Term
| What are the ovaries attached to? |
|
Definition
| posterior aspect of the broad ligament |
|
|
Term
| What are the three main components of the ovaries? |
|
Definition
| surface epithelium, germ cells, and sex cored-stromal cells |
|
|
Term
| T/F The ovarian stroma is capable of producing hormones. |
|
Definition
| T d/t the granulosa and theca cells |
|
|
Term
| What is a graafian follicle? |
|
Definition
| one dominant follicle that matures every menstrual cycle and is shed during ovulation |
|
|
Term
|
Definition
| the granulosa cells that surround the follicle accumulate lipid and produce progesterone and estrogen |
|
|
Term
| What is the corpus luteum? |
|
Definition
| the collapsed yellow follicle after ovulation that produces progesterone |
|
|
Term
| Name different physiologic cysts of the ovary. |
|
Definition
| inclusion cysts and follicular cysts |
|
|
Term
| What are inclusion cysts? |
|
Definition
| results from invagination of the surface epithelium. extremely common (virtually physiologic) |
|
|
Term
| What are follicular cysts? |
|
Definition
| distention of developing follicles (>2cm) that are lined by granulosa cells and can produce estrogens |
|
|
Term
| What is a corpus luteum cyst? |
|
Definition
| bright yellow convoluted thick rimmed hemorrhagic cyst lined by luteinized cell. assoc. with progesterone production. |
|
|
Term
| What are the symptoms of corpus luteum cysts? |
|
Definition
| menstrual irregularities and hemorrhage |
|
|
Term
| What are possible complications of corpus luteum cysts? |
|
Definition
| rupture and peritoneal reactions |
|
|
Term
| What's another name for polycystic ovarian disease PCOD? |
|
Definition
|
|
Term
|
Definition
| 3-6% of reproductive age women |
|
|
Term
| What is the most common cause of infertility? |
|
Definition
|
|
Term
| What is the presentaiton of PCOD? |
|
Definition
| oligomenorrhea d/t persistent anovulation, obesity (40%), hirsutism (50%), and rarely virilism |
|
|
Term
| PCOD increases your risk of.. |
|
Definition
| endometrial and breast cancer |
|
|
Term
| What do PCOD ovaries look like? |
|
Definition
| enlarged, smooth ovarian surfaces, with subcortical cysts |
|
|
Term
| What does PCOD look like on histology? |
|
Definition
| numerous cystic follicles or follicular cysts within cortex with hyperplasia of the theca interna (follicular hyperthecosis) |
|
|
Term
| Are most ovarian tumors benign or malignant? |
|
Definition
|
|
Term
| What age group is predisposed to ovarian tumors? |
|
Definition
|
|
Term
| Malignant ovarian tumors are more common in what patient population? |
|
Definition
|
|
Term
| What is the most common cause of death from gynecologic malignancies? |
|
Definition
| ovarian tumor, because often detected late d/t inadequate screening mechanisms |
|
|
Term
| What are the risk factors for ovarian cancer? |
|
Definition
| nulliparity, family history, and hertible mutations as well as gonadal dysgenesis |
|
|
Term
| What decreases your risk of ovarian tumors |
|
Definition
| history of oral contraceptive use or tubal ligation decreases the risk |
|
|
Term
| Which women affected by ovarian cancer might have BRCA1? |
|
Definition
| 5% of women < 70 yoa with ovarian cancer |
|
|
Term
| What genetic mutations of ovarian cancer are associated with a poorer prognosis? |
|
Definition
| Her2/neu (ERB-B2) mutations |
|
|
Term
| What genetic mutations cause ovarian tumors? |
|
Definition
| BRCA1, BRCA2, HER2neu (ERB-B2), p53 |
|
|
Term
| What is the frequency of different types of ovarian tumors? |
|
Definition
| 65-70%= surface epithelial cells, 15-20%= germ cell, 5-10% sex cord-stroma, 5% metastasis to ovaries |
|
|
Term
| What are the different types of surface epithelial cell tumors? |
|
Definition
| serous tumor, mucinous tumor, endometrioid tumor, clear cell tumor, brenner tumor, cystadenofibroma |
|
|
Term
| What are the different types of ovarian germ cell tumors? |
|
Definition
| teratoma, dysgerminoma, endodermal sinus tumor, choriocarcinoma |
|
|
Term
| What are the different kinds of sex cord stroma tumors of the ovary? |
|
Definition
| fibroma, granulosa-theca cell tumor, sertoli-leydig tumor |
|
|
Term
| What is the MC kind of malignant ovarian tumor? |
|
Definition
| 90% are surface epithelial tumors |
|
|
Term
| The risk of malignancy of surface epithelial tumors of the ovary increases as does the... |
|
Definition
| amount of discernible solid epithelial growth |
|
|
Term
| All types of surface epithelial tumors can be divided into what categories? |
|
Definition
| benign, borderline, malignant |
|
|
Term
| How many serous tumors are benign? Borderline? Malignant? |
|
Definition
| benign = 60 %, borderline= 10-15%, malignant = 15-20% |
|
|
Term
| Are serous tumors commonly bilateral? |
|
Definition
| yes! 20% benign and 66% malignant |
|
|
Term
| Describe a benign serous tumor. |
|
Definition
| smooth cyst wall with a few papillary projections |
|
|
Term
| Describe a borderline serous tumor? |
|
Definition
| increased number of papillary projections with increasing architectural complexity and nuclear stratification (no invasion) |
|
|
Term
| Describe a malignant serous tumor? |
|
Definition
| large amounts of solid or papillary tumor mass; complex growth with invasion and exterme nuclear atypia |
|
|
Term
| What is the MC malignant ovarian tumor? |
|
Definition
|
|
Term
| Name a histological feature of all ovarian serous tumors? |
|
Definition
|
|
Term
| What is the serum marker for serous tumors? |
|
Definition
|
|
Term
| High levels of CA-125 are suggestive of.. |
|
Definition
| serous cystadenocarcinoma |
|
|
Term
| What is used as a screening mechanism for ovarian tumors? |
|
Definition
|
|
Term
| How do ovarian serous tumors spread? |
|
Definition
| peritoneal spread; invasive or non-invasive implants |
|
|
Term
| Describe a serous cystadenoma. |
|
Definition
| benign cystic neoplasm that contains serous fluid and a single cell layer. |
|
|
Term
| How big is a serous cystadenoma? |
|
Definition
|
|
Term
| What is the most common carcinoma of the ovary? |
|
Definition
| serous cystadenocarcinoma (1/3 of ovarian ca) |
|
|
Term
| Describe gross and histo of serous cystadenoma |
|
Definition
| bulky tumor with papillary features; high mitotic rate, cytologic atypia, invasion |
|
|
Term
| What is the definition of a borderline serous cystadenoma? |
|
Definition
| features in between those of benign and malignant tumors |
|
|
Term
| What percent of ovarian neoplasms are mucinous tumors |
|
Definition
|
|
Term
| What is the gross appearance of mucinous tumors? |
|
Definition
| multicystic tumor with sticky gelatinous fluid |
|
|
Term
| What is the hitological apperance of mucinous tumors? |
|
Definition
| tall columnar, epithelium with apical mucin |
|
|
Term
| Mucinous tumors are often associated with... |
|
Definition
| pseudomyxoma peritonei (mucinous ascites, epithelial implants on peritoneal surfaces, and adhesions) |
|
|
Term
| Pseudomyxoma peritonei usually comes from... |
|
Definition
| the appendix with secondary ovarian peritoneal spread |
|
|
Term
| Mucinous cystadenocarcinoma is ___% of ovarian c/a. |
|
Definition
|
|
Term
| How large are mucinous cystadenocarcinomas |
|
Definition
|
|
Term
| Is mucinous cystadenocarcinoma more solid or cystic? |
|
Definition
|
|
Term
| Endometrioid carcinoma histo= |
|
Definition
| tubular glands with a resemblance to the endometrium |
|
|
Term
| Are endometrioid carcinomas of the ovary accompanied by uterine endometrioid carcinoma? |
|
Definition
|
|
Term
| Endometrioid carcinoma of the ovary is commonly accompanied by what other conditions? |
|
Definition
| 15-30% have carcinoma of the endometrium and 15% have coexistent endometriosis |
|
|
Term
| Is clear cell carcinoma common |
|
Definition
|
|
Term
| What is the histological appearance of clear cell carcinoma? |
|
Definition
| large tumor cells with clear cytoplasm and hobnail appearance |
|
|
Term
| What is the behavior of clear cell carcinoma? |
|
Definition
| aggressive clinical course |
|
|
Term
|
Definition
| surface epithelial tumor of the ovarythat consists of nests of transitional cells |
|
|
Term
| What is the gross appearance of brenner tumors? |
|
Definition
| usually unilateral, firm, solid |
|
|
Term
| What is the histo appearance of brenner tumor? |
|
Definition
| fibrous stroma with well-demarcated epithelial nests resembling transitional epithelium |
|
|
Term
| What is the behavior of Brenner tumors? |
|
Definition
|
|
Term
| What is the age group of germ cell tumors? |
|
Definition
| most often seen in children or young adults |
|
|
Term
| What is the prognosis of germ cell tumors? |
|
Definition
| 95% are benign cystic teratomas but the younger the pt is the more likely the tumor will be malignant |
|
|
Term
| What are the three types of ovarian teratomas? |
|
Definition
| mature, immature, and monodermal |
|
|
Term
| A mature ovarian teratoma is aka... |
|
Definition
|
|
Term
| Is a mature ovarian teratoma mostly solid or cystic? |
|
Definition
|
|
Term
| What are Rokitansky's protuberance? |
|
Definition
| central area of a mature ovarian teratoma that contains bone and teeth |
|
|
Term
| Are immature (malignant) teratomas rare or common? |
|
Definition
|
|
Term
| Are immature/malignant teratomas of the ovary solid or cystic? |
|
Definition
|
|
Term
| What is the composition of immmature/malignant ovarian teratomas? |
|
Definition
| embryonal and adult tissues from all three germ layers; main component is usually neural with neuroepithelial rosettes and immature glial elements |
|
|
Term
|
Definition
| a type of monodermal ovarian teratoma that is composed primarily of thyroid tissue and may be hyperfunctioning and produce hyperthyroidism |
|
|
Term
| What are two types of monodermal ovarian teratomas? |
|
Definition
| struma ovarii and carcinoid |
|
|
Term
| What is an ovarian carcinoid? |
|
Definition
| a type of monodermal teratoma of the ovary that presumably arises from intestinal epithelium within the teratoma and may result in carcinoid syndrome |
|
|
Term
| What is the female version of a seminoma? |
|
Definition
|
|
Term
| What is the pt age for a dysgerminoma? |
|
Definition
| 80% are under the age of 30 |
|
|
Term
| Are dysgerminomas unilateral or bilateral? solid or cystic? |
|
Definition
|
|
Term
| What is the gross appearance of dysgerminoma? |
|
Definition
| large, encapsulated with bosselated surface |
|
|
Term
| What is teh histological appearance of a dysgerminoma? |
|
Definition
| tumor cells have clear cytoplasm with prominent nucleoli set in well-defined nests separated by fibrous stroma infiltrated by lymphocytes |
|
|
Term
| How do you treat a dysgerminoma? |
|
Definition
| extremely radiosensitive; responsive to chemotherapy |
|
|
Term
| An ovarian yolk sac tumor is aka a... |
|
Definition
|
|
Term
| What is the age group for a yolk sac tumor? |
|
Definition
| children and young adults |
|
|
Term
| Yolk sac tumors produce... |
|
Definition
|
|
Term
| What do yolk sac tumors look like grossly in the ovary? |
|
Definition
|
|
Term
| What is the histology of yolk sac tumors? |
|
Definition
| schiller-duval bodies= papillae lined by embryonal cells with fibrovascular core |
|
|
Term
| Is an embryonal carcinoma of the ovary rare or common/ |
|
Definition
|
|
Term
| What is the gross appearance of an embryonal carcinoma? |
|
Definition
|
|
Term
| What is the microscopic apperance of an embryonal carcinoma/ |
|
Definition
| solid sheets and nests of large primitive cells with abortive glandular formations |
|
|
Term
| Is a pure ovarian choriocarcinoma rare or common/ |
|
Definition
|
|
Term
| What is the most common origin of ovarian choriocarcinomas? |
|
Definition
|
|
Term
| What is the histological difference between placenta and choriocarcinomas? |
|
Definition
|
|
Term
| What is the behavior of choriocarcinomas? |
|
Definition
| aggressive! widespread mets to the lung, liver, bone, and other viscera is common by the time of diagnosis |
|
|
Term
| Choriocarcinomas produce... |
|
Definition
|
|
Term
| What is the prognosis of choriocarcinomas? |
|
Definition
| choriocarcinomas arising in placental tissue are responsive to chemo; those arising in the ovary are not responsive to chemo and often fatal |
|
|
Term
| What age group gets granulosa cell tumors? |
|
Definition
| 5% before puberty, 40% postmenopausal |
|
|
Term
| Granulosa cells produce... |
|
Definition
|
|
Term
| What is the appearance of granulosa cell tumors? |
|
Definition
| vary from microscopic foci to large, solid and cystic encapsulated masses |
|
|
Term
| What is the microscopic appearance of granulosa cell tumors? |
|
Definition
| coffee bean nuclei forming Call Exner bodies (rosettes of tumors cells around central space) |
|
|
Term
| Which tumor is positive for inhibin? |
|
Definition
|
|
Term
| What is the behavior of granulosa cell tumors? |
|
Definition
| all are potentially malignant (5-25%); difficult to predict behavior from the histology |
|
|
Term
| What is the most common ovarian stromal tumor? |
|
Definition
| 76% of stromal tumors are fibromas |
|
|
Term
| What is the gross appearance of fibromas? |
|
Definition
|
|
Term
| What is the microscopic appearance of fibromas? |
|
Definition
| spindle cell proliferation (fibroblasts) |
|
|
Term
|
Definition
| ovarian tumor, hydrothorax (right sided), and ascites (assoc with fibroma) |
|
|
Term
| In what age group do thecomas occur? |
|
Definition
|
|
Term
| Thecomas produce... which causes... |
|
Definition
| estrogens; irregular menses, endometrial hyperplasia, or carcinoma |
|
|
Term
| What is the gross appearance of thecomas? |
|
Definition
|
|
Term
| What is the microscopic apperance of thecomas? |
|
Definition
| plump spindle cells with lipid droplets; |
|
|
Term
| What are fibroma thecomas? |
|
Definition
| thecomas with a mixture of cell types |
|
|
Term
| A sertoli-leydig cell tumor is aka... |
|
Definition
|
|
Term
| What ages get sertoli-leydig cell tumors? |
|
Definition
| all ages but there is a peak incidence in teh 2nd to 3rd decade |
|
|
Term
| What are the symptoms of sertoli-leydig cell tumors? |
|
Definition
| defeminization with atrophy of the breasts, amenorrhea, sterility, and loss of hair |
|
|
Term
| What is the gross appearance of a sertoli-leydig cell tumor? |
|
Definition
| solid, grey to golden tan cut surface |
|
|
Term
| What is teh histology of sertoli=leydig cell tumors? |
|
Definition
| well-differentiated tumors comprised of tubules of sertoli cells with interspersed leydig cells and stroma; less differentiated tumors have more poorly formed tubules |
|
|
Term
| What are hilus cell tumors aka? |
|
Definition
|
|
Term
| Are hilus cell tumors common or rare? |
|
Definition
|
|
Term
| What is the histology of hilus cell tumors/ |
|
Definition
| large lipid laden cells with distinct cell borders that contain crystalloids |
|
|
Term
| What is the presentation of hilus cell tumors? |
|
Definition
| masculinization: hirsutism, voice changes, clitoral enlargement |
|
|
Term
| What is the behavior of hilus cell tumors? |
|
Definition
|
|
Term
| Are gonadoblastomas common? |
|
Definition
|
|
Term
| What are ovarian gonadoblastomas composed of? |
|
Definition
| germ cells and sex cord-stromal elements |
|
|
Term
| What is the pt pop for gonadoblastomas? |
|
Definition
| individuals with abnormal sexual development and gonadal dysgenesis |
|
|
Term
| What is the premalignant lesion that has a 50% chance of giving rise to a dysgerminoma? |
|
Definition
|
|
Term
| What to metastatic lesions to the ovaries look like? |
|
Definition
| bilateral with multiple nodules; less than 10 cm |
|
|
Term
| What is a krukenberg tumor? |
|
Definition
| metastatic adenocarcinoma that is nearly always bilateral and composed of diffusely infiltrating signet ring cells. Primary site is usually the stomach but also includes breast and large intestines |
|
|
Term
| What are the papillary progections of the fallopian tube called? |
|
Definition
| papillary fronds or plica |
|
|
Term
| What are the three cell types of the fallopian tube? |
|
Definition
| ciliated, secretory, and intercalated (nons-secretory) |
|
|
Term
| Sequalae of PID that include the fallopian tube? |
|
Definition
| acute salipingitis and tubo-ovarian abscess (TOA) |
|
|
Term
| What organisms most commonly cause PID? |
|
Definition
45% by N. gonorrhea
20% by Chlamydia |
|
|
Term
| What microorganisms commonly cause PID d/t spontaneous/induced abortions or normal/abnormal deliveries? |
|
Definition
| polymicrobial (staph, strep, coliforms) |
|
|
Term
| What are the symptoms of PID? |
|
Definition
| cervical motion tenderness, pelvic pain, vaginal d/c |
|
|
Term
|
Definition
| acute salpingitis with lumen filled with acute inflammatory cells |
|
|
Term
| What are the sequelae of PID? |
|
Definition
| chronic follicular salpingitis (scarring within the tube leading to fused plicae), hydrosalpinx (dilated fluid filled tube), infertility, increased risk of ectopic pregnancy |
|
|
Term
| IUD increases risk of ectopic pregnancy by.. |
|
Definition
|
|
Term
| What happens to an ectopic pregnancy in the fallopian tube? |
|
Definition
| strophoblastic invasion into the wall of the tube causing hematosalpinx; typically ruptures at 12 weeks approx; less commonly undergoes spontaneous resorption or is extruded into the peritoneal cavity (tubal abortion) |
|
|
Term
| Are paratubal cysts common? |
|
Definition
|
|
Term
| What is the appearance of paratubal cysts? |
|
Definition
| .1 to 2 cm translucent cysts filled with clear serous fluid |
|
|
Term
| What are hydatids of morgagni? |
|
Definition
| larger cysts found near the fimbriated end of the tube or in the broad ligaments, presumed to arise in remnants of the mullerian duct |
|
|
Term
| Is primary adenocarcinoma of the fallopian tubes common? |
|
Definition
| no, rare. Much more likely to see secondary involvement from extension of ovarian or endometrial carcinoma; assoc with BRCA mutation |
|
|
Term
| Where is the site of exchange in teh normal placenta? |
|
Definition
|
|
Term
| What are the possible configurations of the amnion and chorion for twins? |
|
Definition
monochorionic-monoamniontic= monozygotic
monochorionic-diamnionic= monozygotic
dichornionic diamnionic placenta= monozygotic or dizygotic |
|
|
Term
| What is twin-twin tranfusion syndrome? |
|
Definition
| monochorionic twin placentas d/t vascular anastomoses which connect the twin circulations. If there is abnormal distribution of circulation one or both fetuses may die |
|
|
Term
| What is chorioamnionitis? |
|
Definition
| inflammation of the chorion, amnion, and extraplacental membrane |
|
|
Term
| What causes chorioamnionitis? |
|
Definition
| ascending infection (assoc with premature rupture of the membranes, most commonly) or hematogenous infection |
|
|
Term
| In chorioamnionitis, what are the risks to the fetus? |
|
Definition
| pneumonia secondary to amniotic fluid inhalation as well as infections of eyes, skin and GI tract |
|
|
Term
| What are the risks to mother with chorioamnionitis? |
|
Definition
|
|
Term
|
Definition
| inflammation of the umbilical cord |
|
|
Term
|
Definition
| hematogenous spread; common organisms= TORCH (toxoplasma, others: syphilis, TB, listeriosis, Rubella, CMV, Herpes simplex) |
|
|
Term
| What is the term describing when the placental villi adhere to the underlying myometrium? |
|
Definition
|
|
Term
| What do you call it when placental villi invade the myometrium? |
|
Definition
|
|
Term
| What do you call it when placental villi penetrate through the uterine wall? |
|
Definition
|
|
Term
| What is gestational trophoblastic dz? |
|
Definition
| spectrum of tumors and tumor-like conditions characterized by the proliferation of pregnancy associated trophoblastic tissue of progressive malignant potential |
|
|
Term
| What are examples of gestational trophoblastic disease? |
|
Definition
| hydatidiform mole (partial and complete), invasive mole, choriocarcinoma |
|
|
Term
| T/F Hydatidiform moles are a common complication of pregnancy. |
|
Definition
| T; occurs in 1 of every 1,000 to 2,000 pregnancies |
|
|
Term
| How can you perform early detection of gestational trophoblastic disease? |
|
Definition
| monitoring the circulating HCG levels |
|
|
Term
| What is a complete hydatidiform mole? |
|
Definition
| d/t fertilization of an empty ovum (46 XX paternally derived) |
|
|
Term
| What are the risk factors for a complete hydatidiform mole/ |
|
Definition
| age <15 yrs or > 50 yrs; previous mole (20x) |
|
|
Term
| What are the clinical features of complete hydatidiform moles? |
|
Definition
| excessive enlargement of uterus for gestational age, bleeding, markedly elevated HCG |
|
|
Term
| What does a hydatidiform mole look like on US? |
|
Definition
|
|
Term
| What is the microscopic appearance of a hydatidiform mole? |
|
Definition
| swollen villi without vessels, large cisternae, trophoblastic hyperplasia |
|
|
Term
| What are possible complications of complete hydatidiform moles? |
|
Definition
| ~2% risk of developing choriocarcinoma |
|
|
Term
| What are partial hydatidiform moles? |
|
Definition
| triploid/normal ovum fertilized by two sperm (69 chromosomes); 25-40% of all moles; fetus often present with both normal and abnormal villi identified. No risk of choriocarcinoma |
|
|
Term
| What is an invasive hydatidiform mole? |
|
Definition
| hydatid mole in which villous trophoblast has invaded the myometrium |
|
|
Term
| What are the complications of an invasive hydatidiform mole? |
|
Definition
may invade the venous channels and embolize to distant sites (lungs)
also, uterine rupture |
|
|
Term
| T/F Invasive hydatidiform moles are associated with persistently elevated HCG levels. |
|
Definition
|
|
Term
| How do you treat invasive hydatidiform moles? |
|
Definition
|
|
Term
| A choriocarcinoma is a malignant tumor of _______. |
|
Definition
|
|
Term
| What is the incidence of choriocarcinoma? |
|
Definition
| 1/30,000 pregnancies (22% follow normal pregnancies; 25% in spontaneous abortions; 50% hydatidiform moles; 3% ectopic pregnancies) |
|
|
Term
| A choriocarcinoma is composed of __________ and ___________. |
|
Definition
| cytotrophoblasts and syncytiotrophoblasts; NO chorionic villi |
|
|
Term
| What is the behavior of choriocarcinoma? |
|
Definition
| invasion thru venous sinuses in myometrium; hematogenous mets to lung (>90%), brain, and GI |
|
|
Term
| T/F Choriocarcinoma is associated with a marked HCG elevation? |
|
Definition
|
|
Term
| How do you treat choriocarcinomas? |
|
Definition
| good response to chemotherapy |
|
|
Term
| What is gestational trophoblastic disease? |
|
Definition
| neoplastic proliferations of extravillous trophoblasts (intermediated trophoblasts) |
|
|
Term
| What is the presentation of placenta-site trophoblastic tumor (PSTT)? |
|
Definition
| uterine mass; accompanied by either abnormal uterine bleeding or amenorrhea, moderate elevation of beta-HCG |
|
|
Term
| What is teh histological appearence of placental-site trophoblastic tumor (PSTT)? |
|
Definition
| malignant trophoblastic cells diffusely infiltrating the endomyometrium |
|
|
Term
| Placental-site trophoblastic tumor (PSTT) is preceded by .. |
|
Definition
| 1/2= normal pregnancy; 1/5 hydatidiform mole; 1/6 spontaneous abortion |
|
|
Term
| What isthe prognosis of placental-site trophoblastic tumor (PSTT)? |
|
Definition
excellent if= localized dz or a less than 2 year interval from the prior pregnancy to diagnosis
poor if= advanced stage or diagnosed 2 or more years following pregnancy |
|
|
Term
| 10-15% of women with PSTT die of... |
|
Definition
|
|
