Ovarian Pathology Flashcards by Aliya Hussain

Potential symptoms of ovarian pathology?

Pain

Swelling

Endocrine effects (hormone secretion)

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Main pathologies affecting the ovaries?

Cysts

Endometriosis

Tumour

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Elements of the ovary from which ovarian cysts can arise?

Follicular, e.g: polycystic ovaries

Luteal

Endometriotic

Epithelial

Mesothelial

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Occurrence of follicular cysts?

Very common

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Formation of follicular cysts?

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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Outcome of follicular cysts?

Usually resolve over a few months

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What is endometriosis?

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

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Sites in which endometriosis can occur?

Ovary (‘chocolate’ cysts)

Pouch of Douglas

Peritoneal surfaces, inc. uterus

Cervix, vulva, vagina

Bladder, bowel, etc

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Pathogenesis of ovarian endometriosis?

Regurgitation of shedding endometrium into the fallopian tubes

Metaplasia

Vascular or lymphatic dissemination

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Macroscopic appearance of ovarian endometriosis?

Perioneal spots or nodules

Fibrous adhesions

Chocolate cysts

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Microscopic appearance of ovarian endometriosis?

Endometrial glands and stroma

Haemorrhage, inflammation and fibrosis

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Complications of endometriosis?

Pain

Cyst formation

Adhesions

Infertility

Ectopic pregnancy

Malignancy (endometrioid carcinoma)

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Classifications of ovarian tumours?

Solid vs cystic

Benign vs malignant

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

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Types of epithelial ovarian tumours?

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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Features of benign epithelial ovarian tumours?

No cytological abnormalities

Proliferative activity is absent or scant

No stromal invasion

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Features of borderline epithelial ovarian tumours?

Cytological abnormalities and proliferative activity present

No stromal invasion

Features of malignant epithelial ovarian tumours?

Stromal invasion

2 types of serous carcinoma?

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

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

Strong assoc. with endometriosis of the ovary

Assoc. with Lynch syndrome

Grading of endometrioid carcinoma?

Graded the same as uterine tumours

Most endometrioid carcinomas are low-grade and early stage

Primary diagnosis of ovarian cancer?

Often made on ascitic fluid

What is Brenner tumour?

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

NOTE - transitional epithelium is also found in the bladder

Occurrence of germ cell ovarian tumours?

15-20% of all ovarian tumours

Most common ovarian germ cell tumour?

Teratoma

What is a dermoid cyst?

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

Other germ cell tumours?

Immature teratoma Dysgerminoma Yolk sac tumour Choriocarcinoma Mixed germ cell tumour

Occurrence of dysgerminoma?

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)

Types of ovarian sex cord / stromal tumours?

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

Metastatic tumours at the ovary?

``` 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

Figo staging of ovarian cancer?

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

What is the most common primary malignancy of the ovaries?

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

Pathologies affecting the fallopian tubes?

Inflammation, e.g: salpinigits due to infection Cysts and tumours Serous Tubal Intraepithelial Carcinoma (STIC) Endometriosis Ectopic pregnancy

What is an ectopic pregnancy?

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

When should a diagnosis of an ectopic pregnancy be considered?

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