path of ovary 12/10 Flashcards
surface inclusion cysts
secondary to invagination of suface epithelium
theca lutein cysts
theca interna cells overstimulated by high levels of gonadotropin
cysts lined by theca lutein cells
PCOS
also called Stein-leventhal syndrome
stromal hyperplasia and hyperthecosis
usually in post-menopausal women who present with symptoms similar to PCOS
grossly see uniform enlargement of both ovaries
micro. shows hypercellular stroma with luteinnization of stromal cells
ovarian tumors overview
most are benign
benign are common in young females and malignant in older females
most non-functional
often discovered late
tumors of surface epithelium
benign
usually cystic with smooth lining
surface epithelium
malignant
show papillary projections and solid areas
can seed peritoneum resulting in ascites
usually discovered late CA-125
surface epithelium tumor
most common ovarian tumors
serous cystadenoma(-adenocarcinoma)–>mucinous
–>endometroid–>clear cell adenocarcinoma–>brenner
features of benign serous tumors
one or several cysts with smooth inner and outer surfaces
cysts lined by a layer of tall columnar,serous secreting,ciliated or non-ciliated cells with no atypia
outer surface covered by mesothelium
when there is abundant fibrous stroma–> cystadenofibroma
features of malignant serous tumors
numerous cysts with many papillary projections and solid areas
epithelium piles up–>more than one layer
solid masses of epithelial cells that invade into wall of cysts
common finding in serous papillary cystadenocarcinoma
psammoma bodies
mucinous tumors
less often bilateral than serous
see tall columnar,mucin secreting cells
are often very large
pseudomyxoma peritonei (jelly belly) is a common complication in 2-5% of pts
endometroid tumor of surface epithelium
most are malignant
histo. similar to endometrial CA
some have endometriosis in ovaries
some are associated with independent endometrial carcinoma in uterus
clear cell adenocarcinoma
variant of endometriod CA
may be solid or cystic
see large cells with clear cyto or hobnail type cells, arranged in solid,tubular or papillary configuration
aggressive, poor prognosis beyond ovary
brenner tumor
transitional cell (urothelial)
most are benign
germ cell tumors
most are mature teratomas(Dermoid cysts)–>benign
malignant teratoma
immature
seen in kids and young adults
contain immature embryonic tissues,mostly solid with focal necrosis and hemorrhage
monodermal germinal tumors
specialized
struma ovarii
dysgerminomama
ovarian counterpart of seminoma
always malignant
50% of malignant ovarian germ cell tumors
often produce gonadotropins
large cells with clear cyto. and centrally located nuclei in cords or sheets, seperated by thin, fibrous septae that contains lymphocytes
serum LDH may be elevated
endodermal sinus (yolk sac) tumor
malignant and very aggressive
children and young women
schiller-Duval bodies that contain intracyto. hyalin droplets. (glumeroloid)
droplets contain AFP and A1-antitrypsin
choriocarcinoma
much more malignant than placental choriocarcinoma and spreads widely very early
produces chorionic gonadotropin
embryonal CA
solid with necrosis and hemorrhage
see solid sheets and nests of large primitive cells
can see syncytiotrophoblast-like cells, secrete chorionic gonadotropin
can also see elevated AFP
sex cord stromal tumors
granulosa cell tumor
thecoma and fibroma
sertoli-leydig (arrhenoblastoma)
leydig (hilus cell tumor)
lipid cell tumor
granulosa cell tumor
smooth surface, lobulated, gray-yellow color
microfollicular with call-exner bodies: see coffee-bean nuclei
75% associated with hyperestrinism–> endometrial hyperplasia or precocious puberty
Vimentin positive
Keratin negative
thecoma and fibroma
65% in post-menopausal
nearly all are benign
round,firm solids
fascicles of spindle cells, can sometimes see fat in thecomas
may see hyperestrinism in thecomas
Meigs’ syndrome
seen in fibroma
ascites and right sided hydrothorax
Sertoli-leydig cells
(virilizing tumors)
rare, average age is 25
see Reinke crystals in Leydig cell tumor (benign)
lipid cell tumor
rare, yellow or brown (25% malignant)
gynandroblastoma: mix of granulosa and sertoli-leydig tumor
sex cord tumor with annular tubules. 1/3 of cases are associated with Peutz-Jegher
Krukenberg tumor
mets from stomach
usually bilateral, solid diffuse infiltration by signet ring cells
acute salpingitis
most common organism is gonoccus, but also E.Coli
bacteroids, strep and chlamydia
chronic salpingitis
repeated inflammation
see fibrous adhesions
can result in pyo or hydrosalpinx
see lymphocytes
can find granulomatous salpingitis in pts with TB
other lesions
salpingitis isthmica nodosa: diverticular lesion of tubal epithelium in isthmus
paratubal cyst: benign
endosalpingitis: presence of tubal epithelium in sites other than fallopian tube
