Ovarian Pathology Flashcards
What is the most common disorder of the fallopian tubes?
inflammation (salpingitis), almost invariably occurring as a component of pelvic inflammatory disease. Less common abnormalities are ectopic pregnancy, endometriosis, and rarely primary tumors
Inflammation of the fallopian tubes mostly occurs due to what?
bacterial, now more due to nongonoccal organisms such as Chlamydia, Mycoplasma hominis, and streptococci in postpartum settings
NOTE: Nongonnocal infections can pentrate the tube walls and spread via blood and seed to the meninges, heart, and joints
How does salpingitis present?
fever, lower abdominal or pelvic pain, all of which are the result of distention of the tubes with debris or exudate
Describe tumors of the fallopain tubes
Primary adenocarcinomas are rare but are associated with BRCA mutations (usually occur in the fimbria)
NOTE: It is generally well accepted that serous carcinomas generally arise here and metastasize to the ovary and not the other way around
What are follicular ovarian cysts?
These are so commonplace that they are considered part of normal physiology and begin from unruptured graafian follicles. These cysts are often multiple, small, and filled with clear fluid. When small they are lined by grnaulosa or luteal cells (but when they grow larger, fluid accumulation may produce pressure that causes cellular atrophy). These usually spontanoeusly rupture and dissappear.
What is this?
This is a corpus leuteal cyst- again mostly harmless but can cause ovarian torsion (20% in pregnancy). In these cases, pts. present with acute unilateral lower abdominal pain caused by venous congestion.
Histologically, these cysts are lined by a rim of bright yellow tissue containing luteinized granulosa cells. They occasionally rupture and cause a peritoneal reaction.
What is Polycystic Ovarian Disease?
aka Stein-Leventhal disease, this is a disorder in which multiple cystic follicles in the ovaries produce excess androgens and estrgoens and typically comes to attention after menarche in teenage girls who present with oligomenorrhea, hirsutism, infertility, and obesity.
Tumors of the ovaries arise from what three structures?
- surface epithelium
- germ cells
- sex cord-stroma
Where do most ovarian tumors arise from?
The vast mjaorty originate in the surface epithelium
How do epithelial tumors typically form?
Repeated cycles of ovulation and scarring causes the surface epithelium to become entrapped in the cortex of the ovary, forming small cysts that can become metaplastic or give rise to a number of tumors
What are the risk factors for ovarian cancer?
nulliparity and unmarried women
fam Hx
germline mutations in certain tumor suppressor genes like BRCA
T or F. Prolonged use of oral contraceptives lowers the risk of ovarian cancer
T.
Describe serous ovarian epithelial tumors
These are the most common ovarian epithelial tumors, with the majority being benign (60%) and malignant versions typically being found in older pts. These typically present at an advanced age and cause a significant number of deaths
What are the variants of serious epithelial ovarian tumors?
There are Type I (low grade) types that arise in the ovaries and produce borderline tumors that can progress to invasive carcinomas and then Type II (high grade) that probably arise in the fimbriae as STIC lesions fallopian tubes and are more strongly associated with BRCA and T53 mutations
Are serous epithelial ovarian tumors bilateral?
Bilaterality is common, occurring in 20% of benign serous cystadenomas, 30% of serous borderline tumors, and approximately 66% of serous carcinomas.
What is this?
Borderline serous epithelial ovarian tumor showing increased architectural complexity and epithelial cell stratification.
How can you distinguish low grade and high grade ovarian epithelial tumors histologically?
High-grade serous carcinomas are distinguished from low-grade tumors by having more complex growth patterns and widespread infiltration of the underlying stroma
What is this?
A mucinous tumor of the ovarian epithelium. The vast majority of these are benign, very large and commonly multicystic