ovary fallopian tube pathology Flashcards
ectopic pregnancy sx
severe abdominal pain approx 6 weeks after LMP, but can develop much longer. Most common cause of hematosalpinx
types of benign ovarian cysts
Chocolate cyst- hemosiderin laden macrophages. Cortical inclusion cysts. Simple serous cyst- no excresences
PCOS pathphys
Persistent anovulation due to asynchronous release of FSH and LH. Excess androgens with peripheral conversion to E2
PCOS sx and treatment
Infertility, oligomenorrhea, obesity, hirsutism. Ovaries twice normal size and absent corpora lutea. Treat: metformin
Cystic ovarian teratoma incidence, Sx, path
aka dermoid cyst. Most common ovarian tumor. Contains adult type tissues from all three germ layers. Most are asymptomatic. Anti-NMDAR mediated paraneoplastic encephalitis associated with ovarian teratoma
What is the origin of most ovarian epithelial tumors
fimbriated end of fallopian tube
describe the ovarian surface epithelial tumors
“Seers make everything clear” 1. Serous: Hierarchical branching, cuboidal cells. 2. mucinous: Huge tumors, Intestinal vs Endocervical epithelium. 3. endometrioid: Same appearance as uterine endometrioid tumors. 4. clear cell: associated with endometriosis
risk factors for ovarian tumors
Decreased risk: OCPs, full term pregnancy, gyn surgery, breast feeding. Increased risk: infertility, unopposed estrogen for >10 yrs, family hx
Genes associated with risk for ovarian cancer
- BRCA1 and BRCA2. DNA repair genes. Risk of breast and ovarian cancer, with mortality higher from ovarian. Typically cause high grade serous carcinoma. 2. HNPCC: mutated mismatch repair genes MLH1, MSH2, PMS2 or MSH 6 leads to microsatellite instability. Colon cancer, endometrial cancer
type I vs type II epithelial tumors
type I: progression. Type II: sporadic/ de novo
Borderline ovarian epithelial tumors responsiveness to therapy
Low proliferative rate ∴ not responsive to radiotherapy or chemotherapyLow proliferative rate ∴ not responsive to radiotherapy or chemotherapyLow proliferative rate ∴ not responsive to radiotherapy or chemotherapyLow proliferative rate ∴ not responsive to radiotherapy or chemotherapy
Sx of malignant ovarian tumor
vaginal bleeding, increased abdominal girth
spread of epithelial ovarian tumors
- Direct invasion can occur in uterus, fallopian tubes, peritoneum and broad ligament. 2. Exfoliated tumour cells are transported by peritoneal fluid and implant on the peritoneum and mesothelial linings of pelvic and abdominal organs (serosa). Nests of tumor cells can be found on the omentum, mesenteryand diaphragm. 3. lymphatic spread to pevlic and paraaortic lymph nodes. 4. hematogenous spread is rare but can involve any organ, esp liver.
Sx associated with intraperitoneal dissemination of ovarian cancer
ascites
describe ovarian serous neoplasms pathology and list the types
type of surface epithelial ovarian tumor. Tubal type epithelium (ciliated columnar cells), with epithelial tufting. Serous cystadenoma, serous borderline tumor and serous carcinoma
serous ovarian neoplasms survival
Benign (100%), Borderline (80%), Malignant (20%)
ovarian serous cystadenoma path
One or multiple thin-walled cysts. Broad papillae with fibrovascular cores. No cytologic atypia or mitoses
ovarian serous borderline tumor path
Large cystic or solid masses with soft papillary projections or surface excrescences. Complex papillae with epithelial tufting and hierarchical branching. No stromal invasion. +/- surface involvement; potential to spread. Psammoma bodies (targetoid calcifications), and detached tufts of cuboidal epithelial cells with moderate cytologic atypia
ovarian serous borderline tumor sx, mutations/ markers
Most common in 4-5th decades and often asymptomatic. Elevated CA-125. K-RAS and BRAF mutations common
ovarian Serous carcinoma gross pathology
Solid, cystic, mixed. Friable with hemorrhage and necrosis. Cysts contain “straw-like” proteinaceous fluid
ovarian serous carcinoma histology
Stromal invasion, complex architectureal patterns, cytologic atypia (pleomorphism and mitoses), may be glandular or solid
ovarian mucinous cystadenoma histology
Simple glandular epithelium with small basal nuclei and abundant blue (mucinous) apical cytoplasm
ovarian mucinous tumors survival and age range
Benign: 80%, 30-50 yrs ol. Borderline: 15%, >60 yrs. Malignant: 5%, > 60yrs
ovarian mucinous borderline tumor histology and survival
10 yr survival is 80%. Stratified epithelium with atypia and scattered mitoses. Intestinal type has goblet cells. Endocervical/ seromucinous type has acute inflammation
ovarian mucinous carcinoma- survival, types of invasion
10 year survival = 35%. 2 types of invasion: Destructive (25% recur), Expansile (<5% recur).
ovarian endometrioid tumors- pathology
Resembles uterine adenocarcinoma. Gland-forming neoplasm w columnar cells and cytologic atypia. Similar genetic alterations as low grade endometrial carcinoma
Ovarian clear cell carcinoma pathology and associations
Very rare. Associated with endometriosis. Can be glandular or papillary (fibrovascular core with lining of epithelial cells). tubulocystic growth pattern. Hobnail cells: nuclei bulging into cystic space without apparent cytoplasm. Eccentric, rounded or angular, hyperchromatic nuclei. Minimal to marked cytologic atypia
list the cell types involved in serous, mucinous, endometrioid and clear cell epithelium
serous: cuboidal. Mucinous: columnar. Endometrioid: columnar. Clear cell: hobnail cells
list the germ cell tumors
Mature teratoma (benign), immature teratoma, dysgerminoma (undifferentiated), yolk sac carcinoma, embryonal carcinoma, choriocarcinoma
List another name for mature cystic teratoma
dermoid cyst
Mature cystic teratoma histology
Adult-type tissues representing all three germ layers typically present. Ectodermal: Epidermis, sebaceous, hair follicles. Mesodermal: fat, cartilage, bone, teeth. Endodermal: respiratory and GI epithelium, thyroid
what is a Rokitanskys protuberance
A rounded polypoid solid mass usually made of fat sen in mature cystic teratomas
Immature teratoma histology and grading
Immature neuroepithelium: Tightly packed small dark cells w lots mitoses. Grading based on amount of immature neural tissue (more is worse)
Ovarian dysgerminoma - prognosis, male counterpart, incidenc
Excellent prognosis, even with widespread metastases. Highly sensitive to radiation and chemotherapy. 10 year survival exceeds 90%. Female counterpart to male seminoma. 50% of malignant germ cell tumors
Excellent prognosis, even with widespread metastases. Highly sensitive to radiation and chemotherapy. 10 year survival exceeds 90%. Female counterpart to male seminoma. 50% of malignant germ cell tumors
ovarian dysgerminoma histology
Sheets and nests of cells with large central nuclei and prominent nucleoli. Clear cytoplasm, squared off nuclear contour, isochromosome 12p.
ovarian yolk sac tumor - age, tumor markers
10-30yrs, but can occur perimenopausal when associated with surface epithelial neoplasms. Produces alpha-fetoprotein (AFP)
ovarian yolk sac tumor- histology
Schiller-Duval body: Glomeruloid structure with central blood vessel surrounded by neoplastic cells. AFP positive hyaline globules
List the sex cord stromal tumors of the ovaries
Granulosa cell tumor, thecoma-fibroma, and sertoli-Leydig cell tumors
Adult granulosa cell tumor of ovaries- associations, labs to monitor progress
Associated with endometrial neoplasia. Serum inhibin used to monitor recurrence. Estrogenic manifestations in 2/3
Granulosa cell tumor of ovary- histology
Call-Exner bodies: resembles primitive follicle. Central space with secretions. Prominent nucear grooves and corded growth pattern
Fibroma - prognosis and associations
Almost all benign, but 1/5 have concurrent endometrial carcinoma.
Fibroma histology
Pink variably cellular stroma composed of fibroblasts without significant nuclear atypia or very many mitotic figures
Meigs syndrome
triad of ovarian fibroma, ascites and hydrothorax.
Thecoma- who gets it and histology
Post-menopausal. Plumper cells with more abundant clear cytoplasm. Abundant reticulin fibers
Sertoli-Leydig cell tumor of ovaries- who gets it, sx
25 yrs avg. 1/3 pts show virilization
compare primary vs metastatic ovarian tumors
primary: unilateral, no surface growth, absence of nodularity, large. Metastatic: bilateral, surface and hilar involvement, nodular growth pattern, infiltrative growth, small.
Krukenberg tumor
metastatic gastric carcinoma in the ovary. Signet ring cell morphology
Pseudomyxoma peritoneii
metastatic appendiceal tumor in the ovary
Tubal intraepithelial carcinoma
fimbriated end of fallopian tube. Putative precursor to most ovarian high grade serous carcinomas. Histology: nuclear enlargement, pleomorphism, at least 1 mitosis, stratification
