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Reproduction and Sexual Health > Ovarian Pathology > Flashcards

Ovarian Pathology Flashcards

1
Q

What happens to ovaries post-menopausal?

A

Ovaries become very small and atrophic

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2
Q

What may ovarian pathology cause?

A
  • Pain
  • Swelling
  • Endocrine effects
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3
Q

What are the main pathologies of the ovaries?

A
  • Cysts
  • Endometriosis
  • Tumours
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4
Q

Where can ovarian cysts arise?

A

These can arise in any area of the ovary and are innate or acquired

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5
Q

List the different types of ovarian cysts.

A
  • Follicular e.g. polycystic ovaries
  • Luteal
  • Endometriotic – an endometrial cyst in the ovary
  • Epithelial – benign or malignant
  • Mesothelial
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6
Q

Follicular cysts are very common

A

True

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7
Q

When do follicular cysts arise?

A

Arise when ovulation doesn’t occur (polycystic ovaries)

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8
Q

Why does ovulation not occurring result in a follicular cyst?

A

Follicle doesn’t rupture, instead it grows until it becomes a cyst

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9
Q

What are follicular cysts lined by?

A

Granulosa cells

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10
Q

Follicular cysts are THICK walled

A

FALSE - they are thin walled

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11
Q

Outline the management of a follicular cyst.

A

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
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12
Q

What should you consider if a follicular cyst does not get smaller within a few months?

A

Neoplastic cyst

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13
Q

What essentially is endometriosis?

A

Endometrial glands AND stroma outside the uterine body

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14
Q

Describe the signs + symptoms of endometriosis.

A
  • Pelvic inflammation
  • Infertility (if the fallopian tube is affected)
  • Pain
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15
Q

Where can endometriosis occur?

A
  • Ovary – ‘chocolate’ cyst
  • Pouch of Douglas
  • Peritoneal surfaces, including uterus
  • Cervix, vulva, vagina
  • Bladder, bowel
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16
Q

What is endometriosis of the ovary known colloquially as?

A

Chocolate cyst

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17
Q

What does the pathogenesis of ovarian endometriosis involve?

A
  • Regurgitation
  • Metaplasia
  • Vascular or lymphatic dissemination
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18
Q

Describe the macroscopic appearance of ovarian endometriosis.

A
  • Peritoneal spots or nodules
  • Fibrous adhesions
  • Chocolate cysts
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19
Q

Describe the microscopic appearance of ovarian endometriosis.

A
  • Endometrial glands and stroma (has to be glands AND stroma)
  • Haemorrhage, inflammation, fibrosis
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20
Q

List the complications of ovarian endometriosis.

A
  • Pain
  • Cyst formation
  • Adhesions
  • Infertility
  • Ectopic pregnancy
  • Malignancy (endometrioid carcinoma)
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21
Q

If an ovarian tumour is completely solid, what is it probably?

A

Fibroma

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22
Q

If an ovarian tumour is completely cystic, what is it probably?

A

Serous cyst

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23
Q

If an ovarian tumour has both solid and cystic components, what should you worry about?

A

Something much more serious

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24
Q

What are the 5 different classifications of ovarian tumours?

A
  • Epithelial
  • Germ cell
  • Sex-cord/stromal
  • Metastatic
  • Miscellaneous
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25
Q

What are the 6 different subtypes of epithelial ovarian tumour?

A
  • Serous *
  • Mucinous*
  • Endometrioid*
  • Clear cell *
  • Brenner*
  • Undifferentiated carcinoma

All above with ‘*’ can be differentiated into; benign, borderline or malignant

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26
Q

What % of all ovarian tumours do epithelial account for?

A

65-70%

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27
Q

Describe benign epithelial ovarian tumours.

A
  • No cytological abnormalities, proliferative activity absent or scant
  • No stromal invasion
28
Q

Describe borderline epithelial ovarian tumours.

A
  • Cytological abnormalities, proliferative
29
Q

Describe malignant epithelial ovarian tumours.

A
  • Stromal invasion
30
Q

What is a high grade serous carcinoma also known as?

A

Serous tubal intraepithelial carcinoma (STIC)

31
Q

What is a low grade serous carcinoma also known as?

A

Serous borderline tumour

32
Q

What is the treatment for serious carcinoma of the ovary?

A

SURGERY !! - think s for s

33
Q

What do low grade serous tumours not respond to?

A

Chemotherapy

34
Q

What are the 2 histological features of a high grade serous carcinoma?

A
  • Prominent nucleoli

* Pleomorphic

35
Q

What ovarian cancers have a strong association with endometriosis of the ovary?

A

Endometrioid and Clear Cell Carcinoma

36
Q

What are Endometrioid and Clear Cell Carcinoma associated with (syndrome?)

A

Lynch Syndrome

37
Q

How is the diagnosis of Endometrioid and Clear Cell Carcinoma made?

A

On ascitic fluid

38
Q

What is Brennen a tumour of?

A

Transitional type epithelium

39
Q

What % of all ovarian tumours are germ cell tumours?

A

15-20%

40
Q

What are germ cell tumours also known as?

A

TERATOMAS !!

41
Q

What accounts for 95% of all germ cell tumours?

A

Mature (benign, cystic) Teratoma

42
Q

What accounts for 95% of all germ cell tumours?

A

Mature (benign, cystic) Teratoma

43
Q

What is odd about teratomas?

A

These are CYSTIC and can contain sebum and hair

44
Q

What are teratomas derived from?

A

Derived from all 3 embryonic layers – ectoderm, mesoderm, endoderm

45
Q

What are 4 common components of teratomas?

A
  • Skin
  • Respiratory epithelium
  • Gut
  • Fat
46
Q

List other germ cell tumours that are not mature teratomas.

A
  • Immature teratoma
  • Dysgerminoma
  • Yolk sac tumour
  • Choriocarcinoma
  • Mixed germ cell tumour
47
Q

A Dysgerminoma is the most common malignant/benign primitive germ cell tumour?

A

Malignant

48
Q

Who do Dysgerminoma’s occur exclusively in? What is the average age of this?

A

Occur exclusively in children and young women

Average age - 22

49
Q

A Fibroma/Thecoma is benign

A

TRUE

50
Q

What may Fibroma/Thecoma’s produce? What does this cause?

A

Oestrogen - uterine bleeding

51
Q

All granulose cell tumours are potentially __________

A

Malignant

52
Q

Sertoli-Leydig Cell Tumours are ____ and may produce _________

A
  1. Rare

2. Androgens

53
Q

What colour is an ovarian fibroma? Why?

A

Yellow – granulosa, hormone producing cells

54
Q

What primary cancer sites are the commonest for producing ovarian mets?

A
  • Stomach
  • Colon
  • Breast
  • Pancreas
55
Q

When should you consider metastatic ovarian tumours?

A

This must be considered in ALL cases, especially if the tumour is bilateral and small !!

56
Q

Bilateral and small ovarian tumours means what?

A

Probably metastatic disease

57
Q

List 5 different fallopian tube pathologies.

A
  • Inflammation - Salpingitis due to infection
  • Cysts and tumours
  • Serous tubal intraepithelial carcinoma
  • Endometriosis
  • Ectopic pregnancy
58
Q

What staging system is used for ovarian cancer?

A

Figo

59
Q

‘Finger like processes of the uterine tubes can become inflamed’. What condition is this seen in?

A

PID

60
Q

What cell type is seen in tissues with PID which should b there?

A

Inflammatory cells

61
Q

Why may tubes in PID not function properly?

A

Tubes may not function properly as adhesions form between the processes due to the inflammation

62
Q

What is an ectopic pregnancy?

A

Implantation of a conceptus outside the endometrial cavity

63
Q

Where is the commonest site for an ectopic pregnancy?

A

Fallopian tube

64
Q

Where else (except fallopian tubes) can an ectopic pregnancy occur?

A
  • Ovary

* Peritoneum

65
Q

Why can an ectopic pregnancy sometimes be fatal?

A

Often ruptures, potentially causing fatal haemorrhage

66
Q
  • Amenorrhoea
  • Acute hypotension
  • Acute abdomen

If a female has any of the above, what should you always consider?

A

Ectopic pregnancy

Reproduction and Sexual Health (51 decks)

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