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  3. What is this?
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    Normal amnion and chorion on placenta
  4. What is this?
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    Normal umbilical cord
  5. What is this?

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    Normal chorionic villi
  6. What is this?
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    Acute chorioamniocentesis
  7. What is the top image? The bottom?
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    • Top: Acute chorioamniocentesis
    • Bottom: normal chorion and amnion
  8. What is this?
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    Acute chorioamniocentesis
  9. 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 cordNotable: the marked acute inflammatory infiltrate with abudnant neutrophils plating out within the membranes themselvesThe bottom most picture: shows neutrophils within the vessel walls and surrounding stroma of the umbilical cord (known as funisitis)
  10. What is this?
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    Normal fallopian tube
  11. What is this?

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    Ectopic pregnancy: notice chorionic villi (placental tissue) within fallopian tube

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  12. What is this?

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    Normal proliferative endometrium
  13. What is this?

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    Normal proliferative endometrium
  14. 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
  15. 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
  16. What is this?
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    Endometriosis in appendix
  17. What is this?
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    Endometriosis in ureter wall
  18. What is this?
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    Endometriosis of bowel wall
  19. What feature is this?
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    Hemosiderin laden macrophages seen in endometriosis
  20. 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)
  21. 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
  22. What is this?
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    Endometrial carcinoma: note the pink mass the is compressing the surface of adjacent normal endometriumNote that the glandular structures in the adenocarcinoma are irregular, branching, and without intervening stroma
  23. What is a leiomyoma? What are the common sx of it? Are they pre-malignant? How do we detect them?
    • Leiomyoma: benign smooth muscle tumorof the uterine corpus; extremely common; range in size from pin-points to basketballs, and may project on
    • a pedicle (risk of infarction)
    • Sx: may be asx or present with abdominal pain, dysfunctional bleeding, and interfere with fertility
    • They are NOT pre-malignant and are the most common benign uterine neoplasm
    • Detection: can be felt on pelvic exam because of enlargement or unusual uterine contour
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