Path Pt 4: Ovaries Flashcards
usually multiple cysts, ranging in size up to 2cm in diameter
- filled with clear serous fluid, and are lined by a gray, glistening membrane
- on occasion, cysts larger than 2cm may be diagnosed by palpation or US (may cause pelvic pain)
follicle cysts
when are granulosa lining cells are present in follicle cysts?
if the intraluminal pressure has not been so great as to cause their atrophy
what would cause outer theca cells to be seen?
increased amounts of pale cytoplasm (a change referred to as lutenization)
- may be associated with increased estrogen production and endometrial abnormalities
cysts that are present in normal ovaries of women of reproductive age
- these cytsts are lined by a rim of bright yellow tissue containing lutenized granulosa cells
- they occasionally rupture and cause a peritoneal reaction
- sometimes the combination of old hemorrhage and fibrosis may make their distinction from endometriotic cysts difficult
luteal cysts
these may present as either a multicystic lesion in which papillary epithelium is contained within a few fibrous walled cysts (intracystic), or as a mass projecting from the ovarian surface
serous ovarian tumors
these tumors typically have a smooth glistening wall with no epithelial thickening or with small papillary projections
benign ovarian tumors
these tumors contain an increased number of papillary projections
borderline ovarian tumors
what features are associated with malignancy in ovarian tumors?
larger areas of solid or papillary tumor mass, tumor irregularity, and fixation or nodularity of the capsule
what is common, and occurs in 20% of benign serous cystadenomas, 30% of serous borderline tumors, and approx 66% of serous carcinomas?
bilaterality
a significant proportion of both serous borderline tumors and malignant serous tumors involve what?
the surface of the ovary
these tumors exhibit increased complexity of the stromal papillae, stratification of the epithelium and mild nuclear atypia, but invasion of the stroma is not seem
serous borderline tumors
serous borderline tumors often grows in a delicate, papillary pattern referred to as “micropapillary carcinoma”, which is thought to be the precursor to what?
low-grade serous carcinoma
these are distinguished from low-grade tumors by having more complex growth patterns and widespread infiltration or frank effacement of the underlying stroma
high-grade serous carcinoma
- the individual tumor cells display marked nuclear atypia, including pleomorphism, atypical mitotic figures and multinucleation
these carcinomas consist of cells morphologically identical to high-grade serous carcinomas, but are distinguished by the lack of invasion
serous tubal intraepithelial carcinomas
the cells of these type of tumor can become so undifferentiated that serous features are no longer recognizable
invasive high-grade serous carcinoma
what is a characteristic of serous tumors, but are not specific for neoplasia?
concentric calcifications (psammoma bodies)
these tumors have a propensity to spread to the peritoneal surface and omentum, and are commonly associated with the presence of ascites
both low and high-grade ovarian serous tumors
- as with other tumors, the extent of the spread outside the ovary determines the stage of disease
these differ from the serous variety in several ways:
- the surface of the ovary is rarely involved and only 5% of primary mucinous cystadenomas and mucinous carcinomas are bilateral
- tend to produce larger cystic masses, some have been recorded with weights more than 25kg
- multiloculated tumors filled with sticky, gelatinous fluid rich in glycoproteins
mucinous tumors
these tumors are characterized by a lining of tall, columnar epithelial cells with apical mucin that lack cilia
- the vast majority demonstrate gastric or intestinal type differentiation
benign mucinous tumors
how are mucinous borderline tumors distinguished from cystadenomas?
by epithelial stratification, tufting, and/or papillary intraglandular growth, often producing an appearance strikingly similar to tubular adenomas or villous adenomas of the intestine
these tumors characteristically demonstrate confluent glandular growth that is now recognized as a form of “expansive” invasion
mucinous carcinomas
- mucinous carcinomas that have spread beyond the ovary are usually fatal, but they are uncommon and must be distinguished from metastatic mucinous adenocarcinomas
these carcinomas typically present with solid and cystic areas of growth
- 40% involve both ovaries which usually implies extension of the neoplasm beyond the genital tract
- low-grade tumors that reveal glandular patterns bearing a strong resemblance to those of endometrial origin
endometrioid ovarian carcinoma
these neoplasms may be solid, or cystic, are usually unilateral, and vary in size from small lesions less than 1cm in diameter to massive tumors up to 20-30cm
transitional cell ovarian tumors
in transitional cell tumors, the fibrous stroma, resembling that of the normal ovary, is marked by what?
sharply demarcated nests of epithelial cells resembling the epithelium of the urinary tract, often with mucinous glands in their center
- sometimes the stroma is composed of somewhat plump fibroblasts resembling theca cells (may have hormonal activity)
