Gynae - fallopian tube and ovary Flashcards
diseases affecting fallopian tubes
- Inflammations: Suppurative (Gonococcus & chlamydiae), TB salpingitis and actinomycosis (IUCD) - Ectopic pregnancy and endometriosis - Tumours and cysts: Hydatids of Morgagni adenomatoid tumour adenocarcinoma
hydatids of Morgagni
benign cystic structures - remnants of mullerian duct
hydrosalpinx
- definition
- cause
blocked fallopian tube that is filled with fluid
- tubal blockage caused by previous pelvic infection (pelvic inflammatory disease)/ endometriosis (endometrium cells growing in FT)
pyosalpinx
- definition
- cause
- clinical symptom/ complication
- treatment
pyo = pus fallopian tube filled w/ pus - Caused by infection by Chlamydia, NG, E. Coli, Staphylococci, Streptococci - Pelvic pain Infertility - treatment: Antibiotics/surgery
actinomycotic salpingitis
- cause
- who does it affect (increased risk)
- treatment
- infection by filamentous branched clubbed organism, gram-positive, non-acid fast
- IUCD (Intrauterine Contraceptive Device) users have increased risk
- antibiotics treatment
adenomatoid tumour
- benign/malignant
- symptoms
- micro appearance
Most common benign tumour of fallopian tube
- Usually asymptomatic
- Invagination of visceral mesothelium
Tubular spaces of varying sizes composed of flattened cells
Salpingitis Isthmica Nodosa
- complications
- location
- infertility, ectopic pregnancy - cause the lumen of the FT gets constricted and small
- Bilateral in 80% of cases with nodular swellings
swelling caused by diverticulae communicating with lumen cause swellings
Non-neoplastic ovarian cysts (4)
- Follicular cysts
- Multiple follicular cysts (polycystic ovary syndrome)
- Corpus luteal cysts (after ovulation)
- Endometriotic cysts
Follicular cysts
- cause
- Arise from unruptured
follicles or from follicles that ruptured and sealed immediately
-> Filled with serous fluid
big sized cysts may mimick tumour
corpus luteal cyst
- associated cause
yellowish thick cyst lining the ovary
Associated with menstrual irregularities
polycystic ovary
- clinical symptoms
- pt physical appearance
- histo appearance
- Amenorrhoea + Persistent anovulatory state
- physical appearance:
Obese, hirsute (hair on chest), acne - Multiple cysts & stromal hyperplasia
high estrogen and androgen levels
ovarian neoplasms (4)
- surface epithelial stromal cell tumours (most common) (EOT) - germ cell tumour - sex cord stroma tumours - tumours metastasised to ovary
ovarian germ cell tumours (5)
- seminoma (m)
- dysgerminoma (m)
- yolk sac tumour (m)
- choriocarcinoma (m)
- teratoma (mature - b, immature - m)
dysgerminoma
- gross appearance
- histo appearance
- large and firm/ soft and fleshy
monotonous tumour cell w/ clear glycogen filled cytoplasm
fibrous septa w/ lymphocytes
mature teratomas
mature teratomas form majority of germ cell tumours
benign: cystic teratoma (colour resembles thyroid follicles w/ colloid),
Struma ovarii
malignant: SCC, thyroid
(immature teratomas are all malignant)
yolk sac tumour
- affects who
- malignancy
- characteristics
- Children and young women
- Highly malignant
- Differentiation towards yolk sac
Rich in alpha-fetoprotein -> tests strongly for AFB
Schiller-Duval bodies - central fibrovascular space
surface epithelium tumours
- Endocervical differentiation: Mucinous tumours - cystadenoma (B) and cystadenocarcinoma (M) - Tubal differentiation: Serous tumours - cystadenoma (B) and cystadenocarcinoma (M) - Endometrial differentiation: endometrioid and clear cell (M) type - Transitional/urothelial: Brenner tumour (B)
B = beign M = malignant
pathogenesis of ovarian epithelial tumours (2 types)**
Type 1 tumours: progress from benign through borderline tumours that give rise to low-grade carcinomas.
Type II tumours: arise from inclusion cysts/FT epithelium that show high grade features (serous)
- majority of malignant epithelial tumours are serous!!**
mucinous cystadenoma histo features
lined by mucin epithelium
locule containing mucin
borderline ovarian neoplasms histo criteria
- Epithelial hyperplasia – stratification, tufts
- Atypia –mild to moderate
- Minimal mitotic activity
- Absence of destructive stromal invasion
mucinous tumours
- clinical presentation
- complications
- massively enlarged abdomen
- rupture -> release mucin into peritoneal cavity
endometroid ovarian tumour
- malignancy
- histo features
- prognosis
most of them are malignant
- Contain tubular glands resembling endometrium
- prognosis better than serous carcinoma
clear cell ovarian adenocarcinoma
- gross and histo appearance
uncommon
- Grossly solid/cystic
- Large sheets of epithelial cells with clear cytoplasm and tubules with hobnail nuclei (bulbous nuclei w/ projections into cytoplasm)
cystic spaces lined by nucleus
brenner tumour
- malignancy
- size
- histo appearance
- Benign
- 1-8cm
- Nests of urothelial-like cells in a dense fibrous stroma
sex cord/stromal tumours
- malignancy
- types
mainly benign - low grade malignancy
- thecomas (fibroma)
- granulosa cell (most common)
thecoma (fibroma)
- malignancy
- histo features
- clinical presentation
- benign
- Stromal tumours with fibroblasts (fibroma) or plump spindle cells with lipid droplets (thecoma)
- Meig’s syndrome: Fibroma, ascites, pleural effusion
granulosa cell tumour
- malignancy
- gross and histo appearance
- malignant: spreads locally
- large tumour (cystic/solid). yellow areas (lipid laden luteinized cells)
- Follicular pattern (call-exner bodies)
Cleaved, elongated nuclei (coffee bean shape)
spread of malignant ovarian neoplasms (4 ways)
- Local infiltration into broad ligament: Urethral obstruction Bladder involvement - Peritoneal spread Ascites with malignant cells in fluid Peritoneal nodules - Lymphatic spread - Hematogenous spread Lung nodules
ovarian tumours caused by metastasis (from other sites)
- 2 types (from where it comes from)
- location it affects
- gross appearance
- Mullerian: Uterus, FT, peritoneum
Extramullerian (outside genitalia tract): breast, GIT
(GIT - Krukenberg**) - Bilateral
- Friable and necrotic with vascular invasion
invades through ovarian surface
where can teratomas occur
- germ cell origin: (sexual gametes) testes/ovaries sacro-coccyx brain mediastinum
metastatic tumour from GIT
- micro appearance
krukenberg tumour
diffused, signet ring cells
