Fallopian/Ovarian Pathology Flashcards
The fallopian tube (oviduct) has four portions:
Infundibulum with fimbria, ampulla, isthmus and intramural division (cornua).
The lumen of fallopian tube is covered by mucosa that is surrounded by a large muscular layer. The mucosa of the fallopian tube is covered with ________ with cilia and non-ciliated (secretory) cells.
simple columnar epithelium
Estrogen promotes ____ and _____, while progesterone stimulates_____ activity. The muscularis component consists of an inner circular and outer longitudinal muscle layer.
ciliogenesis and mitosis
secretory
o Inflammation of the fallopian tube – commonly seen in PID (pelvic inflammatory disease)
o Long term consequences: scarring and abnormal motility
SEe lots of plasma cells and thickend plicae
Salpingitis
Pregnancy implanted outside of the endometrial cavity – most commonly seen in the fallopian tube
Ectopic pregnancy
o Endometrial glands and stroma seen outside of the uterus – can be seen within or around the serosa of the fallopian tube.
o Can cause tubal dysfunction/scarring affecting motility
o Risk factor for tubal ectopic pregnancy
Endometriosis
Tumors of the fallopian tube tend to be associated with ______. Primary tumors of the fallopian tube include:
Serous carcinoma in-situ
Invasive serous carcinoma
BRCA genes
Charecteristics of tubal invasive serious carcinoma
Malignant with prominent nucleoli, see some stroma and RBC
Normal ovary gross
has follicles look like bubbles on outise
inside is medulla
surrounded by coretex
ovary is covered by the germinal epithelium beneath is a connective tissue layer, the ______. The ovary is subdivided into two indistinctly divided outer cortex and inner medulla
tunica albuginea
contains the germ cells within Ovarian Follicles surrounded by stromal (interstitial) cells and loose connective tissue.
The cortex
contains larger blood vessels, lymphatics and nerves surrounded by loose connective tissue. Hilar cells located near the hilum have characteristics similar to Leydig cells in the testis and secrete testosterone.
medulla
Where is the oophorus or germ cell located?
seen in ovarian Graafian follciles
under is the Theca interna and then Theca externa
Most ovarian epithelial tumors are believed to be derived from:
coelomic epithelium or surface lining epithelium
of the ovary are the MOST common mass of the ovary. These are related to normal hormonal cycles and therefore “functional” or “**physiologic cysts.” **
Functional cysts
Follicular cyst (follicles)
Luteal cyst (corpus luteum)
Inclusion cyst (coritical cyst)
Hemorrhagic cyst (corpus luteum)
all are exapmles of:
functional cysts (most common mass of ovary)
o Most common ovarian neoplasm
o 5th leading cause of death in women in US
Ovarian surface epithelial tumors
Risk factors for Ovarian Surface epithelial tumors
Risk factors: obesity, estrogen usage for ≥ 10 y, family history, and germ line mutation in tumor suppressor genes (eg: p53, KRAS, etc)
Protective factors of ovarian surface epithelial tumors
high parity (children)
OCP
Makes up 65-70% of ovarian tumors and
90% of malignant ovarian tumors
age affected: 20+
Surface epithelial cell tumors
Serious, mucinous, endometriod, Clear cell, Brenner and Cystadenofibroma are examples of:
Surface Epithelial cell ovarian tumors
Common age group of surface epithelial tumors
2/3 in reproducive years: 20-60
80% are benign
of those that are malignant/borderline about 85% > 40
Ovarian surface neoplasm types:
- usually cystic~ cystadenoma or cystadenofibroma
- low malignant potential
- Maligant
- Bening (usually cystic)
- Borderline (solid/cystic)
- Malignant (solid cystic)
FEature of borderline surface neoplasm
low malignant potential; starting to brach out and away from normal pattern
histology of benign surface epithelial tumor
you can see the surface is still maintainng normal structure, but it is hyperplastic. seen in cycstic stuff
Most common ovarian epithelial tumor; 60% are benign
Serous ovarian tumor
Malignant Low Grade Serous tumors in ovarian epithelial are caused by:
KRAS, BRAF, ERBB2 mutation
HIgh grade Serous epithelial cell tumors are from:
TP53 mutation
You can sometimes see psammoma bodies in which cancer?
Serous borderline surface epithelial
Mostly unilateral tumors (if bilateral – probably metastatic)
Multicystic in nature, lined with mucin secreting cells Add
Mucinous surface epithelial tumor
If you have bilateral mucinous surface tumors it is:
mets until proven otherwise!
Yikes, what are all these things in the ovaries?
Mucionous cystadenoma (type of surface lining ovary tumor)
Usually malignant with solid and cystic features.
May be associated with endometriosis
Associated with PTEN gene mutation
Endometriod tumor (surface of ovary tumor)
Endometriod tumors are associated with which gene?
Mutation of PTEN suppresor gene
Histology shows babk to back glands with squamous differentiation
Grossly: see hemorrhagic solid mass
Endometriod tumor (surface of ovary)
Rare benign, unilateral mass
Characterized by nests of transitional cells
Brenner tumor
Tumor with nests of transitional epithelium cells, mostly bening
Brenner Tumor
Prognosis of brenner tumore
usually incidental, found with mucious tumors and often benign
Oogonia (dysgerminoma),
Primitive embryonal tissue (embryonal carcinoma) Yolk sac (endodermal sinus tumor/yolk sac tumor) Placental tissue (choriocarcinoma)
Multiple fetal tissues (teratoma) or combination
all are types of
Germ cell tumors
o Most common tumors in the reproductive age group
o Comprises 15-20% of all ovarian tumor
Germ cell tumors
Mass is derived from all three germ layers (ectoderm, endoderm,
mesoderm)
teratoma (more in younger and MOST common)
o Can have hair, teeth, bone, secretory tissue, etc.
o Specialized tumors tumors can actually secrete thyroid hormone (struma ovarii), carcinoid.
Benign (mature) cystic teratoma (aka dermoid cyst)
What is a dermoid cyst?
Benign, MATURE, cystic teratoma
Younger age group (<18 y.o)
Mainly immature neural elements. Can have all 3 layer
mature elements as well.
Malignant (immature) teratoma
Yuck, theres hair and shit in this, what is it?
Dermoid cysty: Mature teratoma; benign
looking through histology you come across at tumor removed fromthe ovaries that has elements of cerebellum in them, what the heck?
Malignant, immature teratoma
o This subset of tumors can be androgen or estrogen secreting or non-functioning
o Comprises 8% of all ovarian tumors
Sex-cord stromal cell tumors
Tends to occur in postmenopausal age group
Characterized by Call-exner bodies that mimic follicles
See in cords, sheets and strands
Granulosa cell tumor
tumor that has mixture of lipd laden theca cells and are usually estrogenic
Granulosa cell tumor
(sex cord derived)
What are my two sex cord derived tumors
Granulosa cell tumors (estrogen secreating)
Sertoli Cell tumors (testosterone secreating)
What are my Stromal cell tumors
Theca, lutein, leydig cell tumors
what turmos secreates testosterone
sertoli cell tumor (sex cord tumor)
What mets most commonly to ovaries?
breast cancer; look into family hx of cancer
