Ovarian Pathology Flashcards
What can ovarian pathology cause?
Pain
Swelling
Endocrine effects
What are the main pathologies that occur with the ovary?
Cysts
Endometriosis
Tumours
From what structure can ovarian cysts arise from?
Follicular; pcos Luteal Endometriotic Epithelial Mesothelial
When do follicular cysts form?
When ovulation doesn’t occur
Follicle doesn’t rupture but grows until it becomes a cyst
Can grow up to several cm in size
What is the structure of a follicular cyst?
Thin walled
Lined by granulosa cells
What is endometriosis?
Endometrial glands and stroma outside the uterine body
What can endometriosis cause?
Pelvic inflammation
Infertility
PAin
Adhesions; increased risk of ectopic pregnancy
What is the pathogenesis of ovarian endometriosis?
Regurgitation
Metaplasia
Vascular or lymphatic dissemination
What are the macroscopic appearances of ovarian endometriosis?
Peritoneal sports or nodules
Fibrous adhesions
Chocolate cysts
What are the microscopic appearances of ovarian endometriosis?
Endometrial glands and stroma
Haemorrhage
Inflammation
Fibrosis
What are known complications of endometriosis?
Pain Cyst formation Adhesions Infertility Ectopic pregnancy; scarring of fallopian tubes Malignancy
What ovarian malignancy does endometriosis increase the risk of?
Endometrioid and clear cell carcinoma
What are the classification subtypes of ovarian tumours?
Epithelial - most common Germ cell - young women Sex cord/ stromal Metastatic Miscellaneous
What are the different forms of epithelial ovarian tumours?
Serous Mucinous Endometrioid Clear cell Brenner Undifferentiated carcinoma
How are epithelial ovarian tumours subdivided?
Histopathological examination; benign/ borderline/ malignant
What is the commonest form of ovarian cancer?
High grade serous carcinoma
What is the histopathological appearance of a benign epithelial ovarian tumour?
No cytological abnormalities
Proliferative activity absent or scant
No stromal invasion
What is the histopathological appearance of a borderline epithelial ovarian tumour?
Cytological abnormalities
Proliferative
No stromal invasion
What is the histopathological appearance of a malignant epithelial ovarian tumour?
Stromal invasion
What is the precursor to high grade serous carcinomas of the ovary?
Serous tubal intraepithelial carcinoma (STIC)
Tubal in origin
What is the precursor to lo grade serous carcinoma of the ovary?
Serous borderline tumour
What ovarian tumour type is assoc with BRCA?
High grade serous; important in primary prevention to remove ovary and fallopian tube
What do endometrioid and clear cell carcinoma of the ovary have a strong assoc with?
Endometriosis of the ovary
Lynch syndrome
How is the primary diagnosis of ovarian cancer often made?
Ascitic tap
What makes a mass highly suspicious of a malignancy?
Extensive solid growth
Some cystic features
What is a brenner tumour?
Tumour of transitional type epithelium, usually benign, borderline and malignant warients
What structure does transitional epithelium typically line?
Bladder
What is the commonest germ cell tumour of the ovary?
Mature benign cystic teratoma
What do dermoid cysts contain?
Cystic
Sebum
Hair
Ectoderm, mesoderm and endoderm
What is a good diagnostic tip for a dermoid cyst?
If any mass on the ovary has fat = dermoid cyst
What are other rare germ cell tumours of the ovary aside from dermoid cyst?
Immature teratoma Dysgerminoma Yolk sac tumour Choriocarcinoma Mixed germ cell tumour
What is a dysgerminoma?
Most common malignant primitive germ cell tumour
Almost exclusively children and young women
What are the 3 types of sex cord/ stromal tumours seen in the ovaries?
Fibroma/ thecoma - benign, produces oestrogen causing uterine bleeding
Granulosa cell tumour - potentially malignant. Oestrogenic manifestations
Sertoli-Leydig cell - can produce androgens
What is the macroscopic appearance of an ovarian fibroma?
White blob
Potato like
From what primary site can cancers metastasize to the ovary?
Stomach
Colon
Breast
Pancreas
When should mets be considered in ovarian tumours?
Bilateral
Small
What is the FIGO staging of ovarian ca?
1A; limited to one ovary
1B; limited to both ovaries
1C; cancer involves ovarian surface/ rupture/ surgical spill/ tumour in washings
2A; extension or implants on uterus/ fallopian tube
2B; extension to other pelvic intraperitoneal
3A; cancer cells in lining of abdomen microscopically
3B; tumours of 2cm or smaller are lining of abdomen
3C; cancer in lymph nodes of >2cm in dimension
4; distant mets
What are common pathologies of the fallopian tubes?
Inflammation; salpingitis Cysts and tumours Serous tubal intraepithelial carcinoma Endometriosis Ectopic
What is an ectopic pregnancy?
Implantation of a conceptus outside endometrial cavity
Commonest site is ampulla of fallopian tube
When should ectopic pregnancy be considered?
In any female of reproductive age with amenorrhoea and acute hypotension or an acute abdomen
