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Year 3 Pathology > Ovarian Pathology > Flashcards

Ovarian Pathology Flashcards

1
Q

Potential symptoms of ovarian pathology?

A

Pain

Swelling

Endocrine effects (hormone secretion)

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2
Q

Main pathologies affecting the ovaries?

A

Cysts

Endometriosis

Tumour

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3
Q

Elements of the ovary from which ovarian cysts can arise?

A

Follicular, e.g: polycystic ovaries

Luteal

Endometriotic

Epithelial

Mesothelial

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4
Q

Occurrence of follicular cysts?

A

Very common

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5
Q

Formation of follicular cysts?

A

Form when an egg is about to be released; if ovulation does not occur, the follicle does not rupture but instead grows to be a cyst

They can grow to be several cm in size

They are thin-walled and lined by granulosa cells

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6
Q

Outcome of follicular cysts?

A

Usually resolve over a few months

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7
Q

What is endometriosis?

A

Endometrial glands and stroma outside of the uterine body; it can cause pelvic inflammation, infertility and pain

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8
Q

Sites in which endometriosis can occur?

A

Ovary (‘chocolate’ cysts)

Pouch of Douglas

Peritoneal surfaces, inc. uterus

Cervix, vulva, vagina

Bladder, bowel, etc

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9
Q

Pathogenesis of ovarian endometriosis?

A

Regurgitation of shedding endometrium into the fallopian tubes

Metaplasia

Vascular or lymphatic dissemination

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10
Q

Macroscopic appearance of ovarian endometriosis?

A

Perioneal spots or nodules

Fibrous adhesions

Chocolate cysts

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11
Q

Microscopic appearance of ovarian endometriosis?

A

Endometrial glands and stroma

Haemorrhage, inflammation and fibrosis

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12
Q

Complications of endometriosis?

A

Pain

Cyst formation

Adhesions

Infertility

Ectopic pregnancy

Malignancy (endometrioid carcinoma)

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13
Q

Classifications of ovarian tumours?

A

Solid vs cystic

Benign vs malignant

Classification:
• Epithelial
• Germ cell
• Sex cord / stromal
• Metastatic
• Miscellaneous
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14
Q

Types of epithelial ovarian tumours?

A

Serous

Mucinous

Endometrioid

Clear cell

Brenner

NOTE - the above are all sub-divided, on histopathological examination, into benign borderline / malignant; malignant serous carcinomas are types as low-grade or high-grade

Undifferentiated carcinoma

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15
Q

Features of benign epithelial ovarian tumours?

A

No cytological abnormalities

Proliferative activity is absent or scant

No stromal invasion

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16
Q

Features of borderline epithelial ovarian tumours?

A

Cytological abnormalities and proliferative activity present

No stromal invasion

17
Q

Features of malignant epithelial ovarian tumours?

A

Stromal invasion

18
Q

2 types of serous carcinoma?

A

They are 2 distinct entities with different precursor lesions:
• High-grade serous carcinoma - precursor is Serous Tubal Intraepithelial Carcinoma (STIC); most cases are essentially tubal in origin
• Low-grade serous carcinoma - precursor is serous borderline tumour

19
Q

Risk factors for endometrioid and clear cell carcinomas of the ovary?

A

Strong assoc. with endometriosis of the ovary

Assoc. with Lynch syndrome

20
Q

Grading of endometrioid carcinoma?

A

Graded the same as uterine tumours

Most endometrioid carcinomas are low-grade and early stage

21
Q

Primary diagnosis of ovarian cancer?

A

Often made on ascitic fluid

22
Q

What is Brenner tumour?

A

Tumour of transitional type epithelium that is usually benign; borderline and malignant variants are rare

NOTE - transitional epithelium is also found in the bladder

23
Q

Occurrence of germ cell ovarian tumours?

A

15-20% of all ovarian tumours

24
Q

Most common ovarian germ cell tumour?

A

Teratoma

25
Q

What is a dermoid cyst?

A

AKA benign, mature cystic teratoma

A cystic tumour containing:
• Sebum and hair
• Ectoderm, mesoderm and endoderm
• Skin
• Respiratory epithelium
• Gut 
• Fat

Rarely, it can become malignant

26
Q

Other germ cell tumours?

A

Immature teratoma

Dysgerminoma

Yolk sac tumour

Choriocarcinoma

Mixed germ cell tumour

27
Q

Occurrence of dysgerminoma?

A

1-2% of all malignant ovarian tumours

It is the most common malignant primitive germ cell tumour

Almost exclusively occurs in CHILDREN and YOUNG WOMEN (~22 years of age)

28
Q

Types of ovarian sex cord / stromal tumours?

A

Fibroma / thecoma - benign; may produce oestrogen, resulting in uterine bleeding

Granulosa cell tumour - all are potentially malignant; may be assoc. with oestrogenic manifestations

Sertoli-Leydig cell tumours - rare; may produce androgens

29
Q

Metastatic tumours at the ovary?

A 
May come from anywhere but the most common is:
• Stomach
• Colon
• Breast
• Pancreas

Must be considered in all cases, part. when tumours are BILATERAL and SMALL

30
Q

Figo staging of ovarian cancer?

A

Stage 1:
• 1A - tumour limited to 1 ovary
• 1B - tumour limited to both ovaries
• 1C - cancer inv. ovarian surface / rupture / surgical spill / tumour in washings

Stage 2:
• 2A - extension or implants on uterus / fallopian tube
• 2B - extension to other pelvic intraperitoneal

Stage 3:
• 3A - retroperitoneal lymph node metastasis or microscopic extra-pelvic peritoneal inv.
• 3B - macroscopic peritoneal metastasis beyond pelvis, up to 2cm in dimension
• 3C - macroscopic peritoneal metastasis >2cm in dimesion

Stage 4 - distant metastasis

31
Q

What is the most common primary malignancy of the ovaries?

A

High-grade, malignant serous carcinoma; it is now thought that this begins in the fallopian tubes, as STIC, and that the cells drop on to the ovaries

32
Q

Pathologies affecting the fallopian tubes?

A

Inflammation, e.g: salpinigits due to infection

Cysts and tumours

Serous Tubal Intraepithelial Carcinoma (STIC)

Endometriosis

Ectopic pregnancy

33
Q

What is an ectopic pregnancy?

A

Implantation of a conceptus outside the endometrial cavity, commonly in the Fallopian tube; may occur in ovary or peritoneum

Often ruptures and may cause fatal haemorrhage

34
Q

When should a diagnosis of an ectopic pregnancy be considered?

A

Consider diagnosis in any female of reproductive age, with amenorrhoea and acute hypotension or an acute abdomen

Year 3 Pathology (9 decks)

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