Ovary Pathology Flashcards
4 Types of Ovarian Cysts
1 - Cystic Follicles - clear fluid and wall of granulosa cells and theca cells outside
2- Surface Epithelial Inclusion Cysts - benign/incidental; include overlying surface epithelium (cuboidal)
- Hemorrhagic Cysts
3 - Corpus luteal cysts - yellow lining w/ bloody contents; thick wall of granulosa cells w/ luteinization on histo
4 - Endometriosis cysts - chocolate cysts w/ adhesions;
see endometrial stroma, endometrial glands and hemosiderin-laden macrophages
Polycystic Ovarian Disease
- Common - 5% reprod women
ANATOMIC + CLINICAL
- Abnormal regulation of androgen synthesis –> anovulation / oligomenorrhea, obesity, hirsutism, dec glucose tolerance (DM), virilism
- Enlarged ovaries w/ thick cortex and multiple small follicle cysts
Common Causes of PID
N. gonorrhea and Chlamydia (ascending infection)
or can occur after abortions or delivery (more likely heme spread)
How does PID present?
Pelvic pain/ adnexal tenderness (so painful that when you palpate adenxa they jump to chandelier - chandelier sign)
Fever
Vaginal d/c
PID Complications
- Peritonitis –> fibrosis
- Intestinal obstruction if adhesions w/ small bowel or pelvis
- Bacteremia –> endocarditis, meningitis, suppurative arthritis
- Infertility if chronic
Ovarian Cancer in General
2nd common but most deadly b/c present late
- 80% benign
- Risk Factors - family hx, nullparity, BRCA mutations (BRCA1 > BRCA2)
- Organized by tissue of origin (surface epithelium, germ cells, stromal or mets)
Surface Epithelium Ovarian Cancers
- Serous - (majority benign) bilateral and unilocular; cystic w/ cuboidal epithelium
- Psammoma bodies in borderline
- Mucinous - (majority benign) unilateral and multi-locular (MU); thick mucin w/ tall columnar mucinous epithelium
- Endometrioid - (majority malignant) associated w/ endometriosis
- Clear Cell - (majority malignant) associated w/ endometriosis; AGGRESSIVE
- Brenner - usually benign and unilateral; nests of cells that resemble urothelial lining of bladder w/ fibrous stroma
Type I v. Type II Surface Epithelium Ovarian Cancers
- Type I
- Includes low grade serous tumors, endometrioid, mucinous
- KRAS, BRAF, ERBB2 mutations
- Type II
- Mainly high grade serous
- p53 mutations
*Both serous and mucinous can range from benign cystadenoma, to borderline to malignant cystadenomcarcinoma (become more complex and papillary as they progress)
Ovarian Germ Cell Tumors
- Teratomas
- 1- mature/benign - cystic & solid; all 3 germ layers
- 2- immature / malignant - solid; mainly in pre-pubertal girls; rapid growth and mets
- 3- monodermal/specialized - like struma ovarii (thyroid)
- Dysgerminoma - radiosensitive so good prognosis w/ radiotherapy;sheets of fried egg cells; lymphocytes and granulomas in surrounding stroma
- Yolk Sac/Endodermal Sinus Tumor - rare and aggressive
- Choriocarcinoma - aggressive and heme spread
- Embryonal - more rare in ovary than testis
Schiller-Duval Bodies
ring of cells around single vessel; looks similar to glomerulus
associated w/ yolk sac tumors
Sex Cord/ Stromal Ovarian Tumors
- Granulosa Cell Tumors - coffee bean nuclei and make estrogen; inhibin +
- Fibroma-thecoma - mix of fibroblasts and spindle cells w/ lipid (thecoma); unilateral solid mass w/ plump spindles on histo
- Sertoli-Leydig (androblastomas) - unilateral; masculinization; peak in 20-30s; see tubules and stroma but Leydig cells may be absent
- Grossly - orange/yellow
Call - Exner Bodies
rosette around a pink center
associated w/ granulosa cell tumors
Meigs Syndrome
- ovarian fibroma, pleural effusion (R > L), ascites
Common Mets to Ovaries (3)
- Mullerian origin tumors can metastasize to fallopian tubes or opposite ovary
- Krukenberg tumors of stomach can metastasize to ovaries (signet rings)
- From breast
