some notes for the pathology test on the female reproductive system.
ovarian cysts-- made up of unruptured graffian follicles or ruptured graffian follicles that immediately reseal. they can be follicular (first 2 weeks of cycle, estrogen related), or luteal (second 2 weeks of cycle, progesterone related). within follicular cysts there is also a subcategory of "cystic follicles" which refers to small, common, physiological cysts less than 2cm, generally filled with serous fluid. luteal cysts are the product of failure of degeneration of the corpus luteum, and rupture of these may lead to peritoneal irritation.
PCOS is a condition we learned about in CPD II and is basically the combination of anovulation and androgenism. theca lutein cells of the ovaries, along with the adrenals, overproduce androstenedione which is then converted to testosterone and estrogen in the periphery. anovulation produces low levels of progesterone and a LH:FSH ratio of 3:1 instead of the normal 1:3. one possible mechanism for the hyperandrogenism is via dysfunction of cytochrome P450c17, which is the enzyme involved in the rate limiting steps for synthesis of androgens. a common allopathic treatment, metformin, seems to work via this pathway, related to reduction of insulin levels.
ovarian tumors are relatively common neoplasms that are more likely to be malignant in 40-60 year olds. risk factors that can increase incidence include nulliparity, family history, BRCA1 and 2 mutations, gonadal dysgenesis. there is also a connection between ovarian adenocarcinoma and abnormal expression of the her2/neu oncogene. the WHO classification of ovarian tumors is based upon the tissue of origin: epithelial, germ cell, or sex cord.
mullerian epithelial tumors are derived from the coelemic mesothelial layer and come in three main flavors: serous, endometroid, and mucinous-- cells that are related to uterine tubes, endometrium, and the cervix, respectively. the more developed the epithelial growth is, the greater likelihood for malignancy. symptoms for tumors may include abdominal pain and GI distress, urinary symptoms, and may progress to ascites and peritoneal implants for carcinoma. the benign mullerian tumors are generally unilateral with no epithelial thickening and abundant cilia / papillae, while the malignant tumors are bilateral with large amounts of tissue mass, increased complexity and stratification of the epithelium, which may also show nuclear atypia.
questions
ovarian cysts...
1. ovarian cysts are generally made up of...
2. what age and demographic is most likely to have ovarian cysts? what percentage has regular vs. irregular menstrual cycles?
3. what is the relationship between hypothyroidism and ovarian cysts?
4. what are some risk factors for ovarian cysts?
5. what is "mittelschmerz"?
6. what are the two different types of ovarian cysts and what distinguishes them?
7. what are the two different types of follicular cysts and what distinguishes them?
8. what is hyperthecosis?
9. what are luteal cysts due to?
10. what is the histological apperance of luteal cysts?
11. rupture of luteal cysts may lead to...
PCOS...
12. what is the pathophysiological connection between PCOS and theca lutein cells?
13. what is a typical hormone imbalance seen in PCOS and why?
14. what is cytochrome P450c17 and how is it related to PCOS?
15. full expression of PCOS may require...
16. what is the morphology of PCOS?
ovarian tumors...
17. in what age group are malignant ovarian tumors more common?
18. what are some risk factors for developing ovarian tumors?
19. what is a genetic marker for ovarian adenocarcinomas that can indicate poor prognosis?
20. epithelial tumors are usually...
21. what is the WHO classification of ovarian tumors based upon?
mullerian epithelial tumors...
22. what germ layer are mullerian epithelial tumors derived from?
23. what are the three major types of mullerian epithelial tumors? what cell types are they from?
24. risk of malignancy increases as...
25. what are the symptoms of a mullerian epithelial tumor?
26. what are the symptoms of a mullerian epithelial carcinoma?
27. what is the morphology of benign mullerian epithelial tumors?
28. what is the morphology of a malignant mullerian epithelial tumor?
serous tumors...
29. describe the morphology of serous tumors.
30. what percentage of serous tumors are benign or borderline malignant?
31. what are "psammoma" bodies?
32. what is the most common type of malignant ovarian tumor?
mucinous tumors...
33. what portion of ovarian neoplasms do mucinous tumors account for?
34. what percentage of mucinous tumors are malignant?
35. what is the histomorphology of mucinous tumors?
36. what are pseudomyoma peritonei?
endometroid tumors...
37. what percentage of ovarian neoplasms do endometroid tumors account for?
38. most endometroid tumors are...
39. describe the morphology of endometroid tumors.
40. what is "seeding" in the context of ovarian neoplasms?
cancer markers...
41. what is CA-125?
42. what is the relationship between tubal ligation, oral contraceptives and the risk of cancer?
teratomas...
43. what are mature/benign dermoid cysts derived from?
44. about 1% of dermoids undergo...
45. what is the morphology of an immature/malignant dermoid?
46. what are the most common monodermal teratomas?
47. what is the average ages that are affected by immature and mature teratomas?
48. what is the cell of origin of a struma ovarii?
49. what is the cell of origin of an ovarian carcinoid?
50. what is carcinoid syndrome?
yolk sac...
51. what is the cell of origin for yolk sac tumors?
52. what is a schiller-duval structure?
53. what markers are present in yolk sac tumors?
granulosa cell tumors...
54. does granulosa theca cell secretion indicate malignancy?
55. what are some other conditions that might result from granulosa cell tumors?
meig's syndrome...
56. meig's syndrome is associated with...
57. what cell type is overproduced in meig's syndrome?
58. what is meig's syndrome called when malignant?
59. what is the clinical presentation of meig's syndrome?
abnormal pregnancy, placental issues...
60. what are the most common sites of implantation for ectopic pregnancies?
61. what are the major risk factors for ectopic pregnancy?
62. what is the clinical presentation of an ectopic pregnancy?
63. what is a hydatidiform mole?
64. what is the difference between a complete and partial molar pregnancy?
65. what is the morphology of a molar pregnancy?
66. what are the risk factors for choriocarcinoma?
67. describe the course of a choriocarcinoma.
answers
1. unruptured graffian follicles or ruptured follicles that immediately reseal.
2. women of childbearing age: 50% with irregular cycles, 30% with regular cycles.
3. TSH is similar to HCG and stimulates the growth of cysts.
4. smoking
ovarian cancer
hormonal imbalance
early menarche
nulliparity
tamoxifen
[s o h e n t] [hes not]
5. unilateral sharp pain that occurs during ovulation in 25% of women that can be related to rupture of a follicular cyst.
6. ovarian and luteal, during the first 2 weeks and second 2 weeks of the menstrual cycle, respectively.
7. cystic follicles: small, common, physiological, less than 2cm, filled with serous fluid.
follicular cysts: larger than 2cm and may cause pain.
8. outer theca cells with increased cytoplasm and pale appearance which may cause increased estrogen production and an abnormal endometrium.
9. failure of corpus luteum to degenerate.
10. rim of bright yellow luteal tissue with luteinizing granulosa cells.
11. peritonitis.
12. theca lutein cells produce androstenedione (also produced in the adrenals) which is then converted into testosterone and estrone.
13. LH:FSH ratio is 3:1 instead of 1:3 due to deficient progesterone due to anovulation.
14. cytochrome p450c17 is a rate limiting enzyme involved in androgen synthesis that can be functionally abnormal in PCOS.
15. insulin resistance and a defect in androgen synthesis.
16. gray-white ovaries that are twice the normal size with thickened superficial cortex and numerous subcortical cysts 0.5-1.5cm.
17. 40-60yo.
18. nulliparity
family history
BRCA1, BRCA2 mutations
"gonadal dysgenesis" in children
[tumors parity family broca gonads] [risk for tumors in the broca family assessed by gonad parties]
19. high levels of expression from her2/neu gene.
20. bilateral.
21. tissue of origin: epithelial, germ cell, sex cord.
22. coelomic mesotheium.
23. serous (tubal), endometriod (endometrium), and mucinous (cervix).
24. discernable epithelial cell growth increases.
25. abdominal pain and enlargement
urinary frequency and dysuria
GI complaints
26. weight loss / cachexia
ascites with peritoneal implants of exfoliated tumor cells
27. unilateral, no epithelial thickening, abundant cilia and papillae
28. bilateral, large amounts of tumor mass, increased complexity and stratification of epithelium, nuclear atypia.
29. lined with tall, columnar ciliated epithelium, filled with clear serous fluid.
30. 75%.
31. concentric calcifications
32. serous cystadenocarcinoma.
33. 25%.
34. 15% malignant.
35. columnar epithelial cells with apical mucin and no cilia.
36. cancer of the peritoneum.
37. 20%.
38. carcinomas.
39. tubular glands that look like endometrium.
40. the spread of a ovarian neoplasm to the peritoneal cavity by bits of malignant tissue that resemble salt or spots.
41. high molecular weight glycoprotein that is present in greater than 80% of serous and endometrial carcinomas.
42. both decrease the risk for cancer by 50%.
43. ectodermal differentiation of totipotent cells.
44. malignant transformation of any one of the component elements.
45. more primordial / embryonic tissue, bulky tumors with smooth external surface.
46. struma ovarii, carcinoid.
47. immature- 18yo. mature- young women during reproductive years.
48. germ cell tumor, mature thyroid tissue.
49. germ cell tumor, intestinal epithelial cell.
50. cutaneous flushing and cramps
diarrhea, cramping, nausea, vomiting
cough, weeding, dyspnea
hepatomegaly
51. malignant germ cells differentiated towards extraembryonic yolk sac structure.
52. glomerular-like structure that involves central blood vessels surrounded by germ cells in a space surrounded by germ cells.
53. AFP, alpha 1 antitrypsin
54. potentially, in 5-25% of cases.
55. precocious puberty
endometrial hyperplasia, carcinoma
cystic breast disease
56. sex cord stromal tumors, such as fibroma thecomas.
57. basal cell.
58. fibrosarcoma.
59. pain, pelvic mass, ascites, hydrothorax.
60. uterine tubes (90%)
ovary
abdominal cavity
corona of tubes
61. PID with chronic salpingitis.
peritubal adhesions
leiomyoma
IUD
62. acute onset of severe abdominal pain ~6 weeks after normal menstrual flow.
63. cystic swelling of chorionic villi with variable trophoblastic growth.
64. complete is diploid, from sperm, no viable embryo. partial is triploid or more, viable embryo for several weeks.
65. may see fetal parts in partial mole
uterus filled with delicate, grape like edematous villi.
66. hydatidiform mole (complete)
previous pregnancy / abortion
67. invades myometrium
penetrates adjacent vasculature
metastasizes to lungs, vagina, brain, bone marrow, liver, kidney
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