Female Repro Pathology II Flashcards
Fallopian tube, Ovary
State the common fallopian tube conditions. (3)
- INFLAMMATION
- suppurative (gonoccocus, chlamydia)
- TB
- salpingitis
- actinomycosis (IUCD) - Ectopic pregnancy and endometriosis
- Tumours and cysts
State everything you know about hydatids of morgagni.
PARATUBAL CYSTS
- most common lesion
- benign
- predunculated cyst structures arising from fimbeial end of fallopain tubes
- serous type, fluid filled cysts
- mullerian duct remnats
State the histological features of hydrosalpinx.
- flattened lining epithelium
- minimal fimbriae structures
- inflammatory infiltrate
State everything you know about hydrosalpinx.
BLOCKED FALLOPIAN TUBE FILLED WITH FLUID
- can be due to previous pelvic infection (eg: PID)
- can be due to endometriosis
State everything you know about pyosalpinx.
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
State everything you know about acute salpingitis.
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
State everything you know about actinomycotic salpingitis.
- caused by actinomyces (gram negative, non-acid fast organism)
- IUCD users predisposed to condition
- treatment: antibiotics
State everything you know about salpingitis isthmica nodusa.
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
State everything you know about adenomatoid tumour (including histological features).
- 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
State the cellular components of normal ovary morphology.
- germinal epithelium
- tunica albuginea
- cortex
- stroma
- medulla
- hilum
State the cellular components of normal germinal follicle morphology.
- theca externa
- theca interna
- granulosa
- antrum
- primary oocyte with zone pellucida around it
State the common non-neoplastic ovarian cysts. (4)
- follicular cyst
- multiple follicular cyst (polycystic ovary syndrome)
- corpus luteal cyst
- endometriotic cyst
State everything you know about follicular cysts.
- mostly physiologic
- arises from unruptured follicles or follicles that rupture and seal immediately
- filled with serous fluid and ovaries have thin walls
State everything you know about polycystic ovary syndrome (multiple follicular cysts)
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
State everything you know about corpus luteal cyst
- cystic corpus luteum >2cm with yellowish thick cyst lining
- follicle seals itself -> lining epithelium undergoes luteinisation -> luteal cells -> THICK!
- presentation: oligomenorrhoea
- occurs after ovulation
State the common types of ovarian neoplasms. (4)
- Surface epithelial cells (65-70%)
- Germ cell (15-20%)
- Sex-cord - stromal (5-10%)
- Metastasis to ovaries (5%)
State the types of spread in ovarian neoplasms.
- Local infiltration into broad ligament - urethral obstruction, bladder involvement
- Peritoneal spread - ascites with malignant cells in fluid, peritoneal nodules
- Lymphatic spread
- Haematogenous spread - lung nodules
State the common types of germ cell tumours.
- Seminoma (testis)
- Dygerminoma (oogonia)
- Tumours of totipotencial cells -> embryonal carcinoma -> extra-embryonic (yolk sac tumour, choriocarcinoma) & embyronic 3 layers (teratoma)
State the histological features of dysgerminoma.
- nests of monotonous tumour cells with clear glycogen-filled cytoplasm
- fibrous septa with lymphocytes
State everything you know about dysgerminoma.
- treat by radiotherapy
- gross: soft and fleshy, large and firm, bosselated external surface
State everything you know about general teratoma.
- ## 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
State the gross and histological and gross features of mature teratoma.
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
State the grading of immature (malignant) teratomas.
Grade 1 - rare foci of immature neuroepithelial tissue occupying <1/LPF in any slide
Grade 2 - 1-3 LPF/slide
Grade 3 - large amounts
State the histological features of yolk sac tumour (endodermal sinus tumour).
- schiller-duval bodies
- appearance similar to primitive glomeruli surrounding vascular space
State everythigng you know about yolk sac tumours.
- highly malignant
- rich in AFP
- common in children and young women
- differentiation towards yolk sac
State the common ovarian surface epithelial tumours. (4 classes, 5 egs)
- endocervical differentiation - mucinous cystadenoma
- tubal differentiation - serous cystadenoma
- endometrial differentiation - endometroid ovarian tumour + clear cell ovarian adenocarcinoma
- transitionl/urothelial - brenner tumour
State the pathogenesis of type 1 and type 2 ovarian surface epithelial tumours.
Type 1:
- benign -> borderline that form low-grade carcinomas
Type 2:
- arise from inclusions cysts/fallopian tube epithelium -> high grade (serous) tumours
State the histological features of borderline ovarian neoplasms.
- epithelial hyperplasia
- nuclear atypia
- minimal mitotic activity
- absence of destructive stromal invasion (confined to cyst)
State the histological features of mucinous cystadenoma (borderline).
- epithelial stratification and tufts
- low mitotic rate
- absence of destructive stromal invasion
- mild-moderate nuclear atypia
- proliferation forming papillary structures
- locules filled with thick mucinous material
- basally located nuclei without stratification
State the histological features of mucinous cystadenocarcinoma (malignant).
- increased mitotic acitivity
- stromal invasion
- necrosis
- complex gland formation
- often mucinous cystic tumours have cysts that are multiloculated
State the histological features of serous cystadenoma (benign)
IS A BENIGN SEROUS (TUBAL DIFFERENTIATION) TUMOUR!!
- cysts filled with clear serous fluid and are multiloculated
- smooth inner surface of cysts
- tubal differentiation - ciliatedcells are ciliated in fallopian tube, peg cells are columnar and glandular in fallopian tube
State the difference between serous cystadenoma benign and borderline.
Borderline has more cystic proliferation (lobules in cysts) .
State the histological features of serous cystadenocarcinoma
- more complexity of cysts
- stromal invasion
THIS IS HIGH GRADE AND WORSE THAN ENDOMETROID OVARIAN TUMOURS
State the histological features of endometrioid ovarian tumours.
- formation of tubular structures lined by simple columnar epithelium
State everything you know about endometrioid ovarian tumours.
- 20% of all ovarian cancers
- most are carcinomas
- contains tubular glands resembling endometrium
- 15% coexist with endometriosis
- better prognosis than serous cystadenocarcinoma (CA)
State the histological features of clear cell ovarian carcinoma.
- Large sheets of epithelial cells with clear cytoplasm (CLEAR CELL DIFFERENTIATION) and tubules with HOBNAIL NUCLEI
State everything you know about clear cell ovarian carcinomas.
- uncommon
- grossly solid and cystic
State the histological features of brenner tumour.
- nuclear grooves (coffee bean nuclei)
- nest of urothelial like cells in dense fibrous stroma
State the 3 types of sex-cord tumours.
- Fibroma - Thecoma
- Granulosa tumour
- Sertoli-Leydig cell tumours (arrrhenoblastoma)
State the histological feature of Fibroma - thecomas.
- stromal tumours with fibroblasts or plump spindle cells with lipid droplets
State everything you know about fibroma - thecomas.
- 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
State the histological features of granulosa cell tumour.
- folliular pattern (call-exner bodies)
- cleaved, elongated nuclei (nuclei grroves)
- strong positivity for inhibin
State everything you know about granulosa cell tumours
- 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
State everything you know about sertoli-leydig cell tumours
- rare mesenchymal tumour of low-grade malignant potential
- resembles testis
- androgen secreting -> masculinism (hirsutism)
- common in young women
State everything you know about metastasis to ovary (krukenberg tumour)
- 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
