Ovarian Pathology Flashcards
Name five types of ovarian cyst
Follicular Luteal Endometriotic Epithelial Mesothelial
Describe a follicular cyst
Very common, can occur when ovulation does not e.g PCOS
Follicle doesn’t rupture and instead becomes a cyst with thin wall of granulosa cells
What is endometriosis?
Endometrial glands/stroma outside of the uterine body
What symptoms can endometriosis cause?
Painful heavy periods
Infertility
Pelvic inflammation
Name the common sites of endometriosis
Ovary - chocolate cyst Pouch of Douglas Peritoneal Surfaces Cervix, vulva, vagina Bladder, bowel
What is thought to be the pathogenesis behind endometriosis?
- regurgitation of endometrium through uterine tubes
- metaplastic transformation of epithelium
- vascular/lymphatic dissemination of tissue
Describe the macroscopic appearance of endometriosis
Peritoneal spots/nodules, fibrous adhesions due to inflammation
Describe the microscopic appearance of endometriosis
Endometrial gland and stoma with surrounding haemorrhage, inflammation and fibrosis
State the complications that can occur due to endometriosis
Pain, cyst formation (obstruction of surrounding tissue - ovary), adhesions, infertility (tubal inflammation and scarring), increased risk of ectopic pregnancy and malignancy
What cancers does endometriosis increase your risk of?
Endometrioid carcinoma
Clear cell carcinoma
How are ovarian tumours graded?
Benign
Borderline
Malignant
What type of cell do ovarian tumours arise from?
Mesothelium
Describe benign ovarian tumours
No cytological abnormality, proliferative activity absent and no stromal invasion
Describe borderline ovarian tumours
Cytological abnormality, increased proliferative activity and risk of progression but no stromal invasion
Describe malignant ovarian tumours
Clear evidence of stromal invasion
Where do serous carcinomas arise from?
Fallopian tube
What is the precursor to high grade serous carcinoma?
Serous tubal intraepithelial carcinoma (STIC)
What causes high grade serous carcinomas?
p53 mutation
What is the precursor to low grade serous carcinoma?
Serous borderline tumour
Name two risk factors for endometrioid and clear cell ovarian carcinoma
Endometriosis
Lynch syndrome
What pathological factors suggest malignancy?
Cystic spaces, predominantly solid yellow/tan coloured tumour with friable edges and peritoneal deposits
Is a brenner tumour benign or malignant?
Benign
What does a brenner tumour look like?
Transitional type epithelium, nests of cells in a fibrous stroma
What is the commonest germ cell tumour?
Mature cystic teratoma - dermoid cyst
What is characteristic of a dermoid cyst?
Pleuripotent potential - sebum, hair, cartilage, bone, teeth
What rare malignancy can arise from a dermoid cyst?
Somatic malignancy - SCC, thyroid cancer
What is an immature teratoma?
Immature foetal elements present in a tumour
Are germ cells usually benign or malignant?
Benign
What are the malignant germ cell tumours?
Dysgerminoma
Choriocarcinoma
Describe a dysgerminoma
Seminoma equivalent
Most common malignant germ cell tumour, lots of lymphocytes surrounding an abnormal cell
Who most commonly has dysgerminoma?
Children and young women
Name three sex cord/stromal tumours
Fibroma/thecoma
Granulosa cell
Sertoli-Leydig
Describe a fibroma/thecoma
Arises from cells in the ovarian stroma (fibroblast/theca cells). Solid tumour, collagenous (potato like), produces oestrogen
Describe granulosa cell tumours
Line the follicles which make up the corpus luteum and produce hormones - not often aggressive but all potentially malignant
What do sertoli-leydig tumours do?
Produce androgens
What tumours commonly metastasise to the ovary?
Stomach
Colon
Breast
Pancreas
Describe the figo staging
IA - limited to one ovary
IB - both ovaries
IC - involves ovarian surface/rupture/surgical spill
2A - extension on uterus/fallopian tube
2B - extension to pelvic intraperitoneal
3A - microscopic mets, retroperitoneal lymph nodes
3B - macroscopic mets <2cm
3C - macroscopic mets >2cm
4 - distant mets
What pathology can occur in the fallopian tubes?
Inflammation - salpingitis Cysts and tumours Serous tubal intraepithelial carcinoma Endometriosis Ectopic pregnancy
What is hydrosalpinx?
Dilatation and fluid filled tubes
How are epithelial tumours treated?
Surgery - debunk aim for <1-2cm
Chemo
Fertility preservation
Name two types of chemotherapy
Adjuvant
Neoadjuvant
How are non-epithelial tumours treated?
Surgery and chemotherapy
