Tumors / Cysts

Question 1

Which tumor?

• Originate from specialized ovarian stromal cells
• 5% of ovarian tumors
• Has 3 variants

Answer 1

Sex Cord Stromal Tumors

Question 2

What are the 3 Sex Cord Stromal Tumor Variants

Answer 2

• Thecomas
• Granulosa Cell Tumors
• Sertoli-Leydig Cell Tumors

Question 3

Which tumor?

• Solid tumor
• Secretes estrogens
• Always benign
• Cause menstrual irregularities
• Causes endometrial hyperplasia

Answer 3

Thecomas

(Sex Cord Stromal Tumors)

Question 4

Marshmellow man w/ detached penis beside him

Answer 4

Thecoma of Ovary

(Sex Cord Stromal Tumors)

Question 5

Which tumor?

• Solid tumor
• Cells resemble granulosa cells of ovarian follicles
• Produce estrogens / menstrual irregularities
• Small ones are benign
• Large ones may be malignant
• Can cause precocious puberty in young girls
• Can lead to breast / endometrial cancer in older women

Answer 5

Granulosa Cell Tumors

(Sex Cord Stromal Tumors)

Question 6

“Fish w/ a bloody side fin”

Answer 6

Granulosa Cell Tumor

(Sex Cord Stromal Tumors)

Question 7

• Solid tumors
• Hormonally active cells which secrete Androgens –> cause virilization (deep voice, facial hair, male pattern baldness, hairy chest w/ hypertrophy of clitoris)
• May be benign or malignant

Answer 7

Sertoli-Leydig Cell Tumors

(Sex Cord Stromal Tumors)

Question 8

Tomato w/ sun spots

Answer 8

Sertoli-Leydig Cell Tumor

Question 9

Which tumor?

• Originate most often from carcinomas of endometrium and breast
• Have estrogen receptors (metastasize to ovaries)
• Tumors of GI tract metastasize to ovaries
• Most common is stomach carcinomas (produce bi enlargement of ovaries-Krukenberg tumors)

Answer 9

Metastatic Ovarian Tuors

Question 10

Metastasis of GI tract to ovary

Answer 10

Krukenberg tumors

Question 11

fortune cookie

Answer 11

Krukenberg Tumor

Question 12

• Implantation of fetus in ANY other site other than the normal uterine location
• 1/150 pregnancies
• Chronic Salpingitis (adhesions) leads to this
• Peritubal adhesions from endometriosis, previous surgeries, and leiomyomas
• *Chronic complication of PID*

Answer 12

Ectopic Pregnancy

Question 13

3 most common areas of ectopic

Answer 13

• fallopian tubes (95%)
• ovary
• Abdominal Cavity

Question 14

How/why do ectopic pregnancies occur?

Answer 14

• Intratubal adhesions forms barrier to normal passage of zygote (so the zygote implants at site of obstruction)

Question 15

• The entire fertile zygote undergoes its normal development w/ formation of placental tissue & amniotic sac
• Placenta is poorly attached to wall of tube
• This all leads to what 3 things?

Answer 15

• Weakening of tube
• Risk of rupture
• Risk of intraperitoneal hemorrhage

Question 16

W/ ectopic pregnancy, when does rupture usually occur?

Answer 16

2-6 weeks after pregnancy

Question 17

Describe the fallopian tube

Answer 17

Dilated

Question 18

• Severe abdominal pain
• Possibility of shock (which type)?
• Signs/sxs of acute abdomen

Answer 18

Ruptured Ectopic Pregnancy

-Hypovolemic shock (Hemorrhagic Shock)

Question 19

Ectopic Pregnancy

Are pregnancy tests positive or negative?

Answer 19

Positive

Question 20

What procedure could you perform to detect a ruptured ectopic?

Answer 20

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

Question 21

What is helpful in dx of Ectopic Pregnancy?

Answer 21

Endometrial biopsy

Question 22

How is dx of ectopic pregnancy made?

Answer 22

US of fallopian tube showing dilation

Question 23

• Absence of ____ ____ is consistent w/ ectopic pregnancy
• What will biopsy show?
• US will show what?

Answer 23

• Chorionic villi
• Decidual reaction of endometrium
• Dilation of fallopian tube

Question 24

• Rupture of ectopic is medical emergency
• How many die before hemorrhage can be controlled?

Answer 24

1/400

Question 25

* Disease which involves trophoblastic epithelium and includes a spectrum of proliferative lesions

Answer 25

Gestational Trophoblastic Disease

Question 26

3 types of Gestational Trophoblastic Disease (GTD)

Answer 26

* **Benign:** Hydatidiform * **Limited proliferation:** trophoblast * **Highly malignant:** Choriocarcinoma

Question 27

* Has no fetal parts * Only contains placental tissue inside the uterus w/ "snow storm patter" on US * No heart, no baby, ONLY grapes of chorionic villi

Answer 27

Gestational Trophoblastic Disease (GTD)

Question 28

* Placental abnormality marked by trophoblastic proliferation & hydropic degeneration of chorionic villi

Answer 28

Hydatidiform Mole (Gestational Trophoblastic Disease) - benign

Question 29

* Most common form of Hydatidiform Mole * Fetus cannot be identified in amniotic sac * Results from abnormal fertilization (all chromosomes are paternal due to loss of maternal chromosomes from zygote at time of fertilization) * \*\*Duplication of paternal haploid\*\*

Answer 29

Complete Mole | (Gestational Trophoblastic Disease)

Question 30

Alien baby

Answer 30

Complete Hydatidiform Mole | (Gestational Trophoblastic Disease)

Question 31

Answer 31

Swollen Hydropic Villi (of Hydatidiform Mole) (Gestational Trophoblastic Disease)

Question 32

**Complete Hydatidiform Mole (of GTD)** * Has no fetal parts/no embryo development, bc it has no maternal chromosomes, _so the placenta undergoes what?_ * Paternal 23, X set of chromosomes reduplicates = 46 _(this is called what?)_

Answer 32

* Hydropic degeneration * Androgenesis

Question 33

* Evolves from oocytes fertilized w/ 2 spermatozoa. * How many chromosomes? * __ sets from mom * ___ sets from dad

Answer 33

**Incomplete Hydatidiform Mole (GTD)** * 69 * 1 from mom * 2 from dad

Question 34

* Lethal * But, embryo doesn't die immediately * Parts of embryo found encased among hydropically altered placental villi & normal placental tissue

Answer 34

Incomplete Hyatidiform Mole (GTD)

Question 35

**In the US, Hydatidiform Moles of GTD are rare (1/2000)** * What is dx based on?

Answer 35

* enlarged uterus for corresponding / calculated duration of pregnancy * No signs of fetal movement

Question 36

Best method for dx Hydatidiform Mole (GTD)?

Answer 36

US will detect snow-storm patter w/ no fetal heart beat or movement

Question 37

* W/ Hydatidiform Mole, high serum and urine levels of ____ are typically found. * What is the malignant tumor called? * Grossly, placenta is transformed into \_\_\_\_\_\_.

Answer 37

* HCG * Chorio * numerous grape-like clear vesciles filled w/ fluid / covered w/ hyperplastic trophoblastic epithelium

Question 38

* Malignant tumors composed of trophoblastic cells * 50% arise from preexisting complete mole * 25% arise from placental tissue retained after abortion * 25% arise from normal placenta after completion of normal pregnancy

Answer 38

Choriocarcinoma

Question 39

Why is it important to remove all parts of abnormal placenta of Hydatidiform Mole?

Answer 39

Remaining trophoblastic cells could give rise to malignancy (chorio)

Question 40

* Highly invasive tumors * The tumor secretes ___ which is a good marker for the disease and monitors tumor recurrence after chemotherapy

Answer 40

**Choriocarcinoma** HCG

Question 41

* Forms bulky hemorrhagic nodules in placental bed * Invades through wall of uterus & often invades through wall of uterus * Often implants in vagina

Answer 41

Choriocarcinoma

Question 42

By invading \_\_\_\_, metastasizes to lung, liver, and brain.

Answer 42

veins

Question 43

Tumor responds well to chemo w/ _____ and cure rates of 80-100% have been achieved (but only in those w/o metastases.

Answer 43

Methotrexate | (Choriocarcinoma)

Question 44

C shaped

Answer 44

Choriocarcinoma