Ovarian Pathology Flashcards
What may ovarian pathology appear as?
- pain (severe with TORSION - acute)
- swelling (appear 40 wks pregnant)
- endocrine effects
Main ovarian pathologies?
- cysts
- endometriosis
- tumors
What are the diff. types of ovarian cysts?
- follicular (benign and resolves in few months)
- luteal (benign)
- endometriotic (blood filled)
- epithelial (benign/malign.)
- mesothelial
What is a red flag when it comes to cysts?
- High solid content
- high CA125 level
Why may a follicular cyst occur?
- when ovulation doesn’t occur (PCOS)
- follicle doesn’t rupture but GROWS until it becomes a cyst (can grow to to several cm)
What may endometriosis cause?
- pelvic inflammation–> SCARRING
- infertility (d.t adhesions blocking the fallopian tubes)
- PAIN
Why may endometriosis occur?
- REGURGITATION
- METAPLASIA (forming endometrial glands; doesn’t explain the stroma)
- vascular and lymphatic dissemination
How does enodmetriosis present as?
- peritoneal spots/ nodules
- fibrous ADHESIONS
- chocolate cysts
How does enodmetriosis present as?
- peritoneal spots/ nodules (very dark red/black)
- fibrous ADHESIONS
- chocolate cysts
WHat are complications of endometriosis?
- Pain
- Cyst formation
- Adhesions
- Infertility—-fusion of cilia in the the tubes or the fimbraie (OBSTRUCT. of blastocyst movement)
- Ectopic pregnancy
- Malignancy (endometrioid carcinoma)
What are the diff. types of ovarian tumors?
- Surface epithelial (MOST COMMON)
- germ cell
- Sex-cord/ stromal
- metastatic
( Miscellanous)
What is a red flag for the constituency of ovarian tumors?
- cystic and solid is BAD
What are the types of epithelial ovarian tumors?
Serous * (high and low grade) -----can be a SMALL aggressive tumor Mucinous* Endometrioid* Clear cell * Brenner* Undifferentiated carcinoma
How may epithelial tumors be classified?
- bening/ malignant/ borderline
How is borderline tumor diff from benign tumors?
- benign: no stromal invasion, no cytological abnormalities, absent proliferative activity
- borderline: has cytological abnormalities and proliferation, NO stromal invasion
If HIGH or low grade serous CA more common?
- HIGH grade
What is suggested with surgical management of serous ca?
REMOVE ovaries and tubes !
What is endometroid tumors a.w?
- strongly a.w endometriosis
- —–most are low grade and EARLY stage
- —association with LYNCH Syndrome
Which epithelial ovarian tumor has a strong a.w endometriosis?
- Endometroid and Clear Cell carcinoma
—- both also a.w Lynch Syndrome
Which ovarian CA has GOOD prognosis?
- Endometroid ca of the ovary
Primary dx of ovarian tumors is made on _______
ASCITIC fluid
Which sex-cord tumors produce estrogen?
Fibroma tumor
Granulosa Cell tumor
Commonest location from where metastatic tumors arise from?
- stomach
- colon
- breast
- pancreas
Fallopian tubes pathology?
- inflammation
- cysts and tumors
- endometriosis
- ectopic prgenancy
- serous tubal intraepithelial ca
Danger of an ectopic pregnany?
fatal hemorrhage
What does the serous tumor arise from…?
- background of tubal intraepithelial neoplasia
What is a follicular cyst lined by?
- granulosa cells
How to tell a Malignant epithelial ovarian tumor apart from borderline one?
- Stromal invasion is PRESENT in the malignant type
What is the precursor lesion of High grade SEROUS carcinoma?
- STIC
- serous tubal intraepithelial carcinoma
- —most are TUBAL in origin
What is the precursor lesion of the low grade serous carcinoma?
- serous borderline tumor
Most endometroid CA are at what stage _____
LOW stage and early
What gross distinction can be made by the appearance of serous neoplasia (benign and borderline) on slide 19?
- borderline: papillary appearance (not distinct masses; ragged)
What is the brenner tumor usually?
BENIGN
others are rare
Which type of ovarian tumor comprises of 15-20% of ovarian tumors?
- Germ cell tumors ——Dermoid cyst (mature- benign and cystic)
Name the diff. types of germ cell tumors.
- mature teratoma
- immature teratoma
- yolk sac tumor
- choriocarcinoma
- mixed germ cell tumor
Who is exclusively affected by dysgerminoma?
- CHILDREN
- young women (~avg age 22)
When should metastatic ovarian tumors be considered?
- when ovarian tumors are BILATERAL and small!
What are the stages of Figo Staging in ovarian cancer?
1A: limited to ONE ovary . . 1C: involved ovarian surface/ rupture/spill . . 2A: extension to uterus/tube 2B: ext. to other pelvic intraperitoneal
At what stage in FIGO does it highlight peritoneal metastasis?
3B: peritoneal metastasis BEYOND pelvis (<2cm)
3C: peritoneal metastasis >2cm
Define ectopic pregnancy.
implantation of conceptus OUTSIDE the endometrial cavity
When is ectopic pregnancy considered as a ddx in a female?
- when any female of a reproductive age comes in with amennorhea, acute hypotension or acute abdomen
What are the 4 diff. sites of ectopic pregnancy?
ovarian
tubal
interstitial
cervical
