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M2 Pathology > Female Repro Pathology II > Flashcards

Female Repro Pathology II Flashcards

Fallopian tube, Ovary

1
Q

State the common fallopian tube conditions. (3)

A
  1. INFLAMMATION
    - suppurative (gonoccocus, chlamydia)
    - TB
    - salpingitis
    - actinomycosis (IUCD)
  2. Ectopic pregnancy and endometriosis
  3. Tumours and cysts
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2
Q

State everything you know about hydatids of morgagni.

A

PARATUBAL CYSTS
- most common lesion
- benign
- predunculated cyst structures arising from fimbeial end of fallopain tubes
- serous type, fluid filled cysts
- mullerian duct remnats

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3
Q

State the histological features of hydrosalpinx.

A
  1. flattened lining epithelium
  2. minimal fimbriae structures
  3. inflammatory infiltrate
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4
Q

State everything you know about hydrosalpinx.

A

BLOCKED FALLOPIAN TUBE FILLED WITH FLUID
- can be due to previous pelvic infection (eg: PID)
- can be due to endometriosis

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5
Q

State everything you know about pyosalpinx.

A

ACUTE INFLAMED FALLOPIAN TUBE IS CONGESTED AND OEDEMATOUS
- caused by chlamydia, neisseria gonorrhea, E. coli, Staph, Strep
- both ends of fallopian tube close -> pus accumulates due to obstruction
- presentation: fever and pelvic pain
- treatment: antibiotics, surgery (salpingectomy)
- can lead to infertility

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6
Q

State everything you know about acute salpingitis.

A

Pathways:
1. Acute salpingitis -> normal (VERY RARE)
2. Acute salpingitis -> spread to ovary (tubo-ovarian abscess) -> healing with fibrosis -> tubo-ovarian abscess
3a. Acute salpingitis -> blocked fimbriae -> pyosalpinx -> healing with fibrosis -> tubo-ovarian abscess
3b. Acute salpingitis -> blocked fimbriae -> pyosalpinx -> absorption of pus -> hydrosalpinx
3c. Acute salpingitis -> blocked fimbriae -> pyosalpinx -> hydrosalpinx follicularis
4. Acute salpingitis -> healed salpingitis -> distension -> hydrosalpinx follicularis

Hydrosalpinx follicularis = walls of the fallopian tube show multiple lymphoid follicles (chronic inflammation)

TYPES:
1. Actinomycotic salpingitis
2. Salpingitis isthmica nodosa

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7
Q

State everything you know about actinomycotic salpingitis.

A
  • caused by actinomyces (gram negative, non-acid fast organism)
  • IUCD users predisposed to condition
  • treatment: antibiotics
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8
Q

State everything you know about salpingitis isthmica nodusa.

A

NODULE FOUND IN THE ISTHMUS
- uncertain pathogensis in young women (infertility or ectopic)
- bilateral in 80% of cases with nodular swelling
- diverticulae from lumen of fallopian tube communicates with wall to cause swellings

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9
Q

State everything you know about adenomatoid tumour (including histological features).

A
  • usually asymptomatic
  • most common benign tumour of the fallopian tubes
  • Histo:
    1. invagination of visceral mesothelium
    2. tubular spaces of varying sizes composed of flattened cells
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10
Q

State the cellular components of normal ovary morphology.

A
  • germinal epithelium
  • tunica albuginea
  • cortex
  • stroma
  • medulla
  • hilum
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11
Q

State the cellular components of normal germinal follicle morphology.

A
  • theca externa
  • theca interna
  • granulosa
  • antrum
  • primary oocyte with zone pellucida around it
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12
Q

State the common non-neoplastic ovarian cysts. (4)

A
  1. follicular cyst
  2. multiple follicular cyst (polycystic ovary syndrome)
  3. corpus luteal cyst
  4. endometriotic cyst
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13
Q

State everything you know about follicular cysts.

A
  • mostly physiologic
  • arises from unruptured follicles or follicles that rupture and seal immediately
  • filled with serous fluid and ovaries have thin walls
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14
Q

State everything you know about polycystic ovary syndrome (multiple follicular cysts)

A

ALSO KNOWN AS STEIN-LEVENTHAL SYNDROME
- rare - 10% of women
- treatment: surgical resection of part of ovary OR using hormones to control anovulatory state
- symptoms:
1. obesity
2. hirsutism
3. acne (due to increased oestrogen and androgen production)
4. amenorrhea

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15
Q

State everything you know about corpus luteal cyst

A
  • cystic corpus luteum >2cm with yellowish thick cyst lining
  • follicle seals itself -> lining epithelium undergoes luteinisation -> luteal cells -> THICK!
  • presentation: oligomenorrhoea
  • occurs after ovulation
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16
Q

State the common types of ovarian neoplasms. (4)

A
  1. Surface epithelial cells (65-70%)
  2. Germ cell (15-20%)
  3. Sex-cord - stromal (5-10%)
  4. Metastasis to ovaries (5%)
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17
Q

State the types of spread in ovarian neoplasms.

A
  1. Local infiltration into broad ligament - urethral obstruction, bladder involvement
  2. Peritoneal spread - ascites with malignant cells in fluid, peritoneal nodules
  3. Lymphatic spread
  4. Haematogenous spread - lung nodules
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18
Q

State the common types of germ cell tumours.

A
  1. Seminoma (testis)
  2. Dygerminoma (oogonia)
  3. Tumours of totipotencial cells -> embryonal carcinoma -> extra-embryonic (yolk sac tumour, choriocarcinoma) & embyronic 3 layers (teratoma)
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19
Q

State the histological features of dysgerminoma.

A
  1. nests of monotonous tumour cells with clear glycogen-filled cytoplasm
  2. fibrous septa with lymphocytes
20
Q

State everything you know about dysgerminoma.

A
  • treat by radiotherapy
  • gross: soft and fleshy, large and firm, bosselated external surface
21
Q

State everything you know about general teratoma.

A
  • ## tumour composed of tissues representing 2-3 germ layers (endoderm, ectoderm, mesoderm)

PATHWAY:
germ cell -> embryonic differentiation -> neoplastic transformation -> mature or immature teratoma

  • mature -> benign (cystic teratoma, struma ovarii) & malignant (scc, thyroid)
  • immature -> malignant
22
Q

State the gross and histological and gross features of mature teratoma.

A

GROSS:
- presence of hair
- keratinous material trapped in lumen of cyst

HISTO:
- stratified squamous epithelium of skin
- (struma ovarii = benign thyroid tissue) thyroid tissue forms thyroid follicles with colloid

23
Q

State the grading of immature (malignant) teratomas.

A

Grade 1 - rare foci of immature neuroepithelial tissue occupying <1/LPF in any slide
Grade 2 - 1-3 LPF/slide
Grade 3 - large amounts

24
Q

State the histological features of yolk sac tumour (endodermal sinus tumour).

A
  1. schiller-duval bodies
  2. appearance similar to primitive glomeruli surrounding vascular space
25
Q

State everythigng you know about yolk sac tumours.

A
  • highly malignant
  • rich in AFP
  • common in children and young women
  • differentiation towards yolk sac
26
Q

State the common ovarian surface epithelial tumours. (4 classes, 5 egs)

A
  1. endocervical differentiation - mucinous cystadenoma
  2. tubal differentiation - serous cystadenoma
  3. endometrial differentiation - endometroid ovarian tumour + clear cell ovarian adenocarcinoma
  4. transitionl/urothelial - brenner tumour
27
Q

State the pathogenesis of type 1 and type 2 ovarian surface epithelial tumours.

A

Type 1:
- benign -> borderline that form low-grade carcinomas

Type 2:
- arise from inclusions cysts/fallopian tube epithelium -> high grade (serous) tumours

28
Q

State the histological features of borderline ovarian neoplasms.

A
  1. epithelial hyperplasia
  2. nuclear atypia
  3. minimal mitotic activity
  4. absence of destructive stromal invasion (confined to cyst)
29
Q

State the histological features of mucinous cystadenoma (borderline).

A
  1. epithelial stratification and tufts
  2. low mitotic rate
  3. absence of destructive stromal invasion
  4. mild-moderate nuclear atypia
  5. proliferation forming papillary structures
  6. locules filled with thick mucinous material
  7. basally located nuclei without stratification
30
Q

State the histological features of mucinous cystadenocarcinoma (malignant).

A
  1. increased mitotic acitivity
  2. stromal invasion
  3. necrosis
  4. complex gland formation
  5. often mucinous cystic tumours have cysts that are multiloculated
31
Q

State the histological features of serous cystadenoma (benign)

A

IS A BENIGN SEROUS (TUBAL DIFFERENTIATION) TUMOUR!!

  1. cysts filled with clear serous fluid and are multiloculated
  2. smooth inner surface of cysts
  3. tubal differentiation - ciliatedcells are ciliated in fallopian tube, peg cells are columnar and glandular in fallopian tube
32
Q

State the difference between serous cystadenoma benign and borderline.

A

Borderline has more cystic proliferation (lobules in cysts) .

33
Q

State the histological features of serous cystadenocarcinoma

A
  1. more complexity of cysts
  2. stromal invasion

THIS IS HIGH GRADE AND WORSE THAN ENDOMETROID OVARIAN TUMOURS

34
Q

State the histological features of endometrioid ovarian tumours.

A
  1. formation of tubular structures lined by simple columnar epithelium
35
Q

State everything you know about endometrioid ovarian tumours.

A
  • 20% of all ovarian cancers
  • most are carcinomas
  • contains tubular glands resembling endometrium
  • 15% coexist with endometriosis
  • better prognosis than serous cystadenocarcinoma (CA)
36
Q

State the histological features of clear cell ovarian carcinoma.

A
  1. Large sheets of epithelial cells with clear cytoplasm (CLEAR CELL DIFFERENTIATION) and tubules with HOBNAIL NUCLEI
37
Q

State everything you know about clear cell ovarian carcinomas.

A
  • uncommon
  • grossly solid and cystic
38
Q

State the histological features of brenner tumour.

A
  • nuclear grooves (coffee bean nuclei)
  • nest of urothelial like cells in dense fibrous stroma
39
Q

State the 3 types of sex-cord tumours.

A
  1. Fibroma - Thecoma
  2. Granulosa tumour
  3. Sertoli-Leydig cell tumours (arrrhenoblastoma)
40
Q

State the histological feature of Fibroma - thecomas.

A
  1. stromal tumours with fibroblasts or plump spindle cells with lipid droplets
41
Q

State everything you know about fibroma - thecomas.

A
  • presents as solid mass
  • no hormone activity
  • pure thecomas are rare but may be hormonally active
  • meig’s syndrome presents as: fibroma, ascites, pleural effusion
  • benign
42
Q

State the histological features of granulosa cell tumour.

A
  1. folliular pattern (call-exner bodies)
  2. cleaved, elongated nuclei (nuclei grroves)
  3. strong positivity for inhibin
43
Q

State everything you know about granulosa cell tumours

A
  • estrogen secretion in 75% of tumours -> endometrial hyperplasia and carcinoma
  • malignant due to potential for local spread
  • distant metastasis is rare

GROSS:
- tumours are large, focally cystic to solid
- yellow areas of lipid laden lutenised cells

44
Q

State everything you know about sertoli-leydig cell tumours

A
  • rare mesenchymal tumour of low-grade malignant potential
  • resembles testis
  • androgen secreting -> masculinism (hirsutism)
  • common in young women
45
Q

State everything you know about metastasis to ovary (krukenberg tumour)

A
  • bilateral
  • friable and necrotic with vascular invasion
  • ovarian surface involvement
  • known carcinomas at other sites
  • mullerian - to uterus, fallopian tube, peritoneum
  • extramullerian - breast and GIT

M2 Pathology (21 decks)

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