Reproductive - Female Pathology Flashcards Preview

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Flashcards in Reproductive - Female Pathology Deck (76)
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31

Leiomyoma (Fibroids)

P: Asymptomatic; can include abnormal uterine bleeding (iron deficiency), infertility, pelvic mass. Premenopausal (20-40yo); African american

M: benign neoplastic proliferation of smooth muscle from myometrium; most common tumor in females

Estrogen associated (premenopausal, multiple, enlarges during pregnancy, shrinks after menopause)

Multiple well-defined, white, whorled masses

32

Leiomyosarcoma

P: postmenopausal (middle age) women, African American

M: malignant proliferation of smooth muscle from myometrium

De novo (NOT from leiomyoma), single lesion with necrosis, hemorrhage, mitotic activity and cellular atypia. May protrude from cervix and bleed

Highly aggressive; tend to recur

33

Basic histology and function of ovary

Functional unit = follicle
Oocyte surrounded by granulosa and theca cells

1) LH induces androgen production from theca
2) FSH stimulates granulosa to convert androgen to estradiol
3) Estradiol surge induces LH surge leading to ovulation

4) After ovulation, residual follicle becomes corpus luteum and secretes progesterone (drives secretory phase)

34

Hemorrhagic corpus luteal cyst

Hemorrhage into corpus luteum; early pregnancy

Degeneration of follicles results in follicular cysts - small number are common

35

Polycystic ovarian disease

P: obese woman, amennorhea, infertility, hirsutism; 5% of women

M: hormone inmbalance
1) high LH induces androgen production in theta cells (hirsutism)
2) Androgens converted to estrone in adipose
3) Estrone inhibits FSH
4) Decreased FSH results in cystic degeneration of follicles

High LH, low FSH, high T, high E (from aromatization)

Assoc. with insulin resistance (type 2 diabetes 10-15 years later) and endometrial carcinoma (high circulating estrone)

Tx: weight reduction, low dose OCP or medroxyprogesterone (decreases LH/androgenesis), spironolactone (acne/hirsutism), clomiphene (for those who want pregnancy), metformin (diabetes/metabolic syndrome)

36

What are the 3 cell types of ovary?

Surface epithelium
Germ cells
Sex cord stroma

37

Surface epithelial tumors

Most common types of ovarian tumors (70%)

Coelomic epithelium (embryologically produces epithelial lining of fallopian tube (serous), endometrium, and endocervix (mucinous cells)

2 most common subtypes: serous and mucus (both cystic)

Present late with vague abdominal symptoms or compression (urinary frequency)
Poor prognosis (worst of genital tract cancers)

Spread locally (peritoneum); CA-125 for monitoring treatment and recurrence; not for diagnosis

38

Serous cystadenoma

Surface epithelial tumor of ovary (45% of ovarian tumors); Benign
Premenopausal (30-40 yo)

Histology: fallopian tube-like epithelium; single cyst (often bilateral) with simple, flat lining

39

Mucinous cystadenoma

Surface epithelial tumor of ovary; Benign

Histology: intestine-like tissue

Multilocular cyst lined by mucus-secreting epithelium

40

Serous cystadenocarcinoma

Surface epithelial tumor of ovary (45% of ovarian tumors; Malignant and bilateral
Postmenopausal women (60-70 yo)

Histology: complex cysts with thick, shaggy lining; psammoma bodies

Assoc. with BRCA1 (serous carcinoma of ovary and fallopian tube - prophylactic salpingo-oophorectomy)

41

Mucinous cystadenocarcinoma

Surface epithelial tumor of ovary; malignant

Pseudomyxoma peritonei - intraperitoneal accumulation of mucinous material from ovarian or apendiceal tumor

42

Endometrioid tumor

Surface epithelial tumor of ovary; malignant

Endometrial-like glands
May arise from endometriosis

15% associated with independent endometrial carcinoma (endometrioid type)

43

Brenner tumor

Surface epithelial tumor of ovary; benign
Solid tumor that is pale yellow-tan in color and appears encapsulated. "Coffee bean" nuclei on H&E staining

Histology: bladder-like epithelium

44

Germ cell tumors

2nd most common ovarian tumor (15%)
Reproductive age; mimics tissues normally produced by germ cells

1. Fetal tissue - cystic terotoma, embryonal carcinoma
2. Oocytes - dysgerminoma
3. Yolk sac - endodermal sinus tumor
4. Placental tissue - choriocarcinoma

45

Cystic teratoma

Germ cell tumor of ovary, most common germ cell tumor in females; 10% bilateral
Fetal tissue from two or three embryologic layers (skin, hair, bone, cartilage, gut, and thyroid)

Mature teratoma ("Dermoid cyst"): benign

Immature teratoma - aggressively malignant (usually neural ectoderm) or somatic malignancy (squamous cell carcinoma of skin) indicates malignant potential

46

Strauma ovarii

Cystic teratoma of ovary with thyroid tissue
Can present as hyperthyroidism

47

Dysgerminoma

Germ cell tumor of ovary

Large cells with clear cytoplasm and central nuclei (oocytes); uniform cells. Most common malignant germ cell tumor (testicular seminoma)

Elevated LDH, hCG
Assoc. with Turner syndrome
Good prognosis; responds to radiotherapy

48

Endodermal sinus tumor

Cystic termatoma of ovary (testes in boys)
Yolk sac; most common in children (sacrococcygeal area)

Yellow, friable, solid mass

Elevated AFP
Schiller-Duval bodies (glomerulus-like structures)

49

Choriocarcinoma

Germ cell tumor of ovary; malignant
Trophoblasts and syncytiotrophoblasts; mimics placental tissue, but absent chorionic villi

Can develop during or after pregnancy in mother or baby

Small, hemorrhagic tumor with early hematogenous spread (genetically programed to invade blood vessels) - to lungs

High beta-HCG (produced by synctiotrophoblasts)
May lead to theca-lutein cysts in ovary

Poor response to chemotherapy

50

Embryonal carcinoma

Germ cell tumor of ovary
Malignant tumor of large primitive cells (able to move and spread)

Aggressive with early metastasis

51

Granulosa-theca cell tumor

Sex cord-stromal tumor of ovary; malignant but minimal risk for metastasis

Neoplastic proliferation of granulosa and theca cells
Produces estrogens

Signs of estrogen excess (precocious puberty; menorrhagia/metrorrhagia; endometrial hyperplasia with postmenopausal uterine bleed)

Call-Exner bodies - small follicles filled with eosinophilic secretions

52

Sertoli-Leydig cell tumor

Sex cord-stromal tumor of ovary

Sertoli cells that form tubules and Leydig cells (between tubules) with characteristic Reinke crystals (pink cells with crystals)

Signs of androgen excess: hirsutism, virilization

53

Fibroma

Sex cord-stromal tumor of ovary

Benign tumor of fibroblasts; bundles of spindle-shaped fibroblasts

54

Meigs syndrome

Fibroma with pleural effusions (hydrothorax) and ascites
Pulling sensation in groin

Syndrome resolves with removal of tumor

55

Krukenberg tumor

Metastatic tumor of both ovaries
Most commonly from metastatic gastric carcinoma (diffuse type - secretes mucous)

Bilaterality distinguish metastases from primary mucinous carcinoma

Mucin=secreting signet cell adenocarinoma

56

Pseudomyxoma peritonei

Massive amoung of mucus in peritoneum
"jelly belly"

Mucinous tumor of appendix; usually with metastasis to the ovary

57

Ectopic pregnancy

P: lower quadrant abdominal pain a few weeks after missed period; lower than expected increased hCG

Implantation of fertilized ovum at site other than uterine wall; most common is lumen of fallopian tube

Key risk: scarring - salpingitis from PID, endometriosis, ruptured appendix, prior tubal surgery, history of infertility)

Surgical emergency; major complications: bleeding into fallopian tube (hematosalpinx) and rupture

58

Spontaneous abortion

P: vaginal bleeding, cramp-like pain, passage of fetal tissue

Miscarriage before 20 weeks (usually first trimester)

Chromosomal anomalies (trisomy 16), hypercoagulable states (antiphospholipid syndromes), congenital infections, exposure to teratogens (first 2 weeks)

59

Teratogen: Alcohol

Mental retardation, facial abnormalities, microencephaly

60

Teratogen: Cocaine

Intrauterine growth retardation, placental abruption