Ovary and Fallopian Tube Flashcards
1
Q
A
normal histology of the fallopian tube isthmus
- inner longitudinal layer
- outer longitudinal layer
2
Q
A
normal fimbrae histology
- plicae suspended from infundibulum (proximal fallopian tube) in a “frond like” appearance
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)
4
Q
what are the most common causes of infectious salpingitis?
A
- N. gonorrhea
- C. trachomatis
5
Q
define pelvic inflammatory disease (PID)
A
inflammatory processes in the pelvis where fallopian tube is the epicenter
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
- hydrosalpinx: tube is
- tuboovarian adhesions, or
- tubo-ovarian abscess (possibly)
-
chronic salpingiits: neutrophilic infiltrate + VILLOUS BLUNTING. can progress to
-
pyrosalpinx: tubed FILLED with pus, which can become
7
Q
A
acute salpingitis: many neutrophils in the MUCOSA
8
Q
A
pyosalpinx: dilated fallopian tube FILLED with pus - i.e., lumen filled with neutrophils
9
Q
A
chronic salpingitis: neutrophillic infiltate + blunting of villi
10
Q
A
chronic salpingitis: neutrophillic infiltate + blunting of villi
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
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
13
Q
what are the major consequences of PID
A
- infertility
- ectopic pregnancy
- chronic pain/recurrent infection
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)
15
Q
A
hematosalpinx
fallopian tube hemorrhage d/t invasion of maternal vessels into gestational sac (tubal ectopic pregnancy)
16
Q
A
tubal pregnancy - microscopic,
tubal plicae (on right) with chorionic villi from ovum (left)
17
Q
A
tubal pregnancy - microscopic,
embryolic remantns (circled) + chorionic villi (upper)
18
Q
A
ruptured tubal pregnancy
(complication of tubal ectopic pregnancy)
white center: tiny embryo remnant
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
- eventual compression of all vessels
-
edema / enlargement of tube & ovary
- morphology (gross)
- outside:
- necrotic - dusky, dark red
- enlarged
- cut surface: hemorrhagic + cystic
- outside:
- 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
- gross:
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
- gross:
24
Q
A
cystic follicle / follicular cyst - gross
lined by thin, gray glistening membrane filled with a clear, serous fluid
25
cystic follicle / follicular cyst - microscopic
single layer of granulosa small cells + thick layer of large thecal cells
26
cystic corpus luteum / corpus lutem cyst - gross
* **smooth yellow lining**
* filled with **BLOODY FLUID** (usually)
27
cystic corpus luteum / corpus luteum cyst - microscopic
* _large, VACUOLATED_ granulosa cells
* **_smal_**l theca interna cells
28
follicular & corpus luteum cysts - clinical
* both occur during reproductive ages
* corpus luteum cysts: tend to cause rupture/bleeding into peritoneum
29
PCOS
* presentation
* sequela
* morphology
* gross
* microscopic
* 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
PCOS-gross
* ovaries 2-5x normal size
* outer-cortex:
* **smooth and white**
* lacking corpus lutea
31
ovarian neoplasms general info
* benign vs malignant
* prevalence
* demographics
* prognosis
**5th leading cause of cancer deaths**
* benign - comprise 80% of tumors
* demo: _20-25_
* malignant
* demo: _45-65_
* 80% have metastasized by diagnosis
32
what factors are known to increase vs lower risk of ovarian cancer
* 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
WHO classification of ovarian neoplasms
* from what types of tissues?
* what tissues tend to turn benign vs malignant?
* 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
serous tumors
* general characterstics
* discuss the morphology, genetics the sequelae of the benign, borderline and malignant subtypes
* 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
tumors, characteristics
benign serous tumor
* **typically unilateral**
* morphology:
* gross
* **smooth external/internal surfaces**
* straw color fluid
* no stroma
36
tumor, characteristics
benign serous tumor
* **typically unilateral**
* morphology:
* microscopic:
* _single layer_ of _bland looking_ (usually ciliated columnar) epithelial cells
37
tumor, characteristics
borderline serous tumor
* microscopic- **stratification** of epithelium (multiple layers)
38
tumor, characteristics
borderline serous tumor - gross
* microscopic- **stratification** of epithelium (multiple layers)
* gross
* **inc # of papillary projections**
* still no stroma
39
serous tumor (adenocarcinoma)
40
tumor, characteristics
low grade serous tumor (adenocarcinoma)
* type I carcinomas
* genetics
* wild type p53
* morphology
* extensively papillary
* **with MANY psammoma bodies**
* **some fibrous stroma**
41
tumor, characteristics
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
BRCA-1 and BRCA-2 patients mostly have what type of ovarian cancer?
high grade serous carcinomas with TP-53 mutations
43
mucinous tumor
* general characteristics
* benign, borderline and malignant morphologies, genetics
* 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
tumor, characteristics
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
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
tumor, characteristics
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
tumor, characteristics
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**
