neuroectoderm

Question 52

What tissue is typically represented in immature teratoma versus mature teratoma?

Answer 52

Immature teratoma is most typically represented by immature/embryonic-like neural tissue. Mature teratoma are more likely to contain thyroid tissue.

Question 53

What is the most common sex cord stromal tumor?

Answer 53

Granulosa cell tumor

Question 54

In what patient population is granulosa cell tumor predominantly found?

Answer 54

Predominately women in their 50s.

Question 55

What products come from granulosa cell tumors? How do granulosa cell tumors present?

Answer 55

Often produce estrogen and/or progesterone and present with abnormal uterine bleeding, sexual precocity (in pre-adolescents), breast tenderness.

Question 56

What does histology of granulosa cell tumor show? What does this resemble?

Answer 56

Histology shows Call-Exner bodies (resemble primordial follicles)

Question 57

What is the most common (malignant) ovarian neoplasm? How/Where is it typically found?

Answer 57

Serous cystadenocarcinoma; Frequently bilateral

Question 58

What is a characteristic histological finding of serous cystadenocarcinoma?

Answer 58

Psammoma bodies.

Question 59

What is another name to associate with mucinous cystadenocarcinoma? What defines it?

Answer 59

Pseudomyxomal peritonei - intraperitoneal accumulation of mucinous material from ovarian or appendiceal tumor

Question 60

What is the most common neoplasm in adolescents?

Answer 60

Dysgerminoma

Question 61

To what neoplasm is dysgerminoma equivalent? Which of these two is rarer?

Answer 61

Equivalent to male seminoma but rarer.

Question 62

What percentage of all ovarian tumors are dysgerminomas? What percentage of germ cell tumors are dysgerminomas?

Answer 62

1% of all ovarian tumors; 30% of germ cell tumors.

Question 63

What histological finding characterizes dysgerminoma?

Answer 63

Sheets of uniform "fried egg" cells

Question 64

What are 2 tumor markers for dysgerminoma?

Answer 64

hCG, LDH = tumor markers

Question 65

Is choriocarcinoma common or rare? When, and in what patient population(s) can it develop?

Answer 65

Rare; Can develop during or after pregnancy in mother or baby

Question 66

What defines choriocarcinoma?

Answer 66

Malignancy of trophoblastic tissue (cytotrophoblasts, synctiotrophoblasts); no chorionic villi present.

Question 67

What kind of cysts are increased in frequency with choriocarcinoma?

Answer 67

Increased frequency of theca-lutein cysts.

Question 68

How does choriocarcinoma present? What can explain its symptoms?

Answer 68

Presents with abnormal Beta-hCG, shortness of breath, hemoptysis; Hematogenous spread to lungs.

Question 69

How well does choriocarcinoma respond to chemotherapy?

Answer 69

Very responsive to chemotherapy

Question 70

What is the most common tumor in male infants?

Answer 70

Yolk sac (endometrial sinus) tumor)?

Question 71

Is yolk sac (endodermal sinus) tumor aggressive? Where is it found in the body, and in what patient population?

Answer 71

Aggressive, in ovaries or testes (boys) and sacrococcygeal area in young children

Question 72

What are 3 features describing how yolk sac (endodermal sinus) tumor appear grossly?

Answer 72

Yellow, friable (hemorrhagic), solid mass

Question 73

What histological finding do 50% of yolk sac (endodermal sinus) tumors have?

Answer 73

50% have Schiller-Duval bodies (resemble glomeruli)

Question 74

What is a tumor marker for yolk sac (endodermal sinus) tumor?

Answer 74

AFP = tumor marker

Question 75

What is the origin of a Krukenberg tumor? What are its defining features?

Answer 75

GI malignancy that metastasizes to the ovaries, causing a mucin-secreting signet cell adenocarcinoma

Question 76

What are the 3 kinds of vaginal tumors?

Answer 76

(1) Squamous cell carcinoma (SCC) (2) Clear cell adenocarcinoma (3) Sarcoma botryoides (rhabdomyosarcoma variant)

Question 77

In what context does squamous cell carcinoma (SCC) vaginal tumor usually occur? In what context is it rare?

Answer 77

Usually secondary to cervical SCC; Primary vaginal carcinoma rare

Question 78

What patient population do clear cell adenocarcinoma vaginal tumors affect?

Answer 78

Affects women who had exposure to DES in utero

Question 79

What patient population do sarcoma botryoides (rhadomyosarcoma variant) vaginal tumors affect?

Answer 79

Affects girls < 4 years old

Question 80

What 2 histological/lab findings distinguish sarcoma botryoides (rhabdomyosarcoma variant) vaginal tumors?

Answer 80

Spindle-shaped tumor cells that are desmin +