Ovarian Pathology Flashcards
What happens to ovaries post-menopausal?
Ovaries become very small and atrophic
What may ovarian pathology cause?
- Pain
- Swelling
- Endocrine effects
What are the main pathologies of the ovaries?
- Cysts
- Endometriosis
- Tumours
Where can ovarian cysts arise?
These can arise in any area of the ovary and are innate or acquired
List the different types of ovarian cysts.
- Follicular e.g. polycystic ovaries
- Luteal
- Endometriotic – an endometrial cyst in the ovary
- Epithelial – benign or malignant
- Mesothelial
Follicular cysts are very common
True
When do follicular cysts arise?
Arise when ovulation doesn’t occur (polycystic ovaries)
Why does ovulation not occurring result in a follicular cyst?
Follicle doesn’t rupture, instead it grows until it becomes a cyst
What are follicular cysts lined by?
Granulosa cells
Follicular cysts are THICK walled
FALSE - they are thin walled
Outline the management of a follicular cyst.
Usually resolve over a few months !! …
- Get patient to come back in a few months, if smaller then good
- If bigger, then think neoplastic cyst
What should you consider if a follicular cyst does not get smaller within a few months?
Neoplastic cyst
What essentially is endometriosis?
Endometrial glands AND stroma outside the uterine body
Describe the signs + symptoms of endometriosis.
- Pelvic inflammation
- Infertility (if the fallopian tube is affected)
- Pain
Where can endometriosis occur?
- Ovary – ‘chocolate’ cyst
- Pouch of Douglas
- Peritoneal surfaces, including uterus
- Cervix, vulva, vagina
- Bladder, bowel
What is endometriosis of the ovary known colloquially as?
Chocolate cyst
What does the pathogenesis of ovarian endometriosis involve?
- Regurgitation
- Metaplasia
- Vascular or lymphatic dissemination
Describe the macroscopic appearance of ovarian endometriosis.
- Peritoneal spots or nodules
- Fibrous adhesions
- Chocolate cysts
Describe the microscopic appearance of ovarian endometriosis.
- Endometrial glands and stroma (has to be glands AND stroma)
- Haemorrhage, inflammation, fibrosis
List the complications of ovarian endometriosis.
- Pain
- Cyst formation
- Adhesions
- Infertility
- Ectopic pregnancy
- Malignancy (endometrioid carcinoma)
If an ovarian tumour is completely solid, what is it probably?
Fibroma
If an ovarian tumour is completely cystic, what is it probably?
Serous cyst
If an ovarian tumour has both solid and cystic components, what should you worry about?
Something much more serious
What are the 5 different classifications of ovarian tumours?
- Epithelial
- Germ cell
- Sex-cord/stromal
- Metastatic
- Miscellaneous
What are the 6 different subtypes of epithelial ovarian tumour?
- Serous *
- Mucinous*
- Endometrioid*
- Clear cell *
- Brenner*
- Undifferentiated carcinoma
All above with ‘*’ can be differentiated into; benign, borderline or malignant
What % of all ovarian tumours do epithelial account for?
65-70%
Describe benign epithelial ovarian tumours.
- No cytological abnormalities, proliferative activity absent or scant
- No stromal invasion
Describe borderline epithelial ovarian tumours.
- Cytological abnormalities, proliferative
Describe malignant epithelial ovarian tumours.
- Stromal invasion
What is a high grade serous carcinoma also known as?
Serous tubal intraepithelial carcinoma (STIC)
What is a low grade serous carcinoma also known as?
Serous borderline tumour
What is the treatment for serious carcinoma of the ovary?
SURGERY !! - think s for s
What do low grade serous tumours not respond to?
Chemotherapy
What are the 2 histological features of a high grade serous carcinoma?
- Prominent nucleoli
* Pleomorphic
What ovarian cancers have a strong association with endometriosis of the ovary?
Endometrioid and Clear Cell Carcinoma
What are Endometrioid and Clear Cell Carcinoma associated with (syndrome?)
Lynch Syndrome
How is the diagnosis of Endometrioid and Clear Cell Carcinoma made?
On ascitic fluid
What is Brennen a tumour of?
Transitional type epithelium
What % of all ovarian tumours are germ cell tumours?
15-20%
What are germ cell tumours also known as?
TERATOMAS !!
What accounts for 95% of all germ cell tumours?
Mature (benign, cystic) Teratoma
What accounts for 95% of all germ cell tumours?
Mature (benign, cystic) Teratoma
What is odd about teratomas?
These are CYSTIC and can contain sebum and hair
What are teratomas derived from?
Derived from all 3 embryonic layers – ectoderm, mesoderm, endoderm
What are 4 common components of teratomas?
- Skin
- Respiratory epithelium
- Gut
- Fat
List other germ cell tumours that are not mature teratomas.
- Immature teratoma
- Dysgerminoma
- Yolk sac tumour
- Choriocarcinoma
- Mixed germ cell tumour
A Dysgerminoma is the most common malignant/benign primitive germ cell tumour?
Malignant
Who do Dysgerminoma’s occur exclusively in? What is the average age of this?
Occur exclusively in children and young women
Average age - 22
A Fibroma/Thecoma is benign
TRUE
What may Fibroma/Thecoma’s produce? What does this cause?
Oestrogen - uterine bleeding
All granulose cell tumours are potentially __________
Malignant
Sertoli-Leydig Cell Tumours are ____ and may produce _________
- Rare
2. Androgens
What colour is an ovarian fibroma? Why?
Yellow – granulosa, hormone producing cells
What primary cancer sites are the commonest for producing ovarian mets?
- Stomach
- Colon
- Breast
- Pancreas
When should you consider metastatic ovarian tumours?
This must be considered in ALL cases, especially if the tumour is bilateral and small !!
Bilateral and small ovarian tumours means what?
Probably metastatic disease
List 5 different fallopian tube pathologies.
- Inflammation - Salpingitis due to infection
- Cysts and tumours
- Serous tubal intraepithelial carcinoma
- Endometriosis
- Ectopic pregnancy
What staging system is used for ovarian cancer?
Figo
‘Finger like processes of the uterine tubes can become inflamed’. What condition is this seen in?
PID
What cell type is seen in tissues with PID which should b there?
Inflammatory cells
Why may tubes in PID not function properly?
Tubes may not function properly as adhesions form between the processes due to the inflammation
What is an ectopic pregnancy?
Implantation of a conceptus outside the endometrial cavity
Where is the commonest site for an ectopic pregnancy?
Fallopian tube
Where else (except fallopian tubes) can an ectopic pregnancy occur?
- Ovary
* Peritoneum
Why can an ectopic pregnancy sometimes be fatal?
Often ruptures, potentially causing fatal haemorrhage
- Amenorrhoea
- Acute hypotension
- Acute abdomen
If a female has any of the above, what should you always consider?
Ectopic pregnancy
