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Pathology III > Ovary and Fallopian Tube > Flashcards

Ovary and Fallopian Tube Flashcards

1
Q
A

normal histology of the fallopian tube isthmus

  • inner longitudinal layer
  • outer longitudinal layer
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2
Q
A

normal fimbrae histology

  • plicae suspended from infundibulum (proximal fallopian tube) in a “frond like” appearance
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3
Q

what is salpingitis?

what are the major causes of salpingitis?

A

inflammation of the fallopian tube

3 major causes:

  • ascending infection ( from cervix) - m/c
    • n. gonorrhea, c. trachomatis
  • invasive procedures - IUD, D&C
  • endometriosis (rare)
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4
Q

what are the most common causes of infectious salpingitis?

A
  • N. gonorrhea
  • C. trachomatis
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5
Q

define pelvic inflammatory disease (PID)

A

inflammatory processes in the pelvis where fallopian tube is the epicenter

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6
Q

outline the progression/types of salpingitis

A
  • acute salpingitis: neutrophilic infiltrate in mucosa. progresses to
    • pyrosalpinx: tubed FILLED with pus, which can become
      • chronic salpingiits: neutrophilic infiltrate + VILLOUS BLUNTING. can progress to
        • hydrosalpinx: tube is
          • filled w/ CLEAR FLUID
          • smooth d/t loss of plicae (no folds)
          • adhesions on fimbrated end
      • tuboovarian adhesions, or
      • tubo-ovarian abscess (possibly)
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7
Q
A

acute salpingitis: many neutrophils in the MUCOSA

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8
Q
A

pyosalpinx: dilated fallopian tube FILLED with pus - i.e., lumen filled with neutrophils

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9
Q
A

chronic salpingitis: neutrophillic infiltate + blunting of villi

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10
Q
A

chronic salpingitis: neutrophillic infiltate + blunting of villi

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11
Q
A

hydrosalpinx

  • progression from chronic salingitis
    • neutrophilic infiltrate has been replaced with CLEAR FLUID
    • tube walls - d/t loss of villi - are very smooth instead of folded
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12
Q
A

hydrosalpinx

  • progression from chronic salingitis
    • neutrophilic infiltrate has been replaced with CLEAR FLUID
    • tube walls - d/t loss of villi - are very smooth instead of folded
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13
Q

what are the major consequences of PID

A
  • infertility
  • ectopic pregnancy
  • chronic pain/recurrent infection
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14
Q

tubal (ectopic pregnancy)

  • risk factors
  • etiology
  • morphology
    • gross
    • microscopic
  • sequelae
A
  • biggest risk factor: chronic salpingitis (recall - appearance = neutrophilic lumen + villous blunting)
  • etiology: ovum implants into tubal epithelium, then
    • chorionic villi, extra-villous trophoblast grow within lumen or into tubal wall, while,
    • maternal vessels grow into gestational sac
  • morphology:
    • gross: hematosalpinx (blood in fallopian tube) d/t maternal vessels → gestational sac
    • microscopic: intraluminal chorionic villi & extravillous trophpoblast +/- embryonic parts
  • sequelae: tubal rupture → intra-abdominal hemorrhage (life threatening)
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15
Q
A

hematosalpinx

fallopian tube hemorrhage d/t invasion of maternal vessels into gestational sac (tubal ectopic pregnancy)

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16
Q
A

tubal pregnancy - microscopic,

tubal plicae (on right) with chorionic villi from ovum (left)

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17
Q
A

tubal pregnancy - microscopic,

embryolic remantns (circled) + chorionic villi (upper)

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18
Q
A

ruptured tubal pregnancy

(complication of tubal ectopic pregnancy)

white center: tiny embryo remnant

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19
Q

tubo-ovarian (adnexal) torsion

  • definition
  • etiology
  • morphology
  • clinical
A
  • definition: rotation of adnexa (fallopion tube + ovary)
  • etiology: rotation of infundopelvic ligament compromises blood supply
    • compresses tuboovarian vessels (both arteries and veins)
    • but, b/c arteries are muscular & less compressible they remain patent initially → delivery blood while veins collapse & can’t drain. leads to
      • edema / enlargement of tube & ovary
        • eventual compression of all vessels
          • necrosis / infarction / hemorrhage
  • morphology (gross)
    • outside:
      • necrotic - dusky, dark red
      • enlarged
    • cut surface: hemorrhagic + cystic
  • clinical
    • prompt dx is KEY
    • sx: pelvic pain
      • pelvic pain
      • infertility
20
Q
A

outer surface of ovary - dusky red & enlarged

tubo-ovarian torsion

21
Q
A

cut surface of ovary - hemorrhagic & cystic

tubo-ovarian torsion

22
Q

follicular cyst

  • definition
  • etiology
  • morphology
    • gross
    • microscopic
A
  • definition: ovarian cyst lined with 1. granulosa cells & 2. theca interna cells
    • cystic follicle: < 2 cm
    • follicular cyst: > 2 cm
  • etiology: graffian follicle that didn’t rupture post ovulation
  • morphology
    • gross:
      • smooth inner wall
      • lined with grey, glistening membrane
      • filled with CLEAR, SEROUS FLUID
    • microscopic:
      • inner layer: single layer of small granulosa cells
      • outer layer: thick layer of large theca internal cells
23
Q

cystic corpus luteum

  • definition
  • etiology
  • morphology
A
  • etiology: failure of corpus luteum to regress after lack of fertilization
  • morphology
    • gross:
      • smooth yellow lining
      • filled with BLOODY FLUID
    • microscopic:
      • inner layer: thin & made of connective tissue
      • outer layer:
        • large, VACUOLATED granulosa cells
        • small theca interna cells
24
Q
A

cystic follicle / follicular cyst - gross

lined by thin, gray glistening membrane filled with a clear, serous fluid

25
Q
A

cystic follicle / follicular cyst - microscopic

single layer of granulosa small cells + thick layer of large thecal cells

26
Q
A

cystic corpus luteum / corpus lutem cyst - gross

  • smooth yellow lining
  • filled with BLOODY FLUID (usually)
27
Q
A

cystic corpus luteum / corpus luteum cyst - microscopic

  • large, VACUOLATED granulosa cells
  • small theca interna cells
28
Q

follicular & corpus luteum cysts - clinical

A
  • both occur during reproductive ages
    • corpus luteum cysts: tend to cause rupture/bleeding into peritoneum
29
Q

PCOS

  • presentation
  • sequela
  • morphology
    • gross
    • microscopic
A
  • presentation
    • anovulation / inferility
    • hyperandrogenism → hursutism
    • weight gain
  • sequelae: at inc risk for
    • endometrial hyperplasia
    • carcinoma
  • morphology
    • gross
      • ovaries 2-5x normal size
      • outer-cortex:
        • smooth and white
        • lacking corpus lutea
    • microscopic
      • thickened, hypocellular and colllagenous
30
Q
A

PCOS-gross

  • ovaries 2-5x normal size
  • outer-cortex:
    • smooth and white
    • lacking corpus lutea
31
Q

ovarian neoplasms general info

  • benign vs malignant
    • prevalence
    • demographics
    • prognosis
A

5th leading cause of cancer deaths

  • benign - comprise 80% of tumors
    • demo: 20-25
  • malignant
    • demo: 45-65
    • 80% have metastasized by diagnosis
32
Q

what factors are known to increase vs lower risk of ovarian cancer

A
  • increase risk:
    • BRCA-1, or BRCA-1
    • family hx
    • long term estrogen replacement
    • clomiphene use
    • hereditary nonpolyposis colon cancer (lynch syndrome)
    • anything that would inc # of ovulatory cycles
      • nulliparity
      • older age
  • lower the risk
    • anything that would decrease # of estrogen cycles
      • hx of contraceptive risk
      • late menarche (1st menstruation) / early menopause
      • pregnancy
        • multiparity (especially)
        • first pregnancy before 25
      • prophylactic oophorectomy
    • tubal ligation
33
Q

WHO classification of ovarian neoplasms

  • from what types of tissues?
  • what tissues tend to turn benign vs malignant?
A
  • benign. can be
    • serous
    • mucous
    • endometrioid
  • carcinomas
    • type I
      • come from benign/borderline cystadenomas/endometriosis →
        • low grade serous
        • endometrioid
        • mucinous
    • type II
      • usually come from serous tubal intraepithelial carcinoma (STIC) → high grade serous carcinomas
34
Q

serous tumors

  • general characterstics
  • discuss the morphology, genetics the sequelae of the benign, borderline and malignant subtypes
A
  • general
    • propensity to spread to peritoneal surfaces/omentum → ascites
  • benign: 60-70%
    • typically unilateral
    • morphology:
      • microscopic:
        • single layer of bland looking (usually ciliated columnar) epithelial cells
      • gross
        • smooth external/internal surfaces
        • straw color fluid
        • no stroma
  • borderline: 5-10%
    • microscopic- stratification of epithelium (multiple layers)
    • gross
      • inc # of papillary projections
      • still no stroma
  • malignant: 20-25%
    • commonly bilateral
      • low grade → type I carcinomas
        • genetics
          • wild type p53
        • morphology
          • extensively papillary
          • with many psammoma bodies
          • some fibrous stroma
      • high grade → type II carcinomas
        • genetics
          • high frequency of p53 mutations
          • BRCA-1 & 2 tends to cause these
        • morphology
          • papillary, inc arcitechtural complexity
          • +/- psammoma bodies
          • stromal invasion
35
Q

tumors, characteristics

A

benign serous tumor

  • typically unilateral
  • morphology:
    • gross
      • smooth external/internal surfaces
      • straw color fluid
      • no stroma
36
Q

tumor, characteristics

A

benign serous tumor

  • typically unilateral
  • morphology:
    • microscopic:
      • single layer of bland looking (usually ciliated columnar) epithelial cells
37
Q

tumor, characteristics

A

borderline serous tumor

  • microscopic- stratification of epithelium (multiple layers)
38
Q

tumor, characteristics

A

borderline serous tumor - gross

  • microscopic- stratification of epithelium (multiple layers)
  • gross
    • inc # of papillary projections
    • still no stroma
39
Q
A

serous tumor (adenocarcinoma)

40
Q

tumor, characteristics

A

low grade serous tumor (adenocarcinoma)

  • type I carcinomas
    • genetics
      • wild type p53
    • morphology
      • extensively papillary
      • with MANY psammoma bodies
      • some fibrous stroma
41
Q

tumor, characteristics

A

high grade serous tumor (adenocarcinoma)

  • high grade → type II carcinomas
    • genetics
      • high frequency of p53 mutations
      • BRCA-1 & 2 tends to cause these
    • morphology
      • papillary, inc arcitechtural complexity
      • +/- psammoma bodies
      • stromal invasion
42
Q

BRCA-1 and BRCA-2 patients mostly have what type of ovarian cancer?

A

high grade serous carcinomas with TP-53 mutations

43
Q

mucinous tumor

  • general characteristics
  • benign, borderline and malignant morphologies, genetics
A
  • general characteristics
    • almost entirely unilateral
    • KRAS mutations are common
    • two types: intestinal > endocervical
    • metastasis uncommon
  • types
    • benign
      • gross: multi-cystic mass with delicate septa
      • micro: tall, columnar epithelium without cilia
    • borderline
      • intestinal type
        • gross: multilocular cysts filled with gelatinous contents
        • microscopic
          • epithelial stratification (multiple layers)
          • tufting, budding
      • endo-cervical type
        • gross - unilocular cysts
        • microscopic - heirarchal branching of papillae
    • malignant
      • confluent glandular growth of very closely packed glands
44
Q

tumor, characteristics

A

benign mucinous tumor (cystadenoma) - gross

  • general characteristics
    • almost entirely unilateral
    • KRAS mutations are common
    • two types: intestinal > endocervical
    • metastasis uncommon
  • gross: multi-cystic mass with delicate septa
  • micro: tall, columnar epithelium without cilia
45
Q
A

benign mucous tumor (cystadenoma) - micro

  • general characteristics
    • almost entirely unilateral
    • KRAS mutations are common
    • two types: intestinal > endocervical
    • metastasis uncommon
  • gross: multi-cystic mass with delicate septa
  • micro: tall, columnar epithelium without cilia
46
Q

tumor, characteristics

A

mucinous borderline tumor - intestinal type (gross)

  • gross: multilocular cysts filled with gelatinous contents
  • microscopic
    • epithelial stratification (multiple layers)
    • tufting, budding

general characteristics

  • almost entirely unilateral
  • KRAS mutations are common
  • two types: intestinal > endocervical
  • metastasis uncommon
47
Q

tumor, characteristics

A

mucinous borderline tumor - intestinal type (gross)

  • gross: multilocular cysts filled with gelatinous contents
  • microscopic
    • epithelial stratification (multiple layers)
    • tufting, budding

general characteristics

  • almost entirely unilateral
  • KRAS mutations are common
  • two types: intestinal > endocervical
  • metastasis uncommon

Pathology III (5 decks)

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