PATH 8: Pathology of the Ovary

Question 1

Pathogenesis/Manifestation of Polycystic Ovaries (aka. _____________)?

Answer 1

Polycystic Ovaries (Stein Leventhal Syndrome)

• Ovaries with multiple cystic follicles which produce excess estrogens and androgens (primarily)
• Virilization: oligomenorrhoea, hirsutism, infertility, and often obesity
• Ovaries are twice the size of normal, grey-white with a smooth outer cortex, and have multiple subcortical cysts

Question 2

Causes/Clinical Presentation of Ovarian Torsion?

Answer 2

Ovarian Torsion

• Infrequent but significant cause of acute lower abdominal pain in women (70-75% are younger than 30 years, 20% occur in pregnancy)
• Usually occurs in a pathologically enlarged ovary (Right side)
• Sudden onset of severe unilateral lower abdominal pain that worsens intermittently

Risk Factors

○ Children –developmental abnormalities

○ Pregnancy –enlarged corpus luteum

○ Ovulation induction (Fertility Meds)

○ Ovarian tumours (50-60% of cases)

Question 3

Risk factors for Ovarian Carcinoma?

Answer 3

• Nulliparity (NEVER been pregnant)

○ Repeated ovulation => scaring on release of the follicle

○ On pill is protective

○ Pregnancy protective (no ovulation)

○ Breast-feeding protective (no ovulation)

• Family History: 5-10% of Ovarian cancers are familial (mutations in BRCA1 and BRCA2)
• Hormone replacement therapy (infertility treatments)
• Height / tallness / Overweightness
• Tobacco smoking/Asbestos

Question 4

Clinical Features of a Woman with Ovarian Carcinoma?

Answer 4

Physical signs associated with early stage ovarian cancer may be palpable mobile pelvic mass on pelvis examination

• POOR prognosis: 5 year survival = 32%
• Many have symptoms but may be confused with other benign conditions GI => Present late with advanced disease (70%)
• Larger masses may increase abdominal girth
• Smaller masses may tort
• produce ascites and pleural effusions
• Some produce hormones
• Metastatic disease is commonly found in the omentum

Question 5

3 Main Subtypes of Ovarian Carcinoma, Incidence and Examples of Each

Answer 5

Surface Epithelial Stromal Tumours - Benign/borderline malignant

• Serous Tumors: Most common ovarian tumor
• Clear Sell Carcinoma
• Brenner Tumours

Sex Chord- hormone producing

• Granulosa Cell: Characteristic Call-Exner Bodies
• Sertoli Leydig Cell Tumours: produce androgens (virilizing)
• Theca Fibroma: 40% produce Meigs syndrome

Germ Cell: (90% Benign; younger the age, more likely malignant)

• Mature Cystic Teratomas (Dermoid cysts) MOST COMMON
• Immature Teratomas: Grade I, Stage I can be cured whereas Grade IV, stage IV has much worse prognosis
• Yolk Sac Tumour: secrete alpha-fetoprotein (positive for AFP) Histology: Schiller-Duval bodies