Disease of ovaries and Fallopian tubes Flashcards
Salpingitis
Inflammation of the Fallopian tube
- can occur at isthmus ampulla or infundibulum
- *Most common disorder of the Fallopian tubes**
- is ALWAYS a component of PID
ALWAYS caused by infection
- gonorrhea, chlamydia, mycoplasma hominids, coli forms, strep and staph (major offenders)
- **gonorrhea = #1
Symptoms
- fever
- lower abdominal/pelvic pain
- pelvic masses
Can result in
- adhesions (ashermann)
- risk for ectopic pregnancy
- permanent sterility
- tubovarian abscesses
Follicle and luteal cysts
99% of females have this so its pretty much considered normal
- originate from unruptured Graafian follicles
Usually 1-1.5cm (can range to any degree but if they get larger than 4 cm = usually pelvic pain)
- also often multiple and develop sub adjacent to the serosa of the ovary
If these cysts rupture = intraperitioneal bleeding and acute abdomen
Histology = Contain granulosa and luteal cells that begins to a trophy as the cyst gets larger
PCOS (Stein-Leventhal syndrome)
Complex endocrine disorder characterized by
- menstrual abnormalities
- hyperandrogenism
- polycystic ovaries
- decreased fertility
Usually occurs in 15-25s who present with
- oligomenohrrea
- hirsutism
- infertility
- obesity/metabolic syndrome
Ovaries are always enlarged with usually a “string of beads” appearance of cysts
What are the three cell types that tumors of the ovaries can generate from
Multipotent surface (coelomic) epithelium - 90% of total malignant ovarian tumors
Totipotent germ cells
Sex cord stromal cells
majority of ovarian tumors also usually arise from the Fallopian tube or epithelial cysts in the cortex of the ovary
majority of tumors are solid and benign lesions are usually cystic
Risk factors for ovarian cancers
Nulliparity
Family history
Germline mutations in tremor suppressor genes
Not being married??
Prolonged use of OCPs reduces the risk!!
Statistics about BRCA1 and BRCA2 RISK FACTORS
5-10% of ovarian cancers are familial With BRCA1 or BRCA2
Average lifetime risk ovarian cancers = 30% in BRCA1 and 10-20% in BRCA2
8-10% of sporadic ovarian cancers include VRCA1 and BRCA2 genes
Serous tumors
- *most common ovarian epithelial tumors**
- ALSO make up the greatest fraction of malignant ovarian tumors
60% are benign = 30-40s yr old usually
15% are borderline
25% are malignant = 45-65s yr old usually
Two subtypes
1) low grade:
- progress slowly in stepwise manners
- associated with KRAS/RAS mutations
2) high grade:
- usually seen in fimbriae of Fallopian tube tubal intraepithelial carcinoma
- associated with TP53 (95%)
- can be associated with NF1, RB, BRCA1/2 (variable percentage)
Morphology
- large, spherical cystic structures 30-40cm
- 25% of benign versions are bilateral (more common compared to metastatic)
- papillary projections with cystic cavities = malignant version more common
- multicyst spaces with clear serous fluid = benign version more common
- both benign and malignant often shows psammoma bodies
can show borderline tumors (between benign and malignant)
- papillary projections into the lumen that shows NO invasion of the stroma or capsule
Mucinous tumors
Contain mucin-secreting cells and are considerably less malignant compared to serous tumors
- 10% have malignant potential
- 10% are borderline
- 80% are benign
Are often larger and more multi cystic compared to serous tumors. Also have mucinous like internal structure
- much less likely to be bilateral (differs from Krukenberg tumor which are metastatic GI tumors in the ovaries. These are usually bilaterally and look almost identical to mucinous tumors)
- *malignancy = serosa penetration or solid areas of growth**
- usually produces “pseudomyoxma peritonei which shows seeding in the peritoneum with excessive mucin production (also if this is the case it almost always spreads to the appendix as one of the metastasis site)
Endometroid tumors
Solid or cystic tumors that are associated with endometriosis
- *Are usually malignant**
- can still be benign or borderline also though
- bilateral in 30% of cases
- 15-30% of cases also have concomitant endometrial carcinoma
Often present PTEN and gain of function of PI3K-AKT signaling
Histology = formation of tubular glands similar to endometrium tissues
Brenner tumor
Uncommon solid unilateral ovarian tumors that consist of abundant stroma containing nests of transitional-type epithelium that looks similar to the urinalysis tract
Most are often smooth encapsulated gray-white tumors
Most are benign with little showing malignant and borderline tumors
Teratomas
Constitute 15-20% of ovarian tumors and is a germ cell tumor
Tend to arise in the first 20 years of life
- younger the age of onset = higher risk fro malignancy
90% fo these are benign however
Three subtypes:
1) Benign mature Histology = mature tissues derived from all three germ cell layers (ectoderm, endoderm, mesoderm)
- often contains cysts, hair and teeth as well
* *10-15% of cases turn into torsions of the ovary which are medical emergency**
2) malignant immature histology = bulky with areas if necrosis. Contain immature bone, cartilage, muscle, nerve and other tissues as well
3) Specialized histology = very rare and most common = “struma ovarii” which shows mature thyroid tissues and produces hyperthyroidism
Dysgerminoma
Is essentially female testicular seminoma seen in males
Account for roughly 2% of ovarian cancers
accounts for 50% of malignant germ tumors in females
Histology = large polyhedral tumor cells having a clear cytoplasm and centrally placed regular nuclei
- may contain granulomas as well and is infiltrated mature lymphocytes
Yolk sac tumor (endodermal sinus tumor)
Second most common malignant tumor of germ cell origin
Always produces AFP elevation
Usually children (<10 yrs) with abdominal pain and rapidly growing pelvic mass - usually unilateral
Always shows Schiller-duval bodies on histology with central blood vessels in the middle
Choriocarcinoma
Are placental germ cell tumors that are high aggressive
- usually are in combination of other germ cell tumors
If they metastasis = lungs, liver, bone
Always show elevated hCG
If it arises in placenta = usually treatable with chemotherapy
If it arises in ovaries = usually not treatable and often kills
Granulosa cell tumors
Composed of cells that resemble granulosa cells in the developing follicles
- account for 5% of all ovarian tumors
Can be seen at any age however 66% are seen in postmenopausal women
Two broad groups
- adult and juvenile
histology = small cuboidal polygonal cells in sheets/strand patterns
- **always shows “call-exner bodies” (acidophilic material in a immature follicle like structure)
Two main clinical factors for these tumors
1) elaborate large amounts of estrogen = precocious puberty (juvenile); proliferative breast disease with endometrial hyperplasia and carcinoma (adult)
2) they behave like low-grade malignancies
