Ovarian tumor

Surface epithelial tumor (coelomic epithelium)

Serous/mucinouscystic
Benign:cystadenoma
single simple cyst, simple single epithelial cells
premenopausal women (30-40 yo)
cystadenocarcinoma: complicated multiple cyst, thick shaggy lining, invade into
cyst wall
postmenopausal women 65yo
Borderline: metastic potention, better prognosis than cystadenocarcinoma
BRCA1:increase risk of breast and ovary CA; most common serous carcinoma
increase risk of serous carcinoma of fallopian tube
Endometrioid
usu. Malignant
may have association with endometriosis
15% endometrioid CA in ovary can have endometrial CA
Brenner tumor: urothelium cells
Present late: poor prognosis
very vague symptoms, local spread and peritoneum : omental caking
serum tumor marker: CA-125 monitor treatment and screen for recurrence
Germ cell tumor (15% of all ovarian tumors)
reproductive age (15-30yo)
Fetal tissue-cystic teratoma / embryonal CA
yolk sac tumor
dysgerminoma (a lot of germ cell)
choriocarcinoma(placenta CA)
Cystic teratoma
2-3 embryonal layer
most common germ cell tumor in female
benign; if theres immature tissue:malignant risk (neuroectoderm)
Tissue of teratoma contain malignant tissue :squamous cell carcinoma
Struma ovarii: compose thyroid tissue

Dysgermanoma
increase germ cells
large cells with clear cytoplasm and central nuclei
increase LDH
Endodermal sinus tumor (yolk sac tumor)
most common in kids
increase alpha-fetal protein
Schiller-duval bodies
Choriocarcinoma
malignant proliferation cytotrophoblasts and syncytiotrophoblasts: absent of villi
spread quickly
increase beta-HCG
poor response in chemotherapy
Embryonal CA
aggressive with early ma
Sex cord- stromal tumor
granulosa-theca cell tumor
increase estrogen
young child-early puberty
heavy menstrual bleed
postmenopausal uterine bleeding
Sertoli-leydig cells
Tubules and Reinke crystals
produce androgenhirsutism and virilization
Fibroma
Meigs syndrome pleural effusion + ascities

Metastasis
Krukenberg tumor
mucinous tumour
diffuse gastric carcinoma: signet ring cells
breast lobular carcinoma/colon CA
bilateral (metastasis)
Pseudomyxoma peritonei : mucous; jelly belly
usu tumor of appendix

Gestational pathology
Ectopic pregnancy
risk factors: endometriosis/pid

Spontaneous abortion
vaginal bleeding, cramp-like pain, passing of fetal tissue
chromosomal anomalies
Placenta previa
lower uterine segment implantation
3 trimester bleeding
C-section
Placenta abruption
separation of placenta from the decidua (maternal side)
common cause of still birth
3rd trimester bleeding
Placenta accertalets
implantation of the placenta into the myometrium with little or no intervening
decidua
Preeclampsia
HTN, HA
fibrinoid necrosis in vessels of placenta
Preeclampsia: seizures
HELLP
Hemolysis, elevated liver enzymes and low platelets
thrombi in the liver, infarction of liver tissue, low platelets are used to form the
thrombi
SIDS
1month-1year
risk:sleep on stomach, smoking
Hydatidiform mole
grow abnormal placenta tissue
swollen and edematous villis with proliferation of trophoblast
uterus expands more than normal
beta HCG higher than normal
without prenatal care: pass grape-like masses thru vaginal canal
With prenatal care: snowstorm appearance on ultrasound
Complete (46 chromosomes)/partial(69chromosomes)
Beta-hCG monitor the adequate mole removal and screen for the development of
choriocarcinoma
Choriocarcinoma can formed 2 ways
1. Germ cell tumor: response poorly with chemotherapy
2. Gestational pathway response well to chemotherapy

Male Genital System

Penis
Hypospadias
Urethra on the inferior surface of the penis-failure of urethral folds to close
Epispadias
abnormal positioning of the genital tubercule
association with bladder exstrophy
Condyloma Acuminatum
koilocytic change
Lymphogranuloma venereum
Chlamydia (serotypes L1-L3)
Healing with fibrosismay cause rectal strictures
Squamous cells carcinoma
risk factors: high risk HPV and lack of circumcision
Bowen disease:leukoplakia @penile shaft;in situ carcinoma
Erythroplasia: erythroplakia@glans ;in situ carinoma
Bowenoid papulosis: male 40yo, multiple reddish papules; in situ carcinoma does
NOT progress to invasive carcinoma

Testicles
Cryptorchidism-testicles fail to descend. If doesnt resolve spontaneously before
2yo, orchiopexy is performed
complications: testicular atrophy with infertility/seminoma
Orchitis
Inflammation of the testicles
caused by young: chlamydia (serotype D-K) + gonorrhea;increase risk of sterility,
not libido
older: E. coli and pseudomonas (UTI spread to reproductive tract)
Mumps(teenage)infertility; younger than 10 will not see testicular inflammation
Autoimmune orchitis: granulomas involving seminiferous tubules
differentiate autoimmune and tb-TB:AFB stain + necrotizing granuloma
Testicular torsion
Twisting of the spermatic cords