Fallopian Tube & Ovaries

Question 1

What are three non-neoplastic pathologies of the ovary?

Answer 1

1. follicular cysts: results from unruptured graffian follicles or ruptured follicles that immediately seals. Common, with no symtopms usually
2. corpus luteum cysts: results from delayed resolution of a corpus luteum’s central cavity. Hemorrhage into a corpus luteum may result in hemorrhagic corpus luteum cysts.
3. PCOD: multiple follicular cysts, common in women of reproductive age with a 5-15% prevalence. (see other flashcards for more info)

Question 2

What is the surface of the ovary lined with?

Answer 2

Mesothelium = germinal epithelium

one layer of cubodial epithelium that lines the surface of the ovary

*tumors can arise from the mesothelium

Question 3

Describe the following ovarian follicles:

Primordial Follicle -

Primary Follicle -

Secondary Follicle -

Graafian Follicle -

Answer 3

Describe the following ovarian follicles:

Primordial Follicle - follicle prior to puberty

Primary Follicle - follicle post puberty; it is surrounded by a single layer of squamous cells= granulosa cells, while embedded in ovarian stroma (theca cells)

Secondary Follicle - increased thickness of the granulosa cells (squamous cells), and formation of the theca folliculi (stroma cells around the follicle)

Graafian Follicle - pre-ovulatory follicle, final stage before ovulation; a mature graafian follicle has a large antrum filled with fluid (liquor folliculi)

Question 4

What is the corpus luteum?

What important hormone does it secrete? This hormone is secreted by what types of cells?

Answer 4

After ovulation, the remaining wall of the graafian follicle/residual follicle transforms into corpus luteum; wall of the corpus luteum is folded and contains granulosa lutein cells.

Granulosa lutein cells, derived from granulosa cells, secrete progesterone –>

Drives the secretory phase, preparing the endometrium for pregnancy if it were to occur

*hemorrhage into a corpus luteum can resulti n a hemorrhagic corpus luteal cysts (esp during early pregnancy!)

Question 5

What is a follicle consists of?

What is the regular cycle of hormones that occurs in a follicle?

Answer 5

Follicle = oocyte surrounded by granulosa and theca cells

LH acts on theca cells –> androgen

FSH acts on granulosa cells to covert that androgen to estradiol

The estradiol drives the proliferative phase –> induces the LH surge via positive feedback –> ovulation

Question 6

Polycystic Ovarian Syndrome (PCOS)

Characterized by (3):

Initiating event?

Histology:

Answer 6

Excess secretion of androgenic hormones

persistent anovulation

MANY subcapsular ovarian cysts –> enlarged ovaries

Initiating event is UNCLEAR

Histology:

follicles lined by granulosa cells with hyperplastic theca (interna)

Question 7

PCOS pathogenesis?

Answer 7

LH is KEY to pathogenesis

LH> FSH

LH –> theca cells –> INC androgen = hyperandrogenemia and follicular atresia

INC androgen –> hirsutism, acne, androgen-dependenet alopecia

–> conversion of androgen –> E1 in peripheral tissue/adipose tissue–> INC in E1 = INC risk for endometrial hyperplasia/CA

–> DEC progesterone, amenorrhea, infertility and polycystic ovaries

Question 8

What are clinical sequela of PCOS? (5)

Answer 8

[Reproductive, metabolic, cardiovascular]

Hirsutism

Chronic anovulation, oligomenorrhea, infertility

Insulin resistance (can develop DM 2 in 10-15 yrs)

Obesity

**Endometrial hyperplasia/ endometrioid CA **

Question 9

PCOS treamtne (3):

Answer 9

1. Weight reduction
2. Hormonal therapy to interrupt constatn excess of androgens
3. Metformin (esp for DM/metabolic syndrome)

Question 10

What types of neoplasms can occur in the ovaries ? (4 categories)

Answer 10

1. Surface Epithelial Cell Tumors
2. Germ Cell Tumors
3. Sex Cord- Stroma Tumors
4. Metastases to the Ovaries

Question 11

Surface Epithelial Tumors:

Overall Frequency?

Proportion of malignancy?

Age group mostly affected?

Types? (6)

Answer 11

Surface Epithelial Tumors:

Overall Frequency: MOST COMMON up to 70%

Proportion of malignancy: 90%

Age group mostly affected: 20+ (reproductive age)

Types: serous, mucinous, endometrioid, brenner, clear cell, cystadenofibroma

Question 12

Benign serous cystadenoma:

age-

gross-

histology-

Answer 12

Benign serous cystadenoma:

age- 30-40 y/o

gross- single cavity or multiple; cyst with thin and smooth surface

histology- single layer of lining cells similar to that of fallopian tube mucosa (columar epithelial), no cytologic atypia, no invasion