Ovary and Fallopian Tube Pathology 3

Question 1

What are the major cell populations of the fallopian tube?

Answer 1

• Ciliate cells
• Secretory cells
  
  • fallopian tube secretory epithelial (FTE) cells
  • origin of serous tubal intraepithelial carcinoma (STIC)

Question 2

What are the major inflammatory diseases of the fallopian tube?

Answer 2

• Bacteria
  
  • gonorrhea
  • tuberculosis
  • syphilis
• Fungi
  
  • actinomyces

Question 3

What are some important features of pelvic inflammatory disease (PID)? Presentation? Consequences?

Answer 3

• Usually due to ascending infection with N. gonorrhea and some other non-gonococcal bacteria
• Less often, polymicrobial infection after abortion or deliveries (puerperal infection) and surgical complications
• Presentation:
  
  • excruciating adnexal pain on palpation
  • upper abdominal pain (Fitz-Hugh-Curtis syndrome)
  • fever and purulent discharge
• Consequences:
  
  • acute peritonitis and spesis
  • chronic condition results in bowel obstruction and infertility

Question 4

What are some histological findings of pelvic inflammatory disease?

Answer 4

• Plicae are distended with acute and chronic inflammatory cells
• When inflammation resolves, intratubal adhesions develop
  
  • can lead to ectopic pregnancies
• Tube becomes markedly dilated and filled with serous fluid (hydrosalpinx)

Question 5

What happens in acute salpingitis?

Answer 5

• A. Plica broadened by inflammation
• B. Plica and lumen is filled with neutrophils
• C. Fallopian tube lumen obliterated by inflammatory infiltrate (arrow marks histiocytes).
• D. This process will lead to adhesions between the fallopian tube and ovary (tubo-ovarian complex). Once infection resolves, the dilated fallopian tube fills with serous fluid (hydrosalpinx)

Question 6

What is the role of the fallopian tube in high grade serous carcinoma? What are other important cell types involved?

Answer 6

• Fallopian tube surface lining cells
  
  • ciliated cells
    
    • terminal differentiated cells
  • secretory cells
    
    • cell origin of most high grade serous carcinomas.
    • PAX8+, Calretenin-
  • functions of tubal surface lining cells.
    
    • carry sperm and fertilized oocytes
    • nourish transported cells
    • source of serous carcinoma
• Ovarian surface epithelial cells
  
  • modified mesothelial cell types
  • PAX8-, Calretenin+
• 2nd Mullerian epithelial system
  
  • rete ovary,
  • endometriosis,
  • endosalpingiotic cysts,
  • paraovarian and paratubal cysts.

Question 7

What are the major histological features of serous tubal intraepithelial carcinomas (STIC)?

Answer 7

• Mostly confined to fallopian tube fimbria
• Intraepithelial proliferations (high Ki-67 index)
• High grade nuclear atypia (>12 cells)
• P53 mutations
• 5-20% of patients with BRCA1/2 germline mutations have STIC in prephylective BSO

Question 8

What are the gross and histologic features of high grade serous carcinomas?

Answer 8

• Gross photomicrograph of high grade serous carcinoma
  
  • solid and cystic growth
  • tan-yellow-flesh cut surface
  • necrosis
  • most have surface involvement
  • often have metastasis at surgery
• Histologic features of high grade serous carcinoma.
  
  • solid, papillary and glandular growth
  • high grade nuclei
  • necrosis
  • lymphovascular invasion
  • often have metastasis at surgery

Question 9

What are some important epidemiological features of high-grade serous carcinomas?

Answer 9

• Facts
  
  • 50-60% of malignant ovarian epithelial carcinoma
  • most identified at stage III
  • 70-80% of ovarian death
  • common in Caucasian women
• strongly associated with BRCA1/2 mutations (germ/somatic/epigenomic)
• family history of breast and ovarian cancer
• Histology
  
  • solid/cystic/papillary/glandular
  • high grade and pleomorphic nuclear
  • high index of mitoses
  • >95% with p53 mutations
  • serous tubal intraepithelial carcinoma in situ can be seen in both prephylective and cancer patients.
• Key features for diagnosis:
  
  • high grade nuclei
  • >12 mitoses/10 high power field