Ovarian Cancer and Pathology Flashcards
What symptoms may ovarian pathology cause?
Pain, swelling or endocrine effect
What are some features of ovarian cysts?
Arise from any element
May be innate or acquired
What are the types of ovarian cyst?
Follicular, luteal, endometriotic, epithelial, mesothelial
How common are follicular ovarian cysts?
Very common = can form when ovulation doesn’t occur leading to polycystic ovaries
What are some features of follicular ovarian cysts?
Follicle doesn’t rupture but grows to become a cyst
May be several cm in size
Thin walled and lined with granulosa cells
Usually resolve over a few months
What is endometriosis?
Presence of endometrial glands and stroma outside the uterine body
What can endometriosis present with?
Pelvic inflammation, pain and inflammation
Where are some sites endometriosis can occur?
Ovaries, pouch of Douglas, peritoneal surfaces, cervix, vagina, vulva, bladder
What is the pathogenesis of ovarian endometriosis?
Regurgitation, metaplasia, vascular or lymphatic dissemination
What is the appearance of ovarian endometriosis?
Macroscopic = peritoneal spots/nodules, fibrous adhesions, chocolate cysts Microscopic = endometrial glands and stroma, haemorrhage, inflammation, fibrosis
What are some complications of endometriosis?
Pain, cyst formation, infertility, ectopic pregnancy, endometrial carcinoma
What are the types of ovarian tumour?
Epithelial, germ cell, sex cord/stromal, metastatic, miscellaneous
What are the types of epithelial ovarian tumour?
Serous, mucinous, endometrioid, clear cell, Brenner, undifferentiated carcinoma
What are some features of epithelial ovarian tumours?
Cell of origin not entirely clear
Account for 65-70% of ovarian tumours
Categorised as benign, borderline or malignant
What are some features of benign epithelial ovarian tumours?
No cytological abnormalities, proliferative activity absent/scant, no stromal invasion
What are some features of borderline and malignant ovarian tumours?
Borderline = cytological abnormalities, proliferative, no stromal invasion Malignant = stromal invasion
How are serous epithelial ovarian tumours graded?
High grade = serous tubal intraepithelial carcinoma (STIC), most cases essentially tubal in origin
Low grade = serous borderline tumour
What are endometrioid and clear cell epithelial ovarian tumours associated with?
Ovarian endometriosis and Lynch syndrome
How are endometrioid epithelial ovarian tumours graded?
Graded the same as uterine tumours = most are low grade and early stage
How common are germ cell ovarian tumours?
15-20% of all ovarian tumours
What is the most common type of germ cell ovarian tumour?
Mature teratoma = benign dermoid cyst
95% of all germ cell tumours
What are some features of mature teratomas?
Cystic = contain sebum and hair
Can rarely become malignant
What are some common sites for mature teratomas to occur?
Skin, respiratory epithelium, gut, fat
What are the other types of germ cell ovarian tumours?
Immature teratoma, dysgerminoma, yolk sac tumour, choriocarcinoma, mixed germ cell tumour
What are some examples of sex chord/stromal ovarian tumours?
Fibroma/thecoma = benign, may produce oestrogen causing uterine bleeding
Granulosa cell tumour = all potentially malignant, may be associated with oestrogenic manifestations
Sertoli-Leydig tumours = rare, may produce androgens
What are some features of metastatic ovarian tumours?
Consider when tumours are bilateral and small
Commonly from stomach, colon, breast or pancreas
What is Figo stage 1 of ovarian cancer?
1A = limited to one ovary 1B = limited to both ovaries 1C = cancer involving ovarian surface
What is Figo stage 2 ovarian cancer?
2A = extension or implants on uterus or fallopian tubes 2B = extension to pelvis (intraperitoneal)
What is Figo stage 3 ovarian cancer?
3A = retroperitoneal lymph node metastases or microscopic extrapelvic peritoneal involvement 3B = macroscopic peritoneal metastasis beyond pelvis up to 2cm in dimension 3C = macroscopic metastasis >2cm in dimension
What is Figo stage 4 ovarian cancer?
Distant metastases
What are some pathologies that can affect the fallopian tubes?
Inflammation = salpingitis
Cysts and tumours
Serous tubal intraepithelial carcinoma (STIC)
Endometriosis or ectopic pregnancy
What is an ectopic pregnancy?
Implantation of conceptus outside endometrial cavity = often rupture to cause haemorrhage
Where can ectopic pregnancies occur?
Most commonly in fallopian tubes
Can also occur in ovary or peritoneum
When should you suspect an ectopic pregnancy?
In any female of reproductive age with amenorrhoea and acute hypotension or acute abdomen
