Ovary and Fallopian Tube Pathology 1 Flashcards
Describe the tumor classification for four types of "ovarian tumors."
List the four major types of ovarian tumors.
- Surface epithelial neoplasms
- Sex-cord stromal tumors
- Germ cell tumors
- Metastatic tumors
What are the major non-neoplastic ovarian cysts?
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Follicular cyst
- common lesions of Graafian follicle origin
- usually multiple and <2cm
- may produce increased estrogen if theca component is luteinized
- increased serum estrogen, pain, or hemoperitoneum
- consist of granulosa and theca cells
- polycystic ovarian syndrome
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Corpus lutein cysts (CLC)
- non-pregnant CLC
- pregnancy CLC
- corpus luteum may appear as ovarian neoplasm
- rupture may cause peritoneal inflammation
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Non-neoplastic epithelial cysts
- ovarian surface epithelial cyst
- ciliate tubal inclusion cyst/Paratubal cyst
- remnant cyst
What is the clinical presentation, pathophysiology, histology, and long-temr sequelae of PCOS?
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Clinical
- 5% of reproductive age women
- obese
- hirsute (rarely virilized)
- diabetic (insulin-resistant)
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Pathophysiology
- persistent anovulation
- oligomenorrhea
- high level of LH & estrogen
- LH and insulin result in overproduction of androgens that are converted in peripheral tissue to estrogen
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Histology
- multiple follicles
- fibrosis
- absence of corpus luteum
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Long-term sequelae
- endometrial hyperplasia/carcinoma
What are the common sources of ovary/FT surface epithelial tumors?
- Glands of endometriosis
- Remnants: rete ovary, walthard and mesonephric ducts (secondary Mullerian system)
- Endosalpingiotic, paraovarian, and paratubal cysts
- The fimbriated end of secretory epithelia (FTE)
- gives rise to significant percentage of hihg-grade serous carcinomas
- fimbria responsible for deposition of neoplastic cells on the surface of the ovary
- Ovarian surface epithelia?
What are the sources of “sex-cord” stromal tumors?
- Stroma of the ovary: fibroblasts and myofibroblasts
- Sex cord: the non-germ cell elements of the Graafian follicle
What are the common sources off germ cell neoplasias?
germ cells within the follicle are the progenitor cells
What are the major epithelial ovarian tumor classifications?
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Serous:
- epithelium of tumor resembles fallopian tube epithelium , the most common neoplasms in ovary
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Mucinous:
- resembles endocervical (associated with endometriosis and teratoma) or colonic mucosa
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Endometrioid:
- resembles proliferative endometrial glands; 30% associated with endometriosis
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Clear Cell:
- similar histology at all sites; ~50% to 70% associated with endometriosis
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Transitional:
- Brenner tumor most common type; cells resemble transitional (urothelial) cells
What is the detection rate and death rate of ovarian carcinoma?
- Accounts for 50% of female genital tract deaths; The death rate for OC has not changed in the past 50 years.
- 75% of OC are detected in late stages and 50% are high grade serous carcinoma
- Recent studies, however, have raised a compelling hypothesis that fallopian tube secretory epithelial cells (FTSECs) may harbor a cell of origin for most high grade serous carcinoma.
What are the major subdivisions of serous epithelial tumors and what are the major features of each?
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Benign (60%):
- serous Cystadenoma and Cystadenofibroma
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Borderline or Low Malignant Potential (15%)
- intraepithelial proliferation
- 30% to 40% have extra-ovarian spread, called “implants” in omentum, peritoneum or lymph nodes
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Malignant: Invasive (25%)
- 50% bilateral; represents 50-60% of all malignant ovarian tumors
- can be divided into low grade and high grade
Describe the histology of serous cystadenoma.
- Multiple cysts with smooth lining
- Showing serous cyst adenofibroma (top) and cyst adenoma with simple papillary architecture (bottom).
- high-power (right) showing fallopian tube-like epithelium
- Lesion usually lined with a pseudostratified row of tall ciliated columnar cells - resembles fallopian tube epithelium
Describe the histology of serous papillary “borderline” tumors.
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Gross
- solid and cystic mass
- yellow tan papillary fronds
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Typical Histology
- intraepithelial proliferation
- pseudo- and true stratified
- tufting
- mild to moderate nuclear atypia
- non or microinvasive
- hierarchical papillary/micropapillary epithelial proliferation
- 30-40% have “implants” of serous tumor on extra-ovarian peritoneal surfaces
- Progression to low-grade invasive serous adenocarcinoma on recurrance has high mortality rate
In serous “borderline” tumors what are important considerations for involvement of extra-ovarian sites?
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Implants vs Metastasis
- common in omentum, pelvic sidewall, diaphragm and uterine serosal surface
- can be found in pelvic lymph node
- can progress to low grade serous carcinoma
What are some features of malignant serous tumors?
- Solid component with invasion into ovarian stroma
- Increased cellular proliferation with cytologic atypia
- Cytologic atypia and psamomma bodies
- High-grade serous carcinomas can also come from mucosa lining fibriated end of the fallopian tube
- spread diffusely throughout peritoneal cavity
What are some important features of ovarian mucinous tumors?
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Middle-aged adults
- rare before puberty / after menopause
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Three groups:
- endocervical
- usually benign
- cystic neoplasms lined by talkk mucin-filled cells
- associated with endometriosis
- intestinal
- maybe benign, LMP, or malignant
- usually large and multicystic
- lined by intestinal-type mucosa with goblet cells
- Mullerian
- endocervical
- Can be heterogeneous and consist of benign borderline and malignant components with on tumor
- Malignant tumors are more solid and complex with stromal invasion
- Must exclude appendiceal or colonic metastasis!
What are the major histologic findings of mucinous cystadenocarcinoma?
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Major histologic features:
- columnar cells with abundant intracytoplasmic mucin and cytologic atypia
- Stromal invasion;
- more solid growth, loss of glandular architecture,
- necrosis
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Differentiation:
- glands are mostly intestinal type
- endocervical type usually
- Carcinoma often merges with borderline or benign mucinous tumors