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Flashcards in Reproduction II Deck (183):
1

What is defined as the abnormal presence of neutrophils in the endometrium?

Acute Endometritis

2

What are 3 causes of Acute Endometritis?

Ascending Infection due to Abortion

Delivery

Medical Instrumentation

**specific cause rare

3

What must Acute Endometritis be distinguished from?

Normal PMN's due to menstruation

4

The presence of plasma cells, lymphocytes, and the occasional lymph nodule within normal Endometrium indicates what?

Chronic Endometritis

5

What is Chronic Endometritis often associated with?
(3 things)

IUD's

PID

Abortion/Delivery substances (that have been retained)

6

Bleeding, Pelvic pain, IUD...

Chronic Endometritis

7

Pus in the Endometrial Cavity is defined as...

Pyometria

8

Anything that causes cervical stenosis (narrowing) will be associated with what condition?

*due to tumor, scarring, etc

Pyometria

9

Long standing pyometria may be associated with what?

How often does this occur?

Endometrial Squamous Cell Carcinoma

**Rare

10

Endometrial tissue that forms tumor-like nodules outside the uterus is known as...

Endometriosis

11

What are 3 places Endometriosis is often found?

Ovary

Fallopian tube

Pelvic peritoneum

12

Endometrial foci are composed of what?

Endometrial glands and stroma

***responds to estrogenic stimulation/cycle

13

Why can't the blood be cyclically discharged in endometriosis?

Foci encased in CT/Peritoneum

14

Endometriosis primarily happens in the 3rd to 4th decade of life, and has a higher incidence in....

Higher socio-economic groups

*marry later

15

T/F
The most popular theory of Endometriosis pathogenesis is the Regurgitation Theory, but is not clearly understood

True

16

What color are the nodules/plaques in Endometriosis?

Red-Brown

17

Where are most foci in Endometriosis found?

Orifice of Fallopian Tubes

18

What percentage of women of reproductive age have Endometrial foci?

15-20%

19

T/F
Endometriosis does not progress to cancer

True

20

Where are Chocolate Cysts found?

How big are they?

Ovarian endometriosis

1-5 cms

*filled with brown red viscous fluid

21

If endometrial glands and stroma enter the myometrium, it can cause what?

Adenomyosis

22

T/F
The deeper the Adenomyosis penetration, the more likely symptomatic with dysmenorrhea (painful menstruation) or menorrhagia (heavy bleeding menstruation)

True

23

Adenomyosis is most often seen in what demographic?

Parous - have had children

24

Small, soft, tan, partially cystic masses in the myometrium is what?

*also mildly proliferative endometrial glands surrounded by stroma of varying fibrotic states

Adenomyosis

25

Adenomyosis is often asymptomatic, what percentage of removed uteri have some degree of this?

1/5

26

Benign tumors of the Myometrial smooth muscle are called what?

Leiomyomas

*Fibroids

27

Leiomyomas are ____ % benign and _____ % malignant and are then called ______

98%

1-2%

Leiomyosarcomas

28

What is the most common uterine tumor?

What % of reproductive-aged women have them?

Leiomyoma

20%

29

In connective tissue, ....oma is ______ and ...sarcoma is ______.

Benign

Malignant

30

T/F
Leiomyomas aren't seen before puberty or after menopause

True

31

Leiomyomas are more commonly seen in what ethnic group?

Blacks

32

Describe the histology of Leiomyoma:

Smooth muscle cells in fascicles

*unencapsulated, white-tan whorled masses

33

What are the 3 types of Leiomyoma fibroids?

Intramural - within myometrium

Subserosal - beneath uterine serosa

Submucosal - in endometrial cavity


****size and location determine symptoms

34

What type of Leiomyoma often compresses the rectum, and can cause abdominal heaviness, urinary urgency, and constipation?

Subserosal

35

What type of Leiomyoma can cause menstrual irregularities, bleeding, and Infertility?

Submucosal

*interfere with embryonic implantation

36

Submucosal fibroid (Leiomyoma) are treated how?

Surgically

small, myomectomy

large, hysterectomy

37

Excessive estrogen can cause what in the endometrium?

Endometrial Hyperplasia

38

Endometrial hyperplasia is mostly what type of tissue?

Glandular

*not much stroma

39

What are the 3 types of Endometrial Hyperplasia?

Simple - minimal glandular complexity, no cell atypia

Complex - multi-layered glandular complexity, no atypia

Atypical Hyperplasia - glandular complexity, cell atypia

40

What are the chances of progression to carcinoma/adenocarcinoma in the 3 types of Endometrial Hyperplasia?

Simple - 1% - carcinoma

Complex - 3% - adenocarcinoma

Atypical - 25% - adenocarcinoma

41

Estrogen -producing tumors, Polycystic Ovarian Syndrome, exogenous estrogen, an Obesity can all cause what?

Endometrial Hyperplasia

42

What is the treatment for Endometrial Hyperplasia?

Progestins (high dose)

*synthetic progesterone

43

What are the benign projections of the endometrial surface called?

Endometrial Polyps

44

What 2 things may cause endometrial foci to produce polyps?

Do polyps slough during menstruation?

Hypersensitive to Estrogen

Unresponsive to Progesterone

NO

45

Where are Endometrial Polyps usually found?

Fundus

46

What bleeds inter-menstually and has a high degree of endomentrial glands and stroma?

Endometrial Polyps

47

Endometrial Polyps aren't considered neo-plastic, but _____ harbor Adenocarcinomas.

0.5%

48

What is the most common malignant tumor of the female genital tract?

It accounts for what % of GYN malignancies?

Endometrial Adenocarcinoma

50%

49

Endometrial Adenocarcinoma arises from what cells?

Associated with?

Epithelial cells lining endometrial glands

More estrogen exposure

50

What are 4 risk factors for Endometrial Adenocarcinoma?

Exogenous estrogen

Estrogen producing tumors

Obesity

Nulliparous (or early menarche/late menopause)

51

What gives the endometrium breaks from proliferation?

Progesterone

*Estrogens stimulate endometrium

52

What is the most important benefit to estrogen supplements?

Prevents bone loss

*but increases carcinoma

53

T/F
The risks outweigh the rewards for estrogen supplements

True

*bone loss more important to address, cancer can be detected early

**15,000 deaths/yr related to osteoporotic bone fractures

54

What is it about endometrial cancers (adenocarcinoma) that justifies estrogen supplementation?

80% confined to uterus.

Excellent prognosis

55

What 2 cancers, other than Endometrial Adenocarcinoma, are also estrogen dependent and have an increased risk for upon diagnosis?

Breast

Ovarian

56

How do most endometrial adenocarcinomas grow?

Exophytic - grow into endometrium

57

Describe the 4 Stages of Endometrial Carcinoma

I - Endometrium only

II - Endometrium, cervix, myometrium

III - Breaches uterus (but not outside pelvis)

IV - Bladder, rectum (outside pelvis)

58

T/F
Endometrial cancer is rare before 35, presents with inter-menstrual bleeding.

True

*mostly diagnosed through irregular bleeding

59

What is the treatment for Endometrial Cancer?

If advanced (or incomplete resection/undetected)?

If inoperable?

Hysterectomy
(with or without ovaries)

Radiation

Chemo

60

What are the most common primary lesions of the Fallopian Tubes?

Benign Paratubal Cysts

61

Describe Benign Paratubal Cysts?

0.1-2.0 cm

Translucent

Clear, serous fluid

62

Where are the largest Benign Paratubal Cysts found?

Fimbrae

Broad Ligament

*little clinical significance

63

Where do Ectopic Pregnancies most often implant?
(3 places)

Ovary

Abdominal cavity

Fallopian tubes (95%)

64

Ectopic Pregnancy incidence?

1/150

65

What is the greatest risk factor for Ectopic Pregnancy?

3 additional factors?

Chronic Salpingitis

Endometrial peritubular adhesions, Previous surgery, Leiomyoma

66

What usually happens in Ectopic Pregnancy 2-6 weeks after fertilization?

Rupture/Intraperitoneal hemorrhage

67

T/F
Decidual reaction of endometrium and no chorionic villi are indicative of Ectopic Pregnancy

True

68

PID ascends due to a variety of microorganisms

True

69

The ascent of PID can result in what 3 acute conditions?

Salpingitis

Pyosalpinx

Tuboovarian abscess

70

List 5 species that cause PID starting with the most common.

Gonorrhea

Chlamydia

Staph, Strept, Mycoplasma

71

What procedure/conditions may cause PID?
2 things

Septic Abortion

Postpartum endometritis

72

Cervicitis is usually due to what 2 bugs and has what symptoms?

Chlamydia/Gonococcus

Cervix red/swollen - yellow mucopurulent discharge

73

What is the most common symptom in Cervicitis/PID?

Lower abdominal pain

74

T/F
Gonococcal urethritis is more painful in men, and often asymptomatic in women

True

75

T/F
Dyspareunia (painful intercourse) and purulent discharge is common in PID

True

76

PID caused by what organism can be especially consequential (leading to infertility) because of mild symptoms?

Trachomatis

77

Name 4 Complications of PID:

Sterility - scars fallopian tubes

Ectopic Pregancy

Abscesses- in Fallopian Tubes, ovaries, peritoneum

Peritonitis - bacterial spread out fallopian tubes/ovaries

78

Increase risk of PID due to IUD is due to what organism?

Actinomyces israelii

79

Actinomyces israelii is found in what % of genital tracts?

What does it produce?

How does it enter the Uterine Cavity?

4%

Sulfur Granules

IUD tail

**G+ Rod

80

Actinomyces israelii PID by IUD can result in what?

Extensive scarring

81

T/F
Tumors of the Fallopian Tubes are rare because epithelium does not shed cyclically and isn't under estrogenic control

True

82

Of Fallopian Tube cancers, what is the most common?

Account for what % of GYN malignancies?

Adenocarcinomas

1%

83

Ovarian Neoplasms come in what 4 subtypes based on their cells of origin?

What % of ovarian tumors do each make up?

Surface tumors (70%)

Germ Cell tumors (20%)

Sex cord stromal tumors (10%)

Ovarian metastases

(1st 3 embryological)

84

T/F
The benign Ovarian tumors are more common than malignant ones.

True

85

What is the 2nd most common GYN cancer?

What does it rank 1st for?

Ovarian

Deaths

*causes more deaths than all other GYN tumors

86

How many patients die from Ovarian cancer/year?

12,000

*19k new cases

87

The most common Ovarian Neoplasms are derived from what?

How do they act cyclically?

Surface Epithelial Cells

Rupture every month

*proliferating cells heals each month - increases cancer risk
**BCP's suppress

88

What are the four types of Ovarian Surface Epithelial Tumors?

*comprises 70% ovarian tumors

Serous

Mucinous

Brenner

Endometroid

*1st 2 cystic, latter 2 solid

89

T/F
All surface tumors of the Ovary are Adenomas

False

Adenomas and Adenocarcinomas

90

How are the Serous and Mucinous Epithelial tumors of the Ovary classified?

Benign

Borderline

Malignant

91

What are the most common surface tumors of the Ovary?

Serous

92

Serous Tumors of the Ovary epithelium consist of what?

What do they mimic?

Several encapsulated cysts

Fallopian tube epithelium

93

In Serous Tumors of Ovarian epithelium, what % are benign?

% borderline?

% malignant?

60%

15%

25%

94

60% of malignant Serous Tumors of the Ovarian epithelium are bilateral. 30% benign as well. Suggest?

Genetic component

95

What do the malignant tumors of the Serous type of Ovarian epithelial cancers form?

Papillary projections

96

Mucinous - type Ovarian Epithelial tumors have what ratio of benign:malignant?

What % are bilateral?

7:1

10-30%

97

Describe a Mucinous-type Ovarian Epithelial tumor.

Thick yellowish or clear jelly-like material

98

If a Mucinous-type Ovarian Epithelial tumor invades the peritoneum, what happens and what is it called?

Entire belly filled with mucous

Pseudomyxoma peritonei

99

What type of tumor mimics Endocervical Epithelium?

Mucinous tumors (Ovarian epithelium)

100

Describe Endometroid Ovarian Surface Epithelial tumors.

Solid, glandular

*resembles endometrial glands

101

What % of Endometroid Ovarian Surface Epithelial tumors have carcinoma of endometrium?

What % have benign endometriosis?

15-30%

15%

102

What type of malignancies are Brenner Tumors?

Transitional Cell Carcinomas

*Ovarian surface epithelial tumor

103

What type of tumor is solid with dense fibrous stroma and scattered nests of Transitional epithelium?

Brenner Ovarian Surface Epithelial tumors

*2%

104

T/F
The vast majority of ovarian tumors are hormonally non-functional

True

105

What antibody is detected in 50% epithelial tumors confined to the Ovary, and 90% that have spread?

CA-125

106

What is the survival rate of the progression-types of Surface Epithelial Tumors?

Benign - 100% (5 yr)

Borderline - 80%

Malignant - 10-40% (depends on stage)

107

What type of tumor accounts for 20% of Ovarian cancers and is predominately seen in women before age 25?

Germ Cell Tumors

108

What is the most common type of Germ Cell Tumor?

(most common ovarian tumor in women less than 25)

Benign Cystic Teratoma
(Dermoid Cyst)

*95%

109

How does Benign Cystic Teratoma present?

Cyst, hairy skin, teeth, etc.

*potentially metastatic but benign in this form
**needs removal

110

What is the ovarian counterpart to male Seminoma?

Dysgerminoma

111

Describe Dysgerminoma

Treatment?

When does it occur?

large and firm

Surgical

Childhood

112

Dysgerminomas are sensitive to what

Radiosensitive

113

Dysgerminoma is homologous to what male tumor?

Seminoma of testes

114

What is the ovarian counterpart to of the Yolk Sac Tumor of the male testes?

Endodermal Sinus Tumor

115

Endodermal Sinus Tumor is rich in what?

Predominantly seen in what age group?

Describe growth

AFP - alpha feto protein

Children/young adults

Agressive/rapid

116

What tumor is histologically identical to Placenta?

What does it excrete? (the Tumor Marker)

Choriocarcinoma

HCG

117

T/F
Choriocarcinomas usually exist in combo with teratocarcinomas (other germ cell tumors)

True

118

T/F
Choriocarcinomas are highly lethal because they get into the bloodstream/liver/lungs/bones at time of diagnosis

True

119

What accounts for 5% of all Ovarian tumors and originate from cells forming the Follicles?

Sex Cord Stromal Tumors

120

What are the 3 variants of Sex Cord Stromal Tumors?

Theocomas - solid/estrogen secreting/benign

Granulosa - solid/estrogen producing/small are benign/large malignant

Sertoli-Leydig Cell Tumors - solid/Androgen secreting

121

What can Granulosa Sex Cord Stromal tumors cause in the young?
Older?

Precocious puberty

Breast/endometrial cancer

122

What does Sertoli-Leydig tumors cause?

What type of tumor is it?

Deep voice, hypertrophy clitoris (micropenis), baldness, etc.

Sex Cord Stromal Tumor

*can be benign/malignant

123

Where do Metastatic Ovarian Tumors most often originate?

What explains this?

Carcinomas of Endometrium and Breast

Tumors have estrogen receptors

124

What is the most common tumor of the GI tract that metastasizes on the ovary?

Krukenberg tumors

***Stomach carcinoma

125

Describe the maternal surface of Normal Placenta

Describe the fetal surface of a Normal Placenta

Dark red, lobules (cotyledons)

Shiny, gray, translucent

126

Out of the syncytiotrophoblast, cytotrophoblast, connective tissue, and endothelium of fetal capillaries that make up the Placenta early in pregnancy, what degenerates in late pregnancy?
What is displaced?
What remains?

Cytotrophoblast

Connective tissue displaced by fetal capillaries

Syncytiotrophoblast/fetal capillary endothelium

127

How does the blastocyst stimulate the endometrium for implantation?

Decidual Reaction

*stimulates Stroma to thicken and vascularize

128

T/F
The placenta produces both steroid and protein hormones

True

129

Name 2 hormones secreted by the Placenta

Human chorionic gonadotropin (hCG)- stimulated progesterone production by corpus luteum

Human placental lactogen (hPL) - induces lypolysis

130

What hormone is considered the Growth Hormone for the fetus?

hPL - Human Placental Lactogen

131

T/F
Estrone, Etstradiol, and Estriol are all steroid hormone of unknown function secreted by the Placenta

True

132

What hormone is used by the fetal adrenal cortex as a precursor for other hormones?

Progesterone

"seeds" cortex

133

What placental variation presents as a thick ring that is over the fetus rather than around the placenta?

Circumvallate Placenta

134

T/F
Placenta can have accessory lobes and are usually of no clinical importance

True

135

What variation of Placenta has small gray or yellowish nodules on the fetal surface associated with oligohydramnios and Potters syndrome (renal agenesis)?

Amnion Nodosa

136

What are the contents of the Umbilical cord?

Right and Left arteries

Vein

Wharton's Jelly

137

What blood is in the Right and Left umbilical arteries?

What blood is in the Umbilical vein?

Deoxygenated blood from fetus to placenta

Oxygenated blood from placenta to fetus

138

T/F
Presence of only on Umbilical artery suggests CV abnormalities

True

139

If the umbilical cord is inserted into the fetal membranes and not the placenta, this suggests what?

Velamentous Insertion

*longer cord - 1%

140

T/F
True knots are found more often in males

True

*false knot is Wharton's jelly accumulation

141

What is it called if the umbilical cord becomes wrapped around the neck?

Nuchal cords

142

T/F
15-20% of pregnancies have one-loop nuchal cords

True

143

T/F
The amniotic fluid increases through the 7th month and decreases in last 2

True

144

What is the volume of amniotic fluid at birth?

What is the exchange rate?

1 liter

400-500mL/HOUR

145

How much amniotic fluid will the term fetus swallow daily?

How much urine excrete daily?

400 mL

500 mL

146

What is produced in fetal hepatocytes?

Elevated levels associated with what?

Reduced levels associated with what?

AFP - alpha fetoprotein

Neural tube defects (spina bifida) or Esophageal problems

Down syndrome

147

Fetal swallowing defects or absorption defects (duodenal) result in what?

What is this associated with?

Polyhydramnios

(too much amniotic fluid)

Diabetes

148

What is a low amount of amniotic fluid called?

Caused by?

Causes what congenital malformations?

Oligohydraminios

Inability to excrete urine

Potter's syndrome/hypoplastic lungs

149

Placenta implanting over the cervix is called what?

It is often caused by?

Placenta previa

Decidua deficiency

**old cesarean scars also have difficulty implanting

150

5 contributing factors for Placenta Previa

C-section

Advanced maternal age

multiparity

Cocaine

Cigarettes

151

What placental condition is marked by the absence of decidua and inability to separate from wall?

Placenta Accreta

152

Placenta Accreta is subclassified according to what?

Depth of villous invasion to myometrium

153

What are the 3 types of Placenta Accreta?

Placenta Accreta - villi to myometrium

Placenta Increta - villi to underlying myometrium

Placenta Percreta - villi across uterine wall

**normal villi

154

What is the most common presentation of Placenta Accreta?

3rd trimester bleeding

155

T/F
Postpartem hemorrhage from Placenta Accreta requires emergency hysterectomy

True

156

Placenta accreta has a maternal death rate of what?

2%

157

Blood between the basal plate of the placenta and uterine wall is what?

Accounts for what % of perinatal deaths?

Retroplacental Hematoma

8%

158

T/F
smoking, advanced age, cocaine, and acute chorioamnionitis are all associated with Retroplacental Hemotama

True

159

What is the term for infection/inflammation of the placental amnion, chorion, and extraplacental membranes?

Chrioamnionitis

160

T/F
Chorioamnionitis can spread to the umbilical cord (funisitis)

True

161

5 Bacteria responsible for Chorioamnionitis starting with the most common

Mycoplasma

Bacteroides

B strep

E. coli

Gardnerella vaginalis

162

These bacteria responsible for chorioamnionitis are found in what % of placentas?

10%

163

Infection of the placental villi can come from what 2 sources?

Endometritis

Transplacental from maternal circulation

*syphilis, rubella, HSV, etc.

164

T/F
Meconium stained placentas occur 18% of the time and are usually in pregnancies that go longer than 42 weeks

True

165

Thick meconium aspiration causes what?

Fetal chemical pneumonitis

166

T/F
There are macrophage within fetal membranes of meconium stained placenta

True

167

What are the 3 most common sites of Ectopic pregnancy?

Tubal - 95%

Ovarian

Peritoneal

168

T/F
The aspiration of fresh blood from the Pouch of Douglas (posterior fornix) denotes ectopic rupture

True

169

What disease involves the trophoblastic epithelium?

Gestational Trophoblastic Disease

170

Trophoblastic proliferation and degeneration of chorionic villi suggest what placental abnormality?

Hydatidiform Mole

171

Complete Hydatidiform Mole is caused by what?

All chromos paternal

Androgenesis 23 X to 46

172

T/F
Without maternal chromos the embryo can't develop and the placenta undergoes hydropic degeneration

True

173

2 Sperm fertilizing an ovum will result in what?

Incomplete Hydatidiform Mole

*69 chromos
**fatal but not immediate

174

What is the incidence of H. moles in the US?

Diagnosis based on what?

1/2000 pregnancies

Enlarged uterus - no fetus

175

What hormone is found in Hydatidiform Mole in high levels?

hCG

176

T/F
Hydatidiform Mole pregnancies are aborted spontaneously mid-pregnancy

True

177

Why is it important to remove Hydatidiform Mole completely upon miscarriage?

Grossly, what does H. Mole look like

Trophoblastic cells are potential malignancies (chorio)

Grape-like clear vesicles

178

The malignant tumor composed of trophoblastic cells is called what?

Choriocarcinoma

179

T/F
50% of Choriocarcinomas arise from a preexisting complete mole
25% retained abortive tissue
25% normal placenta

True

180

Describe the nature of choriocarcinoma and what its marker is

Highly invasive

hCG

181

T/F
Choriocarcinoma forms bulky hemorrhagic nodules in the placental bed
Invades through uterus, often implants in vagina

True

182

Where does Choriocarcinoma often metastasize to once it invades the veins?

Lung, liver, and brain

183

What does Choriocarcinoma respond well to if it hasn't yet metastsized?

Chemo with Methotrexate

80-100% cure rates

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