11. Fallopian tube, Ovary Path Flashcards
Fallopian tubes are from unfused mullerian ducts, MC affected by infections and associated with inflamm conditions, also affected by ectopic pregnancies and endometriosis. What salpingitis is caused by N. gonorrhea (60%) and the rest of cases by chlamydia trachomatis?
Suppurative Salpingitis
What salpingitis is rare in the US, accounting for 1-2% of all salpgitis, more common in parts of the world where the infection is more common and is an important cause of infertility in those areas (AFRICA)?
Tuberuculous Salpingitis
fallopian tubes affected when bacteremia dissemination = systemic miliary Tb
What is the MC primary lesion of the fallopian tubes (besides endometriosis) and are small translucent cysts filled with clear serous fluid?
Paratubal Cysts
What type of paratubal cysts are larger near the fimbriated end of the tube or in the broad ligaments that arise from remnants of the mullerian duct and are lined with benign, serous (tubal type) epithelium? (insignificant)
Hydatids of Morgagni
The fallopian tube and ovaries togethere is called the?
adnexa = parts that adjoin an organ
What tumor is uncommon and benign, occuring subserosally on the tube or in the mesosalpinx- small nodules?
Adenomatoid Tumor
Primary adenocarcinoma of the fallopian tube is rare and may be detected via pelvic exam, others may come to attention via abnormal discharge, bleeding or abnormal cells on pap, 50% are stage 1 at dx, 60% 5yr survival, treated with?
Ovarian cancer chemotherapy protocols
What are very common ovarian cysts that originate from unruptured graafian follicles or in follicles that rupture and then sealed, seen as multiple cysts >2cm, filled w clear serous fluid, lined by gray glistening membrane, hyperthecosis is assoc w increased estrogen production and endometrial abnormalities?
Follicle cyst (if less than 2cm then cystic ovarian follicle)
What cyst is seen in normal ovaries of reproductive age females, lined w a rim of bright yellow tissue** containing leutinizing granulosa cells (yellow cause hormone secretion), may rupture causing peritoneal reaction?
Luteal Cyst (corpora lutea)
old hemorrhage + fibrosis makes them look like endometriotic cysts (CHOCOLATE)
What is a complex endocrine disorder characterized by hyperandrogenism (hirsutism, acne, deep voice), menstrual abnormalities (amenorrhea), polycystic ovaries, chronic anovulation and decreased fertility?
Polycystic Ovarian Syndrome PCOS
PCOS affects 6-10% reproductive females, associatd with underlying metabolic disorder, obesity, T2DM, premature athersclerosis, increased free serum estrone (E1), which places the patient at an increased risk of endometrial hyperplasia and?
carcinoma
(E2: estradiol- most potent estrogen produced by aromatization of testosterone
E3: estriol- least potent placental estrogen from fetal adrenal gland as DHEA)
About 80% of ovarian tumors are benign and occur mostly in young women between 20-45, borderline tumors appear at an older age, and malignant tumore are MC in older women between 45-65, what has occured by the time of diagnosis?
Spread beyond the ovary = disproportionate amount of deaths from cancer in female GT
Tissue source for ovarian cancer is either surface/fallopian tube epithelium and endometriosis, pluripotent germ cells that migrate to the ovary from the yolk sacm and stromal cells (sex cords) what are forerunners of the endocrine apparatus of the postnatal ovary…Sx include abd pain and distention, urinary and GI tract sx due to compression or invasion and ?
vaginal bleeding are the most common
Most primary ovarian neoplasms arise from mullerian epithelium* with 3 types, serous, mucinous and endometrioid, classified as cystic or fibrous and may be benign, borderline or malignant, making up 47% of all ovarian cancers, which kind is MC?
SEROUS ***BILATERALITY w epithelial derived ovarian tumors
Type 1 ovarian epithelial tumors are low grade (serous endometrioid or mucinous) often associated with borerline tumors or endometriosis. Type 2 ovarian epithelial tumors are HIGH grade and mainly serous, associated with inclusion cysts from fallopian tube or?**
Serous tubal intraepithelial carcnioma (STIC?)
Serous tumors are cystic with tubal like epithelium, MC malginant ovarian tumor* 40% of all cancers, 70% are b9 or borderline (20-45y/o) and 30% are malignant occuring later in life, **all serous tumors have what(histo)?
Psammoma Bodies*** = concentric calcifications
Risk factors for malignant serous tumors includes nullparity, fam hx of breast/ovarian cancer, and what two mutations? (note: 40-59 y/o who took OCP therapy or had tubal ligation at a dec risk)
Heritable mutations in BRCA1/BRCA2
Low grade arise in serous borderline tumors w KRAS,BRAF,ERBB2, wildtype TP53 , responds better to chemo. High grade have inc. freq in TP53 mut, BRCA1/2 mut rare, No KRAS/BRAF, inc freq of genomic imbalances, amplification of oncogenes and deletion of tumor suppressors
MEOW
Benign serous tumors have smooth glistening cyst wall w no epithelial thickening or with small papillary projections, 20% bilateral, cysts are lined w columnar epithelium with lots of?
Cilia
Borderline tumor morphology has an *inc # of papillary projections, 30% are bilateral, involve the surface of the ovary, increased complexity of the stromal papillae, mild nuclear atypia but NO?
stromal invasion
High grade serous morphology includes complex patterns of growth, widespread infiltration of underlying stroma, MAKRED nuclear atypia and pleomorphism and multinucleation, increased mitotic activity, are they bilateral?
YAS 66% (malignant)
What has cells identical to high grade but there is no invasion, marked epithelial atypia in fallopian tubes*, indicating a fallopian tube origin, females are BRCA1/2 germline mutations, assoc w sporadic high grade serous ovarian cancer?
Serous Tubal Intraepithelial Carcinoma STIC
Serous tumors usually spread to peritoneal surfaces and omentum**.. Low grade even after spread outside the ovary often progress slowly and patients survive for a long time.. high grade tumors are widely metastatic through the abdomen, associated w rapid?
clinical deterioration
Mucinous tumors from epithelium covers 20-25% of all ovarian neoplasms, most are benign or borderline, common in middle adult life, rare before puberty or after menopause, most have what mutation if it is malignant?
KRAS mutation
Mucinous tumors from epithelium rarely involve the surface of the ovary and are rarely** bilateral, if bilateral think non-ovarian (appendix), produce larger cystic masses, will see multiloculated tumors w sticky gelatinous fluid rich in glycoproteins- can grow V large , will see what growth?
papillary growth v similar to tubular adenmoas and adenomas of the intestine
What is an extensive mucinous ascites, cystic epithelium implants on peritoneal surfaces, adhesions and frequent involvment of the ovaries, result in obstruction and death, *MC extraovarian source is appendix, most primary mucinous are unliateral so if mucinous and bilateral - think nonovarian origin?
Pseudomyxoma Peritonei
What carcinoma comprises 10-15% of ovarian cancers,good prognosis, 15-20% coexist with endometriosis, the main difference is presence of tubular glands resembling benign or malignant endometrium (differ from serous/mucinous)?
Endometrioid Carcinoma
Endometrioid Carcinoma w endometriosis occurs in patients 10 years younger, has PI3K/AKT mutation of PTEN, and mutation of DNA MMR, they are solid and cystic areas of growth, epithelium consists of tubular glands resemblin endometrium, 40% are bilateral*, low grade tumors, 5 year survival of?
75%
Ovarian epithelial tumors (serous, mucinous, endometrioid) all have the same clinical manifestations, most commonly lower abdominal pain, and abdominal enlargment either due to the tumor or?
Ascites
Note: tumor can impinge on other organs causing different symptoms = GI complaints, urinary frequency, dysuria, pelvic pressure
Because most ovarian cancers spread beyong the ovary when they present (high stage), other symptoms include weakness, weight loss, cachexia, ascites/omental cake, and with mets to liver, lungs GI and?
opposite ovary! (50% cross midline and indicate downhill course w death in months)
HE4 and what are two biomarkers that can be used to monitor disease recurence and progression?
CA125
85-90% of ovarian cancer is sporadic, 10-15% is due to BRCA1/2 RAD51C/D mutation and other syndromes such as Lynch, LiFraumeni, Cowden, Gorlin and?
Puetz Jeghers
germ cell tumors make up 15-20% of ovarian tumors, majority of them are benign cystic (mature) teratomas aka dermoid cysts, immature teratomas are?
Malignant
Mature teratomas are benign and most are cystic referred to as dermoid cysts and always lined with skin like structures, young women, discovered incidentally, all are 46,XX - majority arise from ovum after first meiotic division, 1% undergo malignant transformation to?
Squamous Cell Carcinoma (skin component)
Mature benign teratomas morphologically 10-15% are bilateral, unlilocular cysts with hair and sebaceous material, tooth structures alng with carilage, thyroid, and neural tissue, the walls are usually made of stratified?
squamous epithelium
Immature malignant teratomas tumor tissue resembles empryonal and immature fetal tissue, seen in prepubertal teens and young women 18yrs, is a solid, bulky tumor w smooth external surface, may see hair cartilage bone and calcification, grows rapidly and can?
penetrate the capsule and spread locally/ distantly
recur in first two years
Monodermal or specialized teratomas are either struma ovarii or carcinoid, Strumal carcinoid is RARE, combo of both in the ovary, **always unilateral, only 2% metastasize. What is composed entirely of mature thyroid tissue that may be function causing hyperthyroidism always unlilateral?
Struma Ovarii
What arises from intestinal tissue in teratomas and may be functional, >7cm causes 5HT production leading to carcinoid syndrome even in absence of hepatic metastasis because ovarian veins are connected directly to systemic circulation- always unliateral?
Ovarian Carcinoid
What tumor that makes up 50% of all malignant ovarian germ cell tumors and is the ovarian counterpart of testicular seminoma, 2% of all ovarian cancers, may produce hCG, 75% patietns in 20-30s, ALL are malignant*!?
Dysgerminoma
polyhedral tumor cells w round nuclei and adjacent inflammation
Dysgerminoma has OCT3, OCT4, NANOG mutation which maintain pluripotency, 33% have KIT mutations, they are unliateral tumors, large vesicular cells with clear cytoplasm, well defined borders, central nuclei, grow in sheets or cords and have scant fibrous?
stroma infiltrated by mature lymphocytes +/- granulomas
tx w salpingooophrectomy
What tumor is rare and derived from malignant germ cells, produces a-fetoprotein AFP, looks like a glomerulus like structure with central blood vessels envelopbed by the tumor cells in a space lined by tumor cells: ***Schiller Duval Body - characteristic
Yolk Sac tumor aka Endodermal Sinus Tumor
children/young females, adb pain, rapidly growing pelvic mass, 80% survival
What is extraembryonic differentiation of malignant germ cells of palcental origin, exists in combo w other tumors, they are aggressive and metastasized by presentation, HIGH levels of hCG, **unresponsive to chemo and fatal if in ovary, if in placental tissue - responsive?
Choriocarcinoma
