ovary pathology Flashcards
ovarian symptoms
pain
swelling
endocrine effects
types of ovarian cysts
follicular luteal endometric epithelial mesothelial
why might follicular cysts form
when ovulation doesn’t occur - follicle doesn’t rupture but becomes a cyst
pathology of follicular cyst
thin wall
lined by granulosa cells
many follicular cysts in
PCOS
clinical triad of PCOS
hyperandrogenism
oligomenorrhoea
polycystic ovaries on USS
associations with PCOS
obesity metabolic syndrome (hypertension, dyslipidaemia, insulin resistance)
other presentations of PCOS
acne
subfertility
hirsutism
acanthosis nigrans (darkened skin on neck and flexures - hyperinsulinaemia)
criteria for PCOS diagnosis
Rotterdam criteria: 2/3 must be present
polycystic ovaries (12+follicles or ovarian volume >10cm3)
oligo/anovulation
clinical/biochemical signs of hyper androgenism
what should be excluded before diagnosis of PCOS is made
thyroid disease hyperprolactinaemia adrenal hyperplasia androgen secreting tumours cushing's
management of PCOS
weight loss
smoking cessation
treat metabolic diseases
what is endometriosis
endometrial glands and stroma outside the uterine body
common sites of pathological endometrial tissue
ovary pouch of douglas peritoneum cervix/vulva/vagina bladder and bowel
clinical manifestation of PCOS
pelvic inflammation
infertility
pain (including dysuria, dyspareunia, pain on defaecation)
what are endometrial cysts in ovary called
chocolate cysts
why does endometriosis affect women of reproductive age
oestrogen driven
what is adenomyosis
endometrial tissue in myometrium
why might pain be cyclical in endometriosis
response of endometrial tissue to menstrual cycle (oestrogen)
why might pain be constant in endometriosis
formation of adhesions
chronic inflammation
signs of endometriosis on speculum exam
visible lesions
fixed retroverted uterus
complications of endometriosis
cysts/adhesions
infertility
ectopic pregnancy
malignancy
investigations for endometriosis
transvaginal ultrasound (ovarian disease) laparoscopy with biopsy is gold standard
treatment for endometriosis
COCP/progesterone empirically without definitive treatment if fertility not an issue
NSAIDs for pain
surgery if medical treatment fails
types of ovarian cancers
epithelial germ cell (teratoma) sex-cord/stromal metastatic miscellaneous
most common ovarian cancer
epithelial
cell of origin in epithelial tumours
unknown, can be from: serous mucinous endometrioid clear cell brenner
classification of epithelial tumours
benign
borderline
malignant
benign epithelial tumour pathology
no cytological abnormalities
proliferative activity absent/scant
no stromal invasion
borderline epithelial tumour pathology
cytological abnormalities
proliferative
no stromal invasion
difference between borderline and malignant epithelial tissue
borderline - no invasion
malignant - stromal invasion
where do high grade serous epithelial tumours come from
tubal disease
what epithelial cancer is associated with endometriosis
clear cell
what are brenner tumours
epithelial
transition areas
brenner tumours are usually malignant/benign
benign
most common type of germ cell tumour
dermoid cyst - benign
what does dermoid cyst contain
tissue from endoderm, mesoderm and ectoderm
usually contain fat
may contain sebum and hair
thyroid tissue - thyrotoxicosis
other types of germ cell tumour
immature teratoma dysgerminoma yolk sac tumour choriocarcinoma mixed
germ cell tumour found in children and young women
dysgerminoma
types of sex cord/stromal tumours
fibroma/thecoma (benign)
granulosa cell tumour (malignant) - precocious puberty
sertoli-leydig cell tumour
what might sex cord tumours produce
oestrogen
androgens
commonest places for tumours to metastasise from
stomach
colon
breast
pancreas
stage 1A ovarian cancer
cancer in one ovary
stage 1B in ovarian cancer
cancer in both ovaries
stage 1C ovarian cancer
involves ovarian surface/rupture
stage 2A ovarian cancer
involves uterus/tubes
stage 2B ovarian cancer
spread to other pelvic intra-peritoneal organs (eg bladder, bowel)
stage 3a ovarian cancer
retroperitoneal lymph node involvement
stage 3B ovarian cancers
macroscopic peritoneal mass <2cm
stage 3C
macroscopic peritoneal mass >2cm
stage 4
distant metastases
what is salpingitis
infection of fallopian tubes
presentation of ovarian cancer
bloating pelvic mass vaginal bleeding abdo pain weight loss bowel/bladder symptoms
what tumour marker is raised in ovarian epithelial cancers
Ca125
what age group are mostly affected by ovarian cancers
older women - 75-84
risk factors for ovarian cancer
nulliparity
early menarche/late menopause
BRCA 1 and 2
lynch syndrome
what is protective of ovarian cancer
pregnancy
breastfeeding
COCP
tubal litigation
investigations for ovarian mass
TVS
CXR - for staging
CT abdo/pelvis
management for benign tumours
pre-menopausal - rescan in 6 weeks, if <5cm or asymptomatic then leave. if >5cm/symptomatic/dermoid/endometriosis then remove
post-menopausal - manage risks. may need to remove
what are the 2 types of functional cysts
follicular
luteal
management of functional cysts
resolve spontaneously
what is meig’s syndrome
benign fibroma
pleural effusion
