Ovarian cancer - pathology Flashcards
What are the main pathological groups which affect the ovaries ?
- Cysts
- Endometriosis
- Tumours
In general what are symptoms of ovarian cysts and ovarian cancer someone can have ?
- Pain - on intercourse, if a cyst breaks, or abdo pain/pressure
- Abodminal swelling/bloating - this may be due to ascites or presence of a mass + early satiety
- Endocrine effects – e.g. some ovarian tumours or in polycystic ovarian syndrome (thecoma, granulosa cell tumours) may secrete oestrogens or androgens which present relatively early with endometrial abnormalities or virilisation
- Frequent or urgent urinatation
What are ovarian cysts ?
A cyst is a fluid-filled sac.
Ovarian cysts can vary in size - from less than the size of a pea upto or larger than the size of a large melon
Are pretty much a tumour (growth) but are mainly benign although some occasions where they are malignant
In general terms what are the different types of ovarian cysts which can develop ?
- Functional cysts - follicular or corpus luteum cysts
- Dermoid cysts also called cystic teratomas (made up of a variety of different cell types) they are usually benign but sometimes malignant
- Cystadenomas - develop from cells on surface of ovary, most are benign but some can be malignant
- Endometriomas - can develop if you have endometriosis
- Epithelial
- Mesothelial
- Other rare types
Ovarian cysts how are they diagnosed ?
Usually incidental as often no symptoms but you would do abdo and vaginal exam
Then diagnosed with Ultrasound
How do follicular cysts arise ?
They arise where ovulation doesnt occur and the follicle doesnt rupture but grows into a cyst
What are follicular cysts lined by ?
Granulosa cells
What are follicular cysts often associated with ?
Polycystic ovarian syndrome
Perimenopause
What is the normal progression of follicular cysts ?
usually resolve over a number of months
What is endometriosis and what are the common areas it can be found ?
This is the presence of endometrial glands and stroma outside of the uterus:
- Ovary
- Pouch of Douglas
- Peritoneal surfaces, including uterus
- Cervix, vulva, vagina
- Bladder, bowel etc
What are the macroscopic and micoscopic features of ovarian endometriosis ?
Macroscopic:
- Multiple Peritoneal spots or nodules
- Inflammation associated with endometriosis leads to formation of fibrous adhesions - these can then affect fallopian tubes (infertility and predisposes to ectopic pregnancy)
- Chocolate cysts
Microscopic:
- Endometrial glands and stroma
- Haemorrhage, inflammation, fibrosis
What are some of the complications of ovarian endometriosis/in general?
- Pain
- Cyst formation
- Adhesions
- Infertility
- Ectopic pregnancy
- Malignancy (endometrioid carcinoma)
What condition and classic feature of this condition is shown ?
Ovarian endometriosis and the classic chocolate cyst
What are the 3 key features of polycystic ovarian syndrome ?
Is a condition where at least two of the following occur and often all three:
- At least 12 tiny cysts (follicles) develop in your ovaries.
- Clinical or biochemical signs of hyperandrogenism (such as hirsutism, acne, or male pattern alopecia), or elevated levels of total or free testosterone.
- You do not ovulate each month. Some women do not ovulate at all. In PCOS, although the ovaries usually have many follicles, they do not develop fully and so ovulation often does not occur. If you do not ovulate then you may not have a period.
What are the features of PCOS ?
- Excess hair growth (hirtiuism) mainly on the face, tummy and chest
- Acne
- Thinning of hair on scalp (male pattern baldness)
- Weight gain
- Depression
- Irregular or light periods, or no periods at all.
- Infertility
What diagnostic investigations can you do to clarify a diagnosis of PCOS ?
US to look for polycystic ovaries
Blood tests:
- To measure LH and FSH levels - LH levels rasied but FSH levels normal (distinguishes from premature ovarian failure)
- Also measure total testosterone - this may be raised >5
Treatment of PCOS
What are the 3 distinct cell types ovarian the different types of ovarian tumours arise from ?
- Epithelial
- Germ cell
- Sex‐cord/stromal
Metastases to ovary always need to be considered when delaing with malignant tumour in the ovary
What are the different sub-types of epithelial origin ovarian tumours ?
- Serous
- Mucinous
- Endometrioid
- Clear cell
- Brenner
- Undifferentiated carcinoma
What is the cell of origin of epithelial type ovarian tumours ?
Unknown
How are epithelial ovarian tumours categorised ?
Into benign, boderline or malignant based on histopathological exammination:
Benign:
- No Cytological abnormalities, proliferative activity absent or scant
- No stromal invasion
Borderline:
- Cytological abnormalities, proliferative
- No stromal invasion
Malignant:
- Cytological abnormalities present but always malignant if stromal invasion occurs
- Stromal invasion
Macroscopically how may the appearance of epithlial tumours vary ?
They may be smooth walled, cytic lesions or contain a mixture of solid and cystic areas, or just solid areas
After being classified into sub-categories previously mentioned, a serous tumour is now classified as a malignant serous carcinoma - how are malignant serous carcinomas further classified ?
into high or low grade
High grade:
- Serous tubal intraepithelial carcinoma (STIC)
- Most cases are essentially tubal in origin
Low grade:
- Serous borderline tumour
Pic shows high grade serous carcinoma
