Ovarian Pathology Flashcards
What can ovarian pathology cause?
Pain
Swelling
Endocrine effects
What are the main pathological groups of the ovary?
Cysts
Endometriosis
Tumours
When can follicular cysts form?
When ovulation doesn’t occur (PCO)
Follicle doesn’t rupture but grows until it becomes a cyst
Describe the histology of follicular cysts?
Thin-walled, lined by granulosa cells
How long do follicular cells take to resolve?
A few months
What is endometriosis
Endometrial glands and stroma outside the uterine body
What are the common sites of endometriosis?
- ovary (chocolate cyst)
- pouch of douglas
- peritoneal surfaces, including uterus
- cervix, vulva, vagina
- bladder, bowel
What is the pathogenesis of ovarian endometriosis?
- regurgitation
- metaplasia
- vascular or lymphatic dissemination
What is the macroscopic appearance of ovarian endometriosis?
Peritoneal spots or nodules
Fibrous adhesions
Chocolate cysts
What is the microscopic appearance of ovarian endometriosis?
Endometrial glands and stroma
Haemorrhage, inflammation, fibrosis
What are the complications of endometriosis?
- pain
- cyst formation
- adhesions
- infertility
- ectopic pregnancy
- malignancy (endometroid carcinoma)
Ovarian tumours can be;
_____ vs _____
______ vs __________
Ovarian tumours can be;
solid vs cystic
benign vs malignant
What is the classification of ovarian tumours?
- epithelial
- germ cell
- sex-cord/stromal
- metastatic
- miscellaneous
What are the epithelial ovarian tumours?
- serous*#
- mucinous*
- endometrioid*
- clear cell*
- brenner*
- undifferentiated carcinoma
* subdivided on histopathological examination into benign/borderline/malignant
malignant serous carcinomas are typed as low grade or high grade
What are benign epithelial ovarian tumours?
No cytological abnormalities, proliferative activity absent or scant
No stromal invasion
What are borderline epithelial ovarian tumours?
Cytological abnormalities, proliferative
No stromal invasion
What are malignant epithelial ovarian tumours?
Stromal invasion
What is serous carcinoma?
Epithelial ovarian tumour with two distinct entities and two different precursor lesions
High grade serous carcinoma
- serous tubal intraepithelial carcinoma (STIC)
- most cases are essentially tubal in origin*
Low grade carcinoma
- serous borderline tumour
What do endometroid and clear cell carcinoma have a strong association with?
Endometriosis of the ovary
Lynch syndrome
How is endometroid and serous carcinoma often diagnosed?
Primary diagnosis often made on ascitic fluid
What is a brenner tumour?
A tumour of transitional type epithelium, usually benign, borderline and malignant variants are rare
Germ cell tumours make up __-__% of all ovarian tumours
Germ cell tumours make up 15-20% of all ovarian tumours
What are the types of germ cell tumours?
- Teratoma
- Mature (benign, cystic)- dermoid cyst
*
What percentage of germ cell tumours are dermoid cysts?
95%
What are the germ cell tumours other than teratomas and dermoid cysts?
Immature teratoma
Dysgerminoma
Yolk sac tumour
Choriocarcinoma
Mixed germ cell tumoure
what is the commonest malignant primitive germ cell tumour?
Dysgerminoma
Who do dysgerminomas affect?
Children and yound women, average age 22
What are the sex cord/stromal tumours?
- fibroma/thecoma
- granulosa cell tumour
- sertoli-leydic cell tumours
Describe fibromas/thecomas?
Benign
May produce oestrogen causing uterine bleeding
Describe granulosa cell tumours?
Potentially malignant
Associated with oestrogenic manifestations
Describe sertoli-leydig cell tumours
Rare, may produce androgens
When should a metastatic tumour be considered?
in all cases, particularly when tumours are bilateral and small
Describe figo staging of ovarian cancer
1A- tumour limited to one ovary
1B- tumour limited to both ovaries
1C- Cancer involving ovarian surface/rupture/surgical spill/tumour in washings
2A- Extension or implants on uterus/fallopian tube
2B- Extension to other pelvic intraperitoneal
3A- Retroperitoneal lymph node metastasis or microscopic extrapelvic peritoneal involvement
3B- Macroscopic peritoneal metastasis beyond pelvis up to 2cm in dimension
3C- Macroscopic peritoneal metastasis >2cm in dimension
4- Distant metastasis
List the pathologies found in the fallopian tubes?
- inflammation
- salpingitis due to infection
- cysts and tumours
- serous tubal intraepithelial carcinoma
- endometriosis
- ectopic pregnancy
When should ectopic pregnancy diagnosis be considered?
In any female of reproductive age with amenorrhoea and acute hypotension or an acute abdomen
