Ovarian Pathology Flashcards
Luteal Cyst
- > 3cm
- reproductive age
- thick hemorrhagic fluid
- hormone producing
- interspersed peripheral theca cells
Follicular cyst
- Prepubescent and reproductive age
- Contain serosanguinous fluid
- Thin smooth lining of inner granular and outer theca cells
Presence of “ectopic” endometrial tissue at a site
outside of the uterus
• Repeated cyclical hemorrhage during menstrual cycle- “chocolate” color
• Consist of normal looking endometrial glands + stroma + RBC + hemosiderin
• Induce fibrosis, adhesions, pain
• May extend along pelvic ligaments
• Usually associated with infertility
Chocolate cyst
Polycystic Ovarian Syndrome Pathogenesis
Caused by genetics, sedentary lifestyle, obesity
Insulin resistance—> hyperinsulinemia—> increased androgens (prolonged high estrogen levels)—> no LH surge; no ovulation—> no corpus luteum; low progesterone—> unopposed excess estrogen —> inhibits FSH—> increased LH:FSH ratio
Symptoms of PCOS
Hirsutism, acne, infertility and endometrial hyperplasia
Menstrual irregularities
Polycystic ovaries (string of pearls)
Cysts lined by granulosa cells and hypertrophied theca interna cells
PCOS
Type I epithelial ovarian tumors
progress from benign tumors through borderline tumors that may give rise to a low-grade carcinoma.
• These include low-grade serous, endometrioid, and mucinous carcinomas
• Genes involved: KRAS, BRAF
Type II epithelial ovarian tumors
- They demonstrate high-grade features and are most commonly of serous histology.
- STIC: Serous tubal intraepithelial carcinoma—> areas of marked epithelial atypia in fallopian tube epithelium: observed in fallopian tubes of women with germline BRCA1/2 mutations undergoing prophylactic salpingo-opherectomy
- Genes involved: p53, Rb
Serous ovarian tumors
• Benign and borderline tumors
• Serous carcinomas occur later in life
• Papillae: dystrophic calcification at tips —> Psammoma bodies
What are the risk factors
- Women aged 40-59 years on oral contraceptives or tubal ligation: decreased risk
- Germline mutations in BRCA1 and BRCA2
SEROUS CYSTADENOMA
Borderline serous tumor
Serous cyst adenocarcinoma
- KRAS gene mutation
- Very large bulky masses
- Multiloculated (M: Mucinous, M: multiloculated) tumors filled with sticky, gelatinous fluid rich in glycoproteins
- Tall columnar cells with apical mucus vacuole, no cilia
- Pseudomyxoma peritonei can be seen
Mucinous Ovarian Tumors
• Mucinous ascites (jelly belly)
• Cystic epithelial implants on the peritoneal surfaces, adhesions, and frequent involvement of the ovaries
• If extensive, may result in intestinal obstruction and death
• Most cases extraovarian (usually appendiceal) with secondary ovarian and
peritoneal spread
PSEUDOMYXOMA PERITONEI
- Coexists with endometriosis & endometrial carcinoma
- Genes involved: PTEN, microsatellite instability (MSI due to mismatch repair genes), KRAS
- malignant
- cystic and solid areas
- Microscopy: presence of tubular glands resembling benign or malignant endometrium
ENDOMETRIOID TUMORS
Dermoid cysts
Lined by skin
Young women
Gross: Unilocular cyst containing hair and sebaceous materials
Mature Teratoma (benign)
Presence of Alpha-fetoprotein and alpha 1 antitrypsin
Glomerulus-like structure composed of a central blood vessel enveloped by tumor cells within a space that is also lined by tumor cells—> Schiller-Duval body (*)
In young women and children
Presenting with abdominal pain and a rapidly growing pelvic mass
Yolk Sac Tumor
Can be gestational (arising in placenta) or non gestational (arising in ovary)
Aggressive —> usually metastasized hematogenously to the lungs, liver, bone, and other sites by the time of diagnosis
High levels of chorionic gonadotropins
Generally unresponsive to chemotherapy and are often fatal
Choriocarcinoma
