Test 2 Flashcards by Katie Tate

_________: a term used for endometrial tissue that forms __________ like nodules (Foci) outside the uterus. These foci are composed of endometrial _____ and _____. They respond to ________ stimulation and _________ with the normal endometrium.

Endometriosis
tumor
glands and stroma
estrogenic
proliferate

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Common locations of endometriosis

ovary, fallopian tube, pelvic peritoneum

on occasion, outside pelvis -> umbilicus, appendix, colon, pouch of douglas, vulva, bladdder, abdomen

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Common age to suffer from endometriosis

Reproductive years -> 20s-40s and women of a higher SES

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What is the regurgitation theory?

Most probable pathogenesis of endometriosis -> instead of endometrial tissue exiting the body through the vagina during every menstruation, it is regurgitated upstream where it enters the abdominal cavity through the fallopian tubes. The glands of the endometrial tissue implant on the serosa of the ovary or the peritoneum forming red brown nodules or plaques. Most foci of endometriosis are located near the opening of the fallopian tubes which support this theory

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Name for benign tumors originating from smooth muscle cells of the myometrium

Fibroids -> most common uterine tumors

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Name for benign fibroid

Leiomyomas (98%)

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Name for malignant fibroid

leiomyosarcoma (1-2%)

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Fibroid embedded within the myometrium

Intramural

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Fibroid that occurs beneath the covering serosa of the uterus

Subserosal

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Fibroid that protrudes into the endometrial cavity * Associated with miscarriage/infertility bc decreases ability for egg to implant onto uterus

Submucosa

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Risk factors for endometrial adenocarcinoma? (7)

What reduces the risk of this cancer? (1)

Exogenous estrogen
Have estrogen-producing tumors
Obesity
DM
HTN
Nulliparous
Early Menarche/late menopause

Most affected women have excellent prognosis

Risk reduced by multiple pregnancies -> gives endometrium long breaks from proliferation

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What is caused by excessive estrogenic stimulation of the endometrium leading to cystic expansion and thickening of the entire endometrium with multi-layering of the enometrial glands with scant endometrial stroma

Endometrial hyperplasia

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What type of hyperplasia is seen with minimal glandular complexity and no cytologic atypia

Simple Hyperplasia (1% progression to adenocarcinoma)

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What type of hyperplasia is seen with multilayering of the glands with crowding but still no cytologic atypia

Complex Hyperplasia (3% progression to adenocarcinoma)

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What type of hyperplasia is seen with complexity of the glands with crowding and there is cytologic atypia, also the epithelial cells are enlarged and hyperchromic with high nucleus/cytoplasm ratio and prominent nucleoli?

Atypical Hyperplasia (25% progression to adenocarcinoma)

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What is the most common malignant tumor of the female genital tract? (50% of all GYN malignancies and usually in women over 35 years)

Endometrial adenocarcinoma

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Where does endometrial adenocarcinoma originate from?

epithelial cells lining the endometrial glands

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The endometrial adenocarcinoma tumor appears as a ________ mass protruding into the ______ lumen.
The tissue is ______ and ______ bc it consists of atypical _______ with very little stroma.

fungating
uterine
friable and soft
glands

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The most common symptom in endometrial cancers is?

Vaginal bleeding that may occur as spotting between 2 menstruations or as prolonged pronounced menstrual bleeding (menorrhagia)

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Treatment for endometrial adenocarcinoma?

D&C (Dilation and Curettage) -> TAH-BSO ( hysterectomy w/ or w/o ovaries -> possible lymph node removal

(80% of all endometrial cancers are detected while the tumor is confined to the uterus and affected women have an excellent prognosis)

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Most common site of implantation in an ectopic pregnancy?

95% in Fallopian tube -> ovary -> abdominal cavity

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With an ectopic pregnancy, the ______zygote undergoes its normal development with the formation of _______ tissue and _______ sac.
The _________ is poorly attached to the wall of the tube and weakens it with the possibility of ________ and _________ hemorrhage

fertile
placental
amniotic
placenta
rupture
intraperitoneal

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Major sign/symptom of an ectopic pregnancy?

Severe abdominal pain with rupture and possibility of shock

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T/F a pregnancy test will be positive even with an ectopic pregnancy

True

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What denotes rupture during an ectopic pregnancy?

Aspiration of fresh blood from the pouch of Douglas (posterior fornix)

What is the most common pathologic condition leading to ectopics? Plus 3 other causes?

1. CHRONIC SALPINGITIS (PID) 2. Pertubal adhesions as from endometriosis 3. Previous Surgeries 4. leiomyomas

Diagnosis of an ectopic pregnancy involves what 3 things?

1. Biopsy (endometrial - shows decidual reaction) 2. Absence of chorionic villi bc the villi are in the tube 3. Ultrasound -will show dilation of fallopian tube

If there is an ectopic pregnancy in the Fallopian tube, at how many weeks will rupture occur?

2-6 weeks

What are the 2 complications of chronic salpingitis from PID? Also what are 2 more complications of PID?

1. ectopic pregnancy 2. Infertility- risk increases with GC infection, scars FT -> occludes lumen and prevents spem from reaching egg 3. Abscesses 4. Peritonitis

Name 8 types of adenocarcinomas (neoplasia of epithelial tissue of glandular origin)

1. Endometrial Hyperperplasia (non-neo) 2. Endometrial Polyps (non neo) 3. Endometrial Adenocarcinoma (neo) 4. Tumors of the Fallopian tubes (rare, epithelium doesnt shed or respond to estrogen) 5. Tumors of surface epithelium (neo - ovaries) 6. Serous Cystadenocarinoma 7. Solid Serous Cystadenocarcinoma 8. Mucinous Cystadenocarcinoma

What are benign localized overgrowths that project from the endometrial surface into the endometrial cavity? Most arise in the fundus, usually solitary and vary in size.

Endometrial polyps

What is a squamous cell cancer of the female reproductive tract that deals with pus in the endometrial cavity (pyometria)

Pyometria (non neo) | Associated with any lesion that causes cervical stenosis such as a tumor or scarring from surgical tx of the cervix

Name 5 surface germinal epithelium tumors and whether they are benign or malignant (These are the worst of the primary neoplastic ovarian masses)

1. Serous (Benign - borderline Malignant) 2. Mucinous (Benign - borderline Malignant) 3. Brenner (Benign) 4. Endometroid (Malignant) 5. Transitional Cell (Malignant)

Name 5 germ cell tumors and whether they are benign or malignant

1. Dermoid (Benign) 2. Dysgerminoma (Malignant) 3. yolk sac (Malignant) 4. Choriocarcinoma (Malignant) 5. Embryonal (Malignant)

Name 4 sex cord stromal tumors and whether they are benign or malignant

1. Thecoma (Benign) 2. Fibroma (Benign) 3. Granulosa (Malignant) 4. Sertoli- Leydig (Malignant)

Which tumor secretes HCG? | can be used as a diagnostic marker/monitoring tumor recurrence after chemo

Choriocarcinoma

Which sex cord tumor secretes estrogen, causes menstrual irregularities, and endometrial hyperplasia?

Thecoma

What sex cord tumor produces estrogen that can cause menstrual irregularities -> precocious puberty and in older women, lead to breast/endometrial cancer?

Granulosa Cell Tumor

Which sex cord tumor secretes androgens which causes virilization?

Sertoli-Leydig Cell Tumor

Which germ cell tumor is the "worst" and why?

Choriocarcinoma -> highly invasive/malignant -at time of dx tumor has typically already spread throughout blood stream to the lungs and other organs (liver brain bones)

Because the ovary is homologue of testes, what is the male equivalent of a choriocarcinoma?

teratocarcinoma

Choriocarcinomas are an ______ germ cell tumor. Made up of __________ cells. Results in bulky hemorrhagic ________ in placental bed that invades through the wall of the _______ and often implants into the ________. Can be solid or ______

``` ovarian trophoblastic nodules uterus vagina cystic ```

Where do choriocarcinomas arise from? (3)

pre existing complete hydatidiform mole (50%) placental tissue from abortion (25%) normal placenta after delivery (25)

Histologically, the choriocarcinoma is identical to what 3 lesions?

placenta endometrial testicular

What is the most common germ cell tumor? Hint it is the most common ovarian tumor in women less than 25 years of age

benign cystic teratoma aka dermoid cyst (95%) | rare but could lead to malignant teratocarcinoma

What is the homologue tumor of the female dysgerminoma found in males?

1. Seminoma -> tumor is large, firm, with a fleshy cut surface

What female malignant tumor is uncommon but makes up half of all malignant germ cell tumors? Tx is surgical. Usually occurs in childhood. Only 1/3 are aggressive. Highly radiosensitive

Dysgerminoma

What is the counterpart of the yolk sac tumor of the testes and what does it produce?

Endodermal Sinus Tumor | produces alpha fetoprotein (AFP)

What GYN cancer is most deadly?

Ovarian - causes more deaths than all other tumors of the reproductive tract, but is second most common behind endometrial adenocarcinoma

Which type of surface epithelium tumor is most common, mimics fallopian tube epithelium, seen older in life, consists of several cysts lumped together within a common outer capsule, and is least serious of the group?

Serous tumor - commonly benign 7:1

T/F all malignant tumors are characterized by hemorrhage and necrosis both grossly and microscopically

True

What is the Ab to cancer Ag detected in the serum in about 1/2 of the epithelial tumors that are confined to the ovary but 90% have already spread

CA-125

Which surface epithelial tumor mimics endocervical epithelium?

Mucinous - cavity of tumor filled with thick yellowish or clear jelly substance

What can happen is a mucinous tumor is malignant and ruptures?

Pseudomyxoma peritonei

Which surface epithelium tumor mimics urinary system epithelium? Give 2 names

Brenner - AKA transitional cell carcinoma (if in stage III/IV, 8% 5 year survival)

What are characteristics of a Brenner tumor?

Solid by a dense fibrous stroma with nests of transitional epithelium

Which surface epithelium tumor mimics endometrial glands?

Endometrioid -> solid tumor can harbor benign endometriosis 15-30% accompanied by carcinoma of the endomedtium

Tumor of the GI tract that metastasizes to the ovaries. The most common metastatic tumor being a stomach carcinoma that will tend to produce bilateral enlargement of the ovaries

Krukenberg tumor

__________ ______ is a placental abnormality marked by trophoblastic proliferation & hydropic degeneration of chorionic villi

Hydatidiform Mole

The most common form of hydatidiform mole is the ____________ ______ Where the ______ cannot be identified in the ________ ___

Complete Mole Fetus Amniotic Sac

Complete Mole is a result of what? | What is that process called?

abnormal fertilization -> all chromosomes are paternal due to loss of maternal chromosomes from the zygote at the time of fertilization ANDROGENESIS - Paternal 23 chromosomes re-duplicate to create 46 chromosomes

What happens to the embryo in a case of complete mole?

Without maternal chromosomes, the embryo cannot develop and the placenta undergoes hydropic degeneration

What happen with an incomplete hydatidiform mole?

Oocyte fertilized with 2 sperm -> 69 chromosomes Lethal combination, but embryo doesnt die immediately so parts of the embryo are found encased among the hydropically altered placental villi & normal placental tissue

What are some signs or symptoms of a hydatidiform mole pregnancy?

1. Enlarged uterus compared to the normal corresponding growth ( people think its twins!) 2. No fetal movement/ heartbeat 3. Snowstorm pattern on ultasound 4. High serum/urine levels of HCG 5. Aborted spontaneously mid pregnancy

Mucous CT in umbilical cord

Wharton's Jelly -> provides insulation and protection, also site of umbilical cord stem cells

Fetal/newborn feces

Meconium - tar like

As the blastocyst implants into the endometrium, it stimulated the ________ _________ The cells of the endometrial ______ (fleshy endometrial tissue between the glands of the inner lining endometrium) accumulate ______ & _______, become plump and are transformed into _________ cells The________ thickens & becomes more highly ___________, and the endometrium is now called _______ and is ready for blastocyst implantation.

``` Decidual Reaction stroma lipids & glycogen decidual stroma vascularized decidua ```

What is found in 18% of placentas in pregnancies that last longer than 42 weeks?

Meconium-stained placenta - green colored staining, easily rinses off - major complication of thick meconium is aspiration causing fetal chemical pneumonitis

The attachment of the placental villi to the level of the myometrium without further invasion causes?

Placenta Accreta

The placental villi invade into the underlying myometrium causes?

Placenta Increta

The placental villi penetrate into the full-thickness of the uterine wall causes?

Placenta Percreta

The usual term placenta is about ______ in diameter and ______ thick In generally weighs ________ The maternal surface is dark _____ or _____ in color and should be divided into ______ or cotyledons. The fetal surface should be ______, grey and translucent enough to see the color of the underlying cotyledons. Fetal membranes (__________) are usually shiny, wrinkled, and translucent.

``` 22-24 cm in diameter and 2.5-3.0 cm thick 500grams (1lb) red or maroon lobules shiny amnio-chorion ```

The umbilical cord at birth is ______ _______ in color _____ cm in diameter _____ cm long It is _________ positioned, and contains the right and left (2!) umbilical ________, the left umbilical ______(1), and ___________.

``` Pearly white 1-2 cm 50-60 cm eccentrically arteries vein Wharton's jelly ```

The right and left umbilical arteries carry _________ blood from the fetus to the placenta. The umbilical vein carries ___________ blood from the placenta to the fetus.

deoxygenated | oxygenated

The volume of amniotic fluid ________ through the 7th month and then _______ somewhat in the last 2 months. At birth the vol. of amniotic fluid is around ___ L. The rate of water exchange within the amniotic fluid is around _______ ml/hr The term fetus swallows about _____ ml of amniotic fluid daily and excretes ____ml of urine daily Maternally derived water that is similar to ____ _____ in composition, that is continually produced and constantly ________.

``` increases decreases 1 L 400-500 ml/hr 400ml 500ml blood plasma resorbed ```

What does amniotic fluid contain? (10 things)

1. Electrolytes 2. Carbs 3. Amino Acids 4. Lipids 5. proteins (hormones, enzymes, alpha-fetoproteins) 6. urea 7. creatineine 8. desquamated fetal cells 9. fetal urine and feces 10. fetal lung lipids (lecitchin and sphingomyelin -2:1)

What is found on the maternal side of the placenta, consists of main stem of chorionic villus, and split in 15-30 divisions of the placenta?

Cotyledons - if any remain after birth -> post-partum hemorrhaging

Which hormone secreted from the placenta is know as the growth hormone for the fetus?

Human Placental Lactogen (hPL) -> protein hormone that induces lipolysis thus elevating free FA content in mom

What term is used to describe a placenta with extra lobes, usually linked by thin chorionic tissue, and usually of no clinical importance unless a portion of the lobe is retained after birth -> postpartum bleeding

Succenturiate

What term is used to describe a placenta with a rolled and raised ring of fetal membrane, instead of staying at the edge of the placenta? (Chorionic plate < basal plate).

Circumvallate

What are 4 risks with a circumvallate placenta?

1. Prematruity 2. Prenatal bleeding 3. Placental abruption 4. Multiplarity

What is the name of a condition with numerous small, gray, or yellow nodules on the fetal surface of the placenta which may be associated with oligohydramnions

Amnion Nodosa

What is Oligohydramnions? What can it cause?

Low amount of amniotic fluid, can cause Potters Syndrome which is renal agenesis (kidneys fail to develop)

What is the most common complication of a baby being born with amniotic fluid thick with meconium?

Aspiration causing fetal chemical pneumonitis

What can cause acute chorioamnionitis? (3 groups)

1. genital mycoplasm species (M. hominis/U. urealyticum 2. anaerobic bacteroides group 3. aerobe group B Strep, E. coli, and Gardnerella vaginalis Commonly caused by premature rupture of amniochorionic membranes (PROM)

What is the name for inflammation of the umbilical cord typically caused by intrauterine infection (meconium exposure, spread of chorioamnionitis, Candida, Actinomyces, HSV, Syphilis) ?

Funisitis -acute fetal inflammatory respose - can be necrotizing (infiltration into Whartons Jelly) or peripheral (micro-abscesses on surface)

What are two signs of funisitis?

1. Vasculitis of umbilical vessels | 2. PNM inflitration after extension of Wharton's Jelly

Test 2 Flashcards

(87 cards)