••• Chapter 51^ Gynecologic Pathology^513
❍ What is the most common etiologic agent of vaginitis?
Candida albicans.
❍ Why do leiomyomas often increase in size during pregnancy and decrease in size in postmenopausal women?
They are estrogen sensitive, thus during the times of high estrogen (pregnancy) they get larger and in times of low
estrogen they decrease in size.
❍ What is the name of the condition whereby the patient has numerous follicle cysts in association with
oligomenorrhea?
Polycystic ovarian syndrome (Stein-Leventhal syndrome).
❍ In patients with polycystic ovarian disease, how common is true virilism?
It is rare. They typically have persistent anovulation, hirsutism, and almost half are obese.
❍ What is the HAIR-AN syndrome?
Hyperandrogenism (HA), insulin-resistant (IR), and acanthosis nigricans (AN).
❍ At what age does stromal hyperthecosis normally occur?
Postmenopausal women; however, it can be a part of polycystic ovarian disease in younger women.
❍ What is the microscopic appearance of stromal hyperthecosis?
It is characterized by nests and groups of luteinized stromal cells with vacuolated cytoplasm.
❍ In polycystic ovarian syndrome, what are the levels of FSH?
The level of FSH is normal as is 17-ketosteroid production. Androgens, on the other hand, are elevated in the cyst
fluid and urine.
❍ Describe the typical clinical presentation in massive ovarian edema.
The condition is usually unilateral and the patients are young with an average age of 20 years. They present with
abdominal or pelvic pain and an associated palpable abdominal mass.
❍ How can you differentiate between fibromatosis and an ovarian fibroma?
Fibromatosis occurs in younger patients (mean of 25 years) who sometimes have menstrual abnormalities and
contains entrapped follicles and their derivatives. In contrast, fibromas are found in older patients, do not contain
entrapped normal structures, and are not associated with menstrual abnormalities.
❍ What lesion of the ovary is related to human chorionic gonadotropin (hCG) stimulation, and typically
occurs in black multiparous females who are in their 20s or 30s?
The pregnancy luteoma.
❍ How common is extraovarian spread by ovarian malignancies at the time of initial presentation?
It is very common (70% of patients), thus the high mortality rate.