Twenty Four Flashcards
What is suppurative salpingitis? What is the most common cause? What can it be a part of?
SUPPURATIVE SALPINGITIS
- suppurative salpingitis describes fallopian tube infection with a pyogenic organism.
- the most common cause is Neisseria gonorrhoeae (gonococcus) infection, responsible for ~60% of cases.
- suppurative salpingitis can be part of pelvic inflammatory disease (PID).
What is tuberculous salpingitis? Epidemiology? Results?
TUBERCULOUS SALPINGITIS
- tuberculous salpingitis describes fallopian tube infection with Mycobacterium tuberculosis (MTB).
- in USA, MTB infection accounts for only 1-2% of salpingitides.
- in parts of the world where tuberculosis is more prevalent, tuberculous salpingitis is a prominent cause of infertility.
What are paratubal cysts? What are they like? What is the hydatid of morgagni? Where is it located? Benign or malignant?
PARATUBAL CYST
- paratubal cysts are translucent, usually less than 2 cm, and filled with serous fluid.
- the hydatid of Morgagni represents a larger paratubal cyst found near the fimbria or within the broad ligament.
- paratubal cysts are not neoplastic.
What is an adenomatoid tumor of the fallopian tube? `
ADENOMATOID TUMOR
• adenomatoid tumor is a benign neoplasm derived from mesothelial cells.
How common is an adenocarcinoma of the fallopian tube? What mutation can it be associated with? What is the prognosis?
ADENOCARCINOMA
- primary adenocarcinoma (malignant) of the fallopian tube is rare.
- it can be associated with BRCA mutations.
- prognosis is poor: even stage I tumors have less than 40% 5-year survival.
What is the functional unit of the ovary? What does it consist of? What hormones are involved with which cells? What is the funciton of the cells? Describe the basic process of ovulation. What is a hemorrhagic corpus luteal cyst? When does it occur? What are follicular cysts?
I. BASIC PRINCIPLE S
A. The functional unit of the ovary is the follicle.
B. A follicle consists of an oocyte surrounde d by granulos a and theca cells (Pig. 13,11 A)
1 . LH acts on theca cells to induce androgen production.
2. FSH stimulates granulosa cells to convert androgen to estradiol (drives the proliferative phase of the endometrial cycle).
3 . Estradiol surge induces an LH surge, which leads to ovulation (marking the beginning of the secretory phase of the endometrial cycle).
C. After ovulation, the residual follicle becomes a corpus luteum (Fig. 13.1 IB), which primarily secretes progesterone (drives the secretory phase which prepares the
endometrium for a possible pregnancy).
1 . Hemorrhage into a corpus luteum can result in a hemorrhagic corpus luteal cyst, especially during early pregnancy.
D. Degeneration of follicles results in follicular cysts. Small numbers of follicular cysts are commo n in women and have no clinical significance.
What is PCOD? What is the basic pathophys? What is the classic presentation? What additional finding might some women have? What are they at increased risk for?
II. POLYCYSTIC O V A R I A N DISEAS E (PCOD )
A. Multiple ovarian follicular cysts due to hormone imbalance
1 . Affects roughly 5% of wome n of reproductive age
B. Characterized by increased LH and low FSH (LH:FSH > 2)
1 . Increased LH induces excess androgen productio n (from theca cells) resulting in
hirsutis m (excess hair in a male distribution).
- Androgen is converted to estrone in adipose tissue.
i. Estrone feedback decreases FSH resulting in cystic degeneration of follicles.
ii. High levels of circulating estrone increase risk for endometrial carcinoma,
C. Classic presentation is an obese young woman with infertility, oligomenorrhea, and
hirsutism; some patients have insulin resistance and may develop type 2 diabetes mellitus 10-1 5 years later.
What are the three types of cells in the ovary? From which can tumors arise?
I. BASIC PRINCIPLE S
A. Ovary is composed of three cell types: surface epithelium, germ cells, and sex cordstroma.
B. Tumo r can arise from any of these cell types or from metastases.
What is the most common type of ovarian tumor? What is it derived from? Where else is this tissue found? What are the most common subtypes? Describe them generally. What are they like if they are benign? In whom do they arise? What are they like if they are like if they are malignant? In whom do they arise? What are they like if they are borderline? What implications does borderline have clinically? Which type do BRCA-1 mutation carriers have an increased risk for? What clinical implications does this have? What are endometriod tumors? What are some pathophysiologies of these? Malignant or benign? What is a Brennan tumor like? Malignant or benign?
A. Most commo n type of ovarian tumo r (70% ofcases )
B. Derived from coelomic epithelium that lines the ovary; coelomic epithelium
embryologically produces the epithelial lining of the fallopian tube (serous cells),
endometrium, and endocervix (mucinous cells).
C. The two most commo n subtypes of surface epithelial tumors are serous and mucinous; both are usually cystic.
1 . Serous tumors are full of watery fluid.
2. Mucinous tumors are full of mucus-like fluid.
D. Mucinous and serous tumors can be benign, borderline, or malignant,
1 . Benign tumors (cyst adenomas) are composed of a single cyst with a simple, llat lining (Fig. 13.12); most commonl y arise in premenopausal women (30-4 0 years
old)
2. Malignant tumors (cystadenocarcinomas) are composed of complex cysts with a thick, shaggy lining; most commonl y arise in postmenopausal women (60-7 0
years old)
3 . Borderline tumors have features in between benign and malignant tumors .
I. Better prognosis than clearly malignant tumors, but still carry metastatic potential
- BRCAl mutation carriers have an increased risk for serous carcinoma of the ovary and fallopian tube,
i. BRCA1 carriers often elect to have a prophylactic salpingo-oophorectomy (along with prophylactic mastectomy due to the increased risk for breast cancer).
E. Less commo n subtypes of surface epithelial tumors include endometrioid and Brenner tumor.
1 . Endometrioid rumors are composed of endomelrial-like glands and are usually malignant.
i. May arise from endometriosis
ii. 15% of endometrioid carcinomas of the ovary are associated with an independent endometrial carcinoma (endometrioid type).
2, Brenner tumors are composed of bladder-like epithelium and are usually benign.
How do surface tumors present? What is the prognosis? What is their spread like? What is the significance of CA-125?
F. Surface tumors clinically present late with vague abdominal symptoms (pain and fullness) or signs of compression (urinary frequency).
1 , Prognosis is generally poo r for surface epithelial carcinoma (worst prognosis of female genital tract cancers).
2, Epithelial carcinomas tend to spread locally, especially to the peritoneum.
G. CA-125 is a useful serum marker to monitor treatment response and screen for
recurrence.
In whom do germ cell tumors usually occur? What tissues do the subtypes mimic? What are 5 kinds?
EIL G E RM CEL L T U M O R S
A, 2nd most commo n type of ovarian tumo r (15% of cases)
B, Usually occur in women of reproductive age
C. Tumor subtypes mimi c tissues normally produced by germ cells.
1 . Fetal tissue—cystic teratoma and embryonal carcinoma
2. Oocytes—dysgermi no ma
3 . Yolk sac—endodermal sinus tumo r
4. Placental tissue—choriocarcinoma
What is a cystic teratoma? Epidemiology? Benign or malignant? explain. What is a struma ovarii? What is an embryonal CA? Malignant or benign? Cell type? Prognosis/spread?
D. Cystic teratoma
1 . Cystic tumo r composed of fetal tissue derived from two or three embryologic layers (e.g., skin, hair, bone, cartilage, gut, and thyroid, Fig. 13.13)
i. Most commo n germ cell tumo r in females; bilateral in 10% of cases
2. Benign, but presence of immature tissue (usually neural) or somatic malignancy (usually squamous cell carcinoma of skin) indicates malignant potential.
3 . Struma ovarii is a teratoma composed primarily of thyroid tissue.
- Embryonal carcinoma
1 . Malignant tumo r composed of large primitive cells - Aggressive with early metastasis
What is a dysgerminoma? Histology? Epidemiology? What is its testicular counterpart? Prognosis? Treatment? Serum marker?
£. Dysgerminoma
1 . Tumo r composed of targe cells with clear cytoplasm and central nuclei (resemble oocytes, Fig. 13.14); most commo n malignant germ cell tumo r
2. Testicular counterpart is called seminoma, which is a relatively commo n germ cell tumo r in males.
3 . Goo d prognosis; responds to radiotherapy
4. Serum LDH may be elevated.
What is an endodermal sinus tumor? Epidemiology? Serum marker? histology?
F. Endodermal sinus tumo r
1 . Malignant tumo r that mimic s the yolk sac; most commo n germ cell tumo r in children
2. Serum AFP is often elevated.
3 . Schiller-Duval bodies (glomerulus-! ike structures) are classically seen on histology (Fig, 13.15).
What is a choriocarcinoma (germ cell origin)? Cell type? Histology? Spread? Gross pathology? Serum marker? Results of serum marker? Treatment/prognosis?
G. Choriocarcinoma
1 . Malignant tumo r composed of trophoblasts and syncytlotrophoblasts; mimic s placental tissue, but villi are absent
2. Small, hemorrhagic tumor with early hematogenous spread
3 . High |3-hCG is characteristic (produced by syncytiotrophoblasts); may lead to thecal cysts in the ovary
4. Poor response to chemotherapy
