23 - Ovary and uterus pathology Flashcards
The normal ovary?
At birth born with 400 000 primordial follicles that are dormant until puberty. After puberty up to 20 follicles start to mature under the influence of the hormones FSH and LH. Only one reaches maturity and is released down the fallopian tubes.
Neoplasm?
New and abnormal tissue growth
Cycle of the follicles?
primordial, primary, secondary mature, ruptured, corpus luteum (residual follicle), corpus albicians
Malignant (cancerous growth) of follicles?
Germ cell tumour = teratoma
Tumour in the stroma?
Sarcoma as is mesenchymal/fibrous tissue
Benign tumour of the germ cells/follicles?
Teratoma
Sex cord stromal tumours?
Fibroma (benign)
Where do the majority of tumours in the ovaries arise from?
Either the surface or the fimbrial end of the fallopian tubes
Non-neoplastic in ovary
- polycystic ovarian syndrome
- functional ovarian cysts
Benign ovary neoplams?
- epithelial (mucinous/serous cystadenomas
- germ cell (dermoid/teratoma)
- stromal tumour (fibroma)
Malignant ovarian neoplasms
primary - ovarian carcinoma
secondary - metastatic carcinoma
Normal fallopian tube?
The free fimbrial end is composed of fingerlike projections that are adjacent to but not connected to the ovary. They open into the intra-abd cavity
The fimbriae align over the rupturing ovarian follicle at ovulation
Ovum enters the lumen of the FT where fertilisation occurs
The blastocyte then moves down the tube and implants into the uterus
What are the fallopian tubes lined with
Ciliated epithelial cells that push the ovum towards the uterus
Fallopian tubes - non-neoplastic
- saplingitis (can cause infertility)
- ectopic pregnancy
Fallopian tubes - pre-malignant
Tubal intraepithelial carcinoma
Fallopian tubes - benign neoplasm
Adenomatoid tumour
Fallopian tubes - malignant
primary carcinoma
secondary metastatic carcinoma
Normal uterus?
Is composed of the fundus, body and cervix
Consists of a thick muscular wall (myometrium - expands during pregnancy to contract during birth) that is lined by endometrium which contains glands and stroma. Outer surface is the serosal/mesothelial layer.
Cervix runs from … to…
Internal to external os
Structure and function of endometrium?
The endometrium contains hormone RECEPTORS for oestrogen and progesterone
The endometrium develops and sheds under the influence of these hormones
Following menopause the endometrium becomes inactive
Menstrual cycle summary
- as estrogen increases the endometrium is proliferative is that it becomes suited for implantation. The other hormones are relatively static (LH and FSH do increase a little)
- after ovulation estrogen drops and progesterone increases steeply to promote the secretory phase
- if no fertilisation occurs then the luteal phase ends when progesterone decreases and shedding of the endometrium occurs (menstruation)
Normal cervix?
Is inferior narrow part of uterus. Protrudes through into the upper vagina.
What 3 components of the cervix are we interested in and want to get all of when we do a smear?
1 - outer squamous epithelium (ectocervix)
2 - endocervix (lining of the canal)
3 - transformation zone in the middle of the ectocervix and endocervix
CIN 1/2/3?
1 - only basal layer
2 - midway
3 - full thickness of epithelium (carcinoma in situ > has not invaded so isn’t cancer)
What does the grade of the pre-cancer/dysplasia/cervical intraepithelial neoplasia/squamous intraepithelial lesion depend on?
Depends on the severity and extent of the atypia (abnormality of the cells)
How does CIN/SIL become cancer?
accumulation of mutations that allows invasion of BM into the stroma i.e. neoplastic cells can now invade lymphatics or BVs and metastasise.
Congenital abnormalities?
- intersex abnormalities
- malformation of the uterus (bicornuate uterus)
- abnormalities of ovary development
