Female genital tract 2: Ovaries

Question 1

What are the ovarian tumours and where do they arise from?

Answer 1

Arise from surface epithelial cells or stroma.
also from fallopian tube fimbria and may be associated with BRCA1 gene.
Surface epithelial tumours are invariably cystic.
stromal tumours are rare but can be hormonally active: e.g. if they produce oestrogens, patient may present with post menopausal bleeding, e.g. granulosa cell tumour.

Question 2

How are ovarian tumours classified?

Answer 2

Tissue of origin - epithelial or stromal.
Macroscopic appearance - cystic or solid.
Contents of cyst - serous, mucinous, dermoid.
Histological appearance - benign, borderline or malignant.
Serous cystic tumours secrete watery fluid.
Mucinous cystic tumours secrete mucus.
Cysts can be multilocular (multiple cavities) or unilocular.

Question 3

What are the features of borderline tumours?

Answer 3

Complex architecture with papillary structures.
Cytological atypia - variation in nuclear size and shape.
Nuclear stratification
Mitotic activity but no invasion of wall
All have cellular features of cancer without invasion but can present later with metastases.

Question 4

Where do chocolate cysts arise from?

Answer 4

endometriosis in ovary i.e. presence of endometrial stroma and glands outside the endometrial cavity.
when the woman menstruates the endometriosis also menstruates.
blood collects in the cyst.