1. What is this? What is notable about these images? What is seen in the bottom most image?

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    • Acute chorioamnionitis: this shows a section of the umbilical cord and a "membrane roll" of amnion, chorion, and umbilical cord
    • Notable: the marked acute inflammatory infiltrate with abudnant neutrophils plating out within the membranes themselves
    • The bottom most picture: shows neutrophils within the vessel walls and surrounding stroma of the umbilical cord (known as funisitis)
  2. What is an ectopic pregnancy? Where can it occur? What pt hx occurs is 35-45% of cases?
    • Ectopic pregnancy: when a fertilized ovum implants (and usu also grows) outside the endometrial cavity
    • Occurs: ovary surface, peritoneum of bowel, uterine serosa, or fallopian tube (95% of cases occur here)
    • Significant hx: Hx of PID (because it likely causes distortion of normal fallopian tube anatomy)
  3. What is this?

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    What can you ID in the high power?

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    • Ectopic pregnancy in the fallopian tube: note the normal plica within the lumina as well as remnants of the placenta and chorionic villi (implantation site); note that the villi lack blood vessels, indicating the fetus has already degenerated
    • High power: the multinucleated syncytiotrophoblast and cytotrophoblast
  4. What is endometriosis? What are common presentations? Where can it occur? What three theories are used to explain how it arises?
    • Endometriosis: having endometrial glands and stroma in locations outside the uterine cavity
    • Presentations: Pelvic pain, dysmenorrhea, problems with infertility
    • Occurs: the ovaries, uterine ligaments, pelvic peritoneum, and rectovaginal septum
    • Menstrual regurgitation theory: menstrual flow backs up the fallopian tubes
    • Metaplasia theory: metaplastic alteration of tissues in other sites to resemble endometrium
    • Vasculolymphatic dissemination theory: explains the presence of endometriosis in unusual sites like LN and lung
  5. What is this? What three components do we look for to make the dx?
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    • Endometriosis in the appendix: note abnormal glands in the submucosa and muscular wall of the appendix
    • This also has a sample of ovary with normal histo as well as the presence of endometrial glands within the ovarian stroma
    • Three components to look for: 1) endometrial type glands surrounded by 2) endometrial stroma, both in the presence of 3) hemosiderin deposits or hemosiderin-laden macrophages
    • These components are under hormonal influences, even in their unusual locations, and so may undergo cyclic menstrual changes with periodic bleeding
  6. What is endometrial hyperplasia? What is it related to? How is it categorized?
    • Endometrial hyperplasia: a cause of abnormal uterine bleeding characterized by glandular epithelial alterations that may be considered premalignant in some cases
    • Related to: abnormally high and prolonged estrogenic stimulation of the endometrium that is unopposed by progesterone
    • Categoried as: simple or complex depending on degree of gland crowding and complexity as compared to nromal proliferative endometrium
  7. What is one of the most common  malignant neoplasms of the female reproductive tract? When does it occur most often in women? What is one of its strongest etiological associations? What may precede it?
    • Endometrial carcinoma: a type of adenocarcinoma arising from the endometrial glands that often replicates their structure
    • Occurs: most often in perimenopausal and menopausal women, but may be seen in younger women too
    • Strongest etiological association: replacement estrogen therapy (obesity is also a risk factor)
    • May be preceded by: pre-malignant phase of endometrial hyperplasia (this can regress or progress to carcinoma)
  8. What are the predisposing factors for endometrial carcinoma? Who gets it? How does it spread?
    • Predisposing factors: Obesity, diabetes, htn, infertility, and unopposed estrogen stimulation (endometrial hyperplasia is a precursor for this)
    • Who gets it: Perimenopausal and menopausal women age 55-65
    • Spreads: occurs by direct myometrial invasion with eventaul extension to the periuterine structures by direct continuity; dissemination to regional LN eventually occurs and the tumor may ultimately metastasize to lungs, liver, bones, and other organs
    • Note that you can distinguish endometrial carcinoma histologically from endometrial hyperplasia because the carcinoma lacks intervening stroma
  9. What is this?
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    • Endometrial carcinoma: note the pink mass the is compressing the surface of adjacent normal endometrium
    • Note that the glandular structures in the adenocarcinoma are irregular, branching, and without intervening stroma
  10. What is an epithelial tumor of the ovary? How can they arise? What is a serous tumor? Mucinous tumor? Endometriod tumor? Brenner tumor? Are they benign or malignant? What are they called collectively?
    • Epithelial tumors arise from the epithelium that covers the outer surface of the ovary that has differentiated by metplasia into another tissue type (determines the nomenclature)
    • Serous tumor: fallopian tube tpithelium
    • Mucinous tumor: from endocervical glands
    • Endometrioid tumor: from endometrium
    • Brenner tumor: from transitional epithelium of bladder
    • Both benign and malignant
    • Benign: cystadenoma
    • Malignant: cystadenocarcinoma
  11. What is a stromal tumor of the ovary? Are they hormonally active? What are some examples? What are the sex-cord stromal tumors?
    • Stromal cells produce hormones, and stromal tumors can be hormonall active
    • Examples: Granulosa cell tumors, thecomas, fibrothecomas
    • Sex-cord stromal tumors: Sertoli Cell and Leydig cell tumors
  12. What is a germ cell tumor in the ovary? What are examples?
    • Germ cell tumor: tumors derived from germ cells of the ovary; some appear to recapitulate portions of the proliferating zygote/placenta
    • Choriocarcinoma: has cytotrophoblastic and syncytiotrophoblastic cells
    • Embryonal carcinoma
    • Dysgerminoma: tumor analogous to seminoma in men
    • Teratoma: tumor with numerous tissue types as may be seen in developing embryo
  13. What should always be included in your DD if you have a tumor in the ovary? What is a Krukenberg tumor?
    • Must always include the idea of a metastatic tumor
    • Gastrointestinal and breast tumors like to go to the ovary
    • Krukenberg tumor: Bilateral metastases to the ovary by mucinous adenocarcinoomas from the GI tracts
  14. What does a papillary serous cystadenocarcinoma mean?
    • Serous: expressing/secreting a watery or serous fluid
    • Cyst: arising in a cystic structure or having many cysts
    • Adenocarcinoma: malignant epithelial tumor arising from or demonstrating features of glandular epithelia
  15. What is this? What are the cells attached to and why is it significant? How can these implant elsewhere or spread?
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    • Papillary serous cystadenocarcinoma: note the frond-like excrescences formed by the tumor
    • The fronds of malignant tumor cells are attached to: delicate fibrovascular cores, and it is relevant because these cells secreted the watery fluid that filled the tumor
    • Tumors like these can invade through the wall of the ovary and implant throughout the peritoneal cavity
    • May spread via hematogenous or lymphatic routes
  16. What is this? What cell type lines the cyst?
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    • Mucinous cystadenocarcinoma: a multiloculate tumor (in this case) with cysts of varying sizes
    • Cyst lining cells: tall columnar epithelium with apical mucin
  17. What are examples of ovarian germ cell tumors?
    • Teratomas, dysgerminomas, choriocarcinoma, and embryonal carcinoma
    • They are derived from totipotent germ cells that have the ability to differentiate in various directions
  18. What is this? From what cell type is it derived? Are they mature or immature? What is the most common element? What special feature is seen in these?

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    • Mature cystic teratoma
    • Derived from: pluripotential germ cells
    • Mature: and menign; they have tissue elements from ectodermal, mesodermal, and endodermal origin
    • Most common element present: Skin, complete with hair follicles and sebaceous glands
    • Special feature: Rokitansky nodule, often contains a tooth
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