Chap. 20: Pathology of the ovary

Question 1

Chap. 20: Pathology of the ovary

Functional cysts

Types of functional cysts

Answer 1

• Follicular cysts: a follicle can not reach out to ovulation: a process of ovulation failure can give rise to a functional cysts. In fact, a follicle, if not burst, may continue to grow, becoming a functional cyst. So, the follicular cyst is the distension of a follicle to increase the follicular fluid, secondary to degeneration of the oocyte contained in it
• luteal cysts: is developed for the formation of a hematoma or for the collection of a liquid serum
blood in the corpus luteum after ovulation

• Cysts tecoluteinica: is due to a follicle luteinization not broke, resulting accumulation of fluid in its interior

Question 2

Functional cysts. follicular cysts. features.

Answer 2

Features
Unilocular with anechoic content
Diameter
• Up to 7-8 cm: cystic follicle
• From 10 cm: follicular cyst itself
Prognosis
• Spontaneous regression in a few weeks: often just wait for the
next menstruation for regression
• Magnification and pain

Question 3

functional cysts. causes of follicular cysts

Answer 3

Causes
Exaggerated ovarian response to stimulation hormone Abnormalities of ovulation or the corpus luteum

Question 4

Functional cysts. symptoms of follicular cysts.

Answer 4

Symptoms: Most cysts are asymptomatic. Possible symptoms are:
Pain in the iliac fossa: is similar to that of a renal colic with Jordan positive (From space occupation pelvic) Irregularities of the cycle: it is one of the main indicators of the cyst. It is due to excessive production of estrogen or to altered secretion of gonadotropins
Infertility: the functional activity may result in blocking ovulation for excessive negative feedback on gonadotropin

Question 5

functional cysts. diagnosis and therapy of follicular cysts

Answer 5

Diagnosis: ultrasound
or therapy:
Progestogens for 4-6 months
Surgery for cysts larger than 5 cm and painful

Question 6

functional cysts. features and symptoms of luteal cysts

Answer 6

Features
Unilocular
Maximum diameter of 4-5 cm
Content transonic because rich clots
Higher density and vascularity
or Symptoms:same as follicular cysts

Question 7

functional cysts. diagnosis and therapy of lutheal cysts.

Answer 7

or Diagnosis: ultrasound: the sonographic appearance is jagged with a hyperechoic area, which
represents menstrual blood
or therapy if not recede, we proceed to the estrogen-progestin therapy

Question 8

PCOS definition. ultrasound, diagnosis

Answer 8

PCOS
It is a syndrome characterized by the presence of numerous cysts on the ovarian surface, and by alterations endocrine borne mainly by the ovary and adrenal gland.

Ultrasound and the diagnosis is simple: you are having, in fact,
more cysts like a crown on the ovarian surface, on which are found also more follicles in growth
which do not undergo maturation.
The ovaries, in fact, fail to ovulate because the surface epithelium is thickened, covered by a capsule
consistency pearly, and avascolarizzato.

Question 9

PCOS features

Answer 9

Features are:
• Hormonal pattern: the hormonal assays should be carried out immediately after menstruation
or Elevated levels of LH
or Low levels of FSH (with inversion of the relationship FSH / LH) stimulates the growth of new
follicles, which however does not undergo ovulation
or High levels of androgens: cause symptoms such as
Hirsutism
Acne
Irritability
or Low levels of estrogen: determine oligo / chronic anovulation
or High levels of SHBG
or High levels of adrenal hormones (such as 17-hydroxyprogesterone)

Question 10

PCOS clinical picture

Answer 10

Clinical picture
or hirsutism
or Acne
or Infertility: the ovary, in fact, does not have regular ovulation
or Metabolic Syndrome: recently has given great importance to this aspect:

Question 11

PCOS clinical picture. metabolic syndrome details

Answer 11

or Metabolic Syndrome: recently has given great importance to this aspect:
Hyperglycemia: you determine insulin resistance and hyperinsulinemia
Hypertriglyceridemia
Hypercholesterolemia
Hypertension
Overweight (especially between 18 and 20) or obesity

Question 12

PCOS therapy.

Answer 12

Therapy
or regularization of ovulation(in detail in other slide)

or Elimination of imperfections due to acne and irustismo: antiandrogen therapy:
flutamide, finasteride, cyproterone acetate
or reduction of cysts: ovarian drilling: production of micro-cracks on the surface of the ovary
or reduction in prolactin levels: gabergolina or bromocriptine
or NB: progestogens mask the symptoms, but does not give any benefit

Question 13

Pcos therapy. regularization of ovulation

Answer 13

or regularization of ovulation
Clomiphene to stimulate the production of FSH
GnRH analogues
Recombinant gonadotropins

Question 14

pathology of the ovary.
Benign neoplasms
features. forms.

Answer 14

Forms:
Solid
Cystic
Mixed

Question 15

Pathology of the ovary. diagnosis of benign neoplasms.

Answer 15

Diagnosis
Gynecological examination: the cyst appears as a mass (while a malignant cyst
appears as mass):
• Mobile (fixed)
• Do not sore (sore)
• A smooth surface (irregular surface)
• As a taut elastic consistency (hard consistency)
Abdominal ultrasound or transvaginal color Doppler: sonographic findings
suggestive of malignancy are:
• echostructure solid
• Neoangiogenesis
• Presence of vegetations and / or septa
Hormonal assays
Search of tumor markers

Question 16

Pathology of the ovary. symptoms of benign neoplasms.

Answer 16

Symptoms: may be missing entirely and lead to the discovery of the tumor only forms very advanced. However, most frequent manifestations are:

• Meteorism
• Abdominal pains
• Slowed digestion
• Sense of tenderness and weight

Question 17

Pathology of the ovary. complications of benign neoplasms.

Answer 17

complications:
Rupture of the cyst tumor in the peritoneum: is due to cystic tumors and causes
acute abdomen
Ovarian torsion of the pedicle with stenosis of the vessels and subsequent necrosis of
cysts: occurs for large tumors
Hemorrhage endocystic
Malignant degeneration: especially cysts borderline

Question 18

Pathology of the ovary. therapy of benign neoplasms.

Answer 18

or therapy
Of women of childbearing age: enucleation of the cyst by laparoscopy or
laparotomy, trying to preserve the ovary
Of postmenopausal women: annessectomia

Question 19

pathology of the ovary. Types of benign neoplasms.

Answer 19

or Cystadenoma serous:

or Cystadenoma mucinous:

or Teratomas:

Brenner tumor

ovarian fibroma

Question 20

pathology of the ovary. Types of benign neoplasms. serous cystadenoma

Answer 20

Cystadenoma serous: originates from epithelial tissue. It is the most common benign tumor, can
be bilateral, but does not reach large dimensions. Has a content and a fluid
aspect serous and may undergo malignant degeneration (in 25% of cases)

Question 21

pathology of the ovary. Types of benign neoplasms. Cystadenoma mucinous

Answer 21

Cystadenoma mucinous: mucinous epithelial ovarian arises from the cells. Less frequently the previous one, can become very large (up to 40-50 cm) and can be multiloculato. Has a content opalescent consists of mucin and appearance slimy; is also equipped with a capsule of smooth and translucent and has a colorful gray-
bluish. May undergo malignant degeneration

Question 22

pathology of the ovary. Types of benign neoplasms. teratomas

Answer 22

or Teratomas: the most frequent is the cyst dermaoide, which originates from the germinal tissue. It is a training round, smooth, white-grayish, monoloculare, diameter 5-15 cm. Contains residues embryonic (sebum, hair, hair, teeth, thyroid remnants,
and mandibular bone)

Question 23

pathology of the ovary. Types of benign neoplasms. Brenner tumor

Answer 23

Brenner tumor is a rare tumor, with a diameter variable (from a few up to 20 cm), solid,
covered by a capsule, more frequent towards the 50 years, with symptoms poor

Question 24

pathology of the ovary. Types of benign neoplasms. ovarian fibroma

Answer 24

ovarian fibroma: is a solid tumor connective tissue, agenesis, with a smooth surface, of whitish color and variable diameter (from a few mm to 40 cm)

Question 25

Pathology of the ovary. benign neoplasms.
Par. II: malignant ovarian tumor. main features. risk factors.

Answer 25

Main Features
• Risk factors
or Alteration of BRCA 1 and 2
or Familiarity
or late menopause
or early menarche
or Endometriosis
or nulliparity
or previous pelvic irradiation
or obesity and hypertension
or prolonged estrogen therapies
or breast cancer

Question 26

Pathology of the ovary. benign neoplasms.
Par. II: malignant ovarian tumor. main features. protective factors

Answer 26

Protective factors
or use of contraceptive progestogens
or Polycystic Ovarian Syndrome
or Intervention hysterectomy
or Pregnancy

Question 27

Pathology of the ovary. benign neoplasms.
Par. II: malignant ovarian tumor. main features. Classification

Answer 27

Classification
or epithelial tumors (85%)

or germ cell tumors (10%)
Embryonal carcinoma
Choriocarcinoma
or ovarian stromal tumors (4%): especially granulosa cell tumors
or mesenchymal tumors (1%)

Question 28

Pathology of the ovary. benign neoplasms.
Par. II: malignant ovarian tumor. main features. classification: epithelial tumours

Answer 28

epithelial tumours (85%):

Serous cystadenocarcinoma
Mucinous cystadenocarcinoma
Cystadenocarcinoma endometrial
Cystadenocarcinoma clear cell
Carcinoma of Brenner
Undifferentiated carcinoma

Question 29

Pathology of the ovary. benign neoplasms.
Par. II: malignant ovarian tumor. main features. clinic.

Answer 29

• Clinic: the tumor can stay long symptomatic and, when symptomatic, may present with:

• or increase the volume of the abdomen (tumor, ascites)
• or signs of compression (intestinal disorders, constipation)
• or pain (torsion of the pedicle, hemorrhage, rupture)
• or menstrual irregularities
• or Metrorrhagia
• or Cachexia facies ovarian tumor with the classic: emaciated face, profile elongated nose,
• pale mucous membranes

Question 30

Pathology of the ovary. benign neoplasms.
Par. II: malignant ovarian tumor. main features. Mode of spread

Answer 30

• Mode of spread
or peritoneal dissemination: enables cancer cells to arrive up to the diaphragm
(Along with the bowel loops one of the sites most affected by metastases). One of the most
frequent plant is metastatic diaphragmatic pleural effusion, which sleeps for
oozing trans-diaphragmatic in the pleural cavity.
or lymphatic Via: the pelvic lymph nodes and para-aortic
or Via intratubal: come to affect the uterus
or hematogenous Via: liver, lungs, pleura, bones and brain

Question 31

Pathology of the ovary. benign neoplasms.
Par. II: malignant ovarian tumor. main features. Diagnosis.

Answer 31

Diagnosis
or gynecological(more detailed in next slide)
or diagnostic laparoscopy
or CT, MRI, PET: useful for staging
or dosage of tumor markers
CA125: serous carcinoma
CA19, 9 and CEA: mucinous carcinoma

Question 32

Pathology of the ovary. benign neoplasms.
Par. II: malignant ovarian tumor. main features. Diagnosis. gynecological diagnosis.

Answer 32

or gynecological
Palpable mass solid, fixed, sore, with irregular surface (on which you can
appreciate nodularity) and hard consistency
Abdomen globose for the presence of ascites, and with signs of occlusion
or trans-abdominal ultrasound and trans-vaginal Doppler velocimetry