Lecture 27: Pathology of ovary and uterus Flashcards
How does HPV link to cancer formation?
Carinomas
epithelial origin - adenocarcinoma: adrenal epithelium - squamous cell carcinoma: squamous epithelium simple epi --> carcinoma glandular --> adenocarcinoma squamous --> squamous cell carcinoma urothelium --> urothelial carcinoma
Lymphoma
lymphoid tissue origin
- Hodgkin’s disease
- Non- Hodgkins ( T or B cells)
Melanoma
melanocytic cell adipose tissue --> liposarcoma neural tissue --> malignant peripheral nerve sheath bone --> osteosarcoma Cartilage --> chondosarcoma muscle --> leiomyo/Rhabdomyosarcoma
Sarcoma
mesenchymal (structural cells , holding fat, nerves and bones )
- less common
Where can uterine pathologies occur
Uterus + Neighbouring structures: rectum, bladder, sigmoid colon
Note: Ovarian pathologies can easily spread
Follicle quantities in the ovary
400,000 primordial follicles –> dormant until puberty –> FSH and Lh release causes 20 follicles to mature each cycle –> 1 out of the twenty reaches maturity and is released –> Menopause –> only a few follicles remain
Ovary in H&M section (hameotocilin and EOSM slide)
cortex, stroma, mesothelial lining, follicles, BV, hilum
3x Main ovarian tumours
Metastases spread from everywhere to the ovary–>
- Germ: germ cell tumours (teratoma)
- Stromal: sex cord stromal tumours (fibroma)
- Surface: majority of ovarian tumours arise from the surface/fimbrial end of the Fallopian tube
What sort of structure is the ovary inherently?
Cystic structure
- ovaries are constantly forming follicular cysts which develop –> mature –> rupture
Ovarian tumour table
Polycystic ovaries
In cortex –> follicles proliferate but never ovulated –> continued oestrogen stimulation –> no ovulation (no progesterone) –> endometrial hyperplasia and carcinoma
Polycystic ovaries: follicular cyst (never popped)
Ovarian neoplasm
multi cystic (solid) areas
- -> once malignant they become increasingly solid
1. cyst adenoma
2. mucinous cyst adenomas
3. serous
4. mucinous carcinoma
5. serous carcinoma
Histological features of ovarian neoplasm
- large nuclei
2. course chromatin
Dermoid cyst/Teratomas
dermoid cyst –> females try to make baby WITHOUT MALE SPERM –> starts forming structures (e.g. teeth, hair) –> but recapitulates and goes completely wrong
- normally benign, sitting in skin for years
pot. to develop squamous cel carcinoma in skin
relationship b/w stomach and ovary
diffuse gastric cell carcinoma –> often metastasises into ovary
- another stomach carcinoma is Putinburg Signet Ring carcinoma
relationship b/w colon and ovary
colorectal carcinoma –> can metastasise –> become cystic –> mimic primary ovarian neoplasm
Putinburg carcinoma
Signet ring cell carcinoma (of stomach) –> nucleus on top and cytoplasm below –>
length of normal fallopian tube
9-11 cm
What does the fallopian tube open into
peritoneal cavity
Function of Fallopian tube
ovulation –> follicle rupture and fimbrae align overtop –> ovum enters lumen of FT –> FERTILIZATION occurs in fallopian tubes –> BlastoCYTE move through rest of fallopian tube into Uterus –> blastocyte IMPLANTS into uterus after several days
Structure of Fallopian Tube
Plicae: fingerlike projections Lining: serous columnar epithelium cilia: brush egg down towards uterus - smooth muscle wall lining Overall: delicate and complex structure that is very vulnerable to inflammation and tumours --> stops plicae movement --> unable to direct egg --> complications
Fallopian Tube tumour table
Bilateral Salphangitis
Enflamed fimbrial ends stick together –> fallopian tubes fill with puss and blood
Serous carcinoma of fallopian tube
tube expanded by tumour growing within
Thicker = Intrapeithelial neoplasm
Components of the uterus
Fundus
Body
Cervix
- thick muscle myometrium wall –> so can push grown baby out
- endometrial lining –> changes with every cycle –> contains glands and stroma
What are the components of the uterine endometrium
- glands
2. stroma
Function of the endometrium
Note: components = glands and stroma
- endometrium contains oestrogen and progesterone hormone receptors –> endometrium develops and shes under oestrogen and progesterone influence
Menopause –> no hormones –> no stimulation for regular menstrual cycle –> Endometrium become inactive after menoapuse
Menstrual cycle
- Oestrogen stimulated proliferative stage
OVULATION (required to switch stages/hormone stimualtion) - Progesterone stimulated secretory stage
- Menstrual
- Inactive
When is there excessive oestrogen stimulation
- diabeties
2. polycystic ovarian syndrome
What happens if there is no ovulation?
No switch from oestrogen –> progesterone
oestrogen continues to be released –> excessive oestrogen stimulation –> excessive proliferation
Histology of 4x stages of Menstrual cycle
- Proliferation: proliferation mainly in basal layer. little tubules in dense stroma.
- Secretory: (juicy/glandular)
- serrated and convoluted glands
- secreting substances to keep blastocysts happy –> breaks down/sheds upon no implantation
Endometrial tumour table
Myometrial tumour table
Cervix
“neck”
narrower portion of the uterus
Cervix protrudes down into upper vagina
Surface anatomy of cervix
Inferior Vagina –> Superior Cervix
Squamous epi
Endocervical canal
glandular epithelium
Tumour table of the cervix
Precancerous squamous intraepithelial lesion
CIN (cerivcal intraepithelial neoplasia)
dysplasia
squamous intraepithelial lesion
- low grade squamous intraepithelial lesion (CIN)
- high grade squamous intraepithelial lesion (CIN II and III)
HPV virus multiplication
squamous mucosa beomces infected with HPV –> HPV virus integrates itself into DNA –> increased replication and turnover of the cell –> CIN
Grade of pre-cancer
dependany on severity and extent of stypia
CIN I
CIN II
CIN III
Invasion
- want to see these cellular changes during smear test
CIN –> Invaded
neoplastic cells can invade into Blood vessels, nerve and lymphatics –> spread and metastasize
Uterine Congenital abnormalities
Uterus doesnt fuse symmetrically
- Intersex abnormalities
- malformations of the uterus
- abnomalities of ovarian development (Absent ovaries)
e. g Bicornuate uterus: Pregnancies occurring on both sides of the uterus
