Pathology of Fallopian tubes and ovaries Flashcards
Recap of reproductive embryology:
- reproductive development diverges after 7 weeks
- If ___ region on Y-chromosome then male repro, if not then female
- gonads arise from u______ r____
- mesonephric/Wolffian ducts remain for males
- paramesonephric/Mullerian ducts remain for females
Recap of reproductive embryology:
- reproductive development diverges after 7 weeks
- If SRY region on Y-chromosome then male repro, if not then female
- gonads arise from urogenital ridges
- mesonephric/Wolffian ducts remain for males
- paramesonephric/Mullerian ducts remain for females
Males: SRY makes gonads become testis
- testis have spermatogonia, Leydig and Sertoli cells
- Testosterone from _____ cells supports mesonephric/Wolffian ducts
- _____________ develops prostate, penis and scrotum
- Anti-Mullerian Hormone from _____ cells regresses paramesonephric ducts
Mesonephric ducts makes:
rete testis>______ _____>epididymis>vas deferens>seminal vesicle>bladder trigone
Urogenital sinus makes:
bladder>______ ____>bulbourethral gland>______
Pics in folder.
Males: SRY makes gonads become testis
- testis have spermatogonia, Leydig and Sertoli cells
- Testosterone from Leydig cells supports mesonephric/Wolffian ducts
- Dihydrotestosterone develops prostate, penis and scrotum
- Anti-Mullerian Hormone from Sertoli cells regresses paramesonephric ducts
Mesonephric ducts makes:
rete testis>efferent ductules>epididymis>vas deferens>seminal vesicle>bladder trigone
Urogenital sinus makes:
bladder>prostate gland>bulbourethral gland>urethra
Pics in folder.
Females: without SRY gonad becomes ovary
- ovary has oogonia, _____ ____ and surface epithelium
- Without ________ mesonephric duct regresses
- Without ___-_____ _______ the paramesonephric ducts remains
Paramesonephric ducts makes: oviducts/FTs>_____>cervix>upper 1/3 of vagina>vestibule
Urogenital sinus makes: bladder (except trigone)>bulbourethral gland>_____>lower 2/3 of vagina
Females: without SRY gonad becomes ovary
- ovary has oogonia, stromal cells and surface epithelium
- Without testosterone mesonephric duct regresses
- Without Anti-mullerian hormone the paramesonephric ducts remains
Paramesonephric ducts makes: oviducts/FTs>uterus>cervix>upper 1/3 of vagina>vestibule
Urogenital sinus makes: bladder (except trigone)>bulbourethral gland>urethra>lower 2/3 of vagina
Fallopian tubes / oviducts / uterine tubes
- lined by ______ ______ ________
- has complex plicae
- layers of _____ muscle
- outer layer of peritoneum
Fallopian tubes / oviducts / uterine tubes
- lined by ciliated columnar epithelium
- has complex plicae
- layers of smooth muscle
- outer layer of peritoneum
Pathology of Fallopian tubes
- ________ can affect the FTs and is a pelvic inflammatory disease
(means ‘inflamm of fallopian tubes’) - usually caused by infection (e.g. - think of some examples - )
- it is an _______ infection (meaning it has travelled upwards)
- Symptoms: fever, lower abdominal/pelvic pain, pelvic masses if tubes distended, secretions
Pathology of Fallopian tubes
- ‘Salpingitis’ can affect the FTs and is a pelvic inflammatory disease
(means ‘inflamm of fallopian tubes’) - usually caused by infection (e.g. chlamydia, streptococci, staphylococci, gonorrhea)
- it is an ascending infection (meaning it has travelled upwards)
- Symptoms: fever, lower abdominal/pelvic pain, pelvic masses if tubes distended, secretions
Complications of Salpingitis:
- a_______ of tube to ovary (needs incised)
- tubo-ovarian a_____ (collection of pus)
- damage to tube can mean i______
- ruptured tubal ectopic pregnancy can be life threatening
- e_________ commonly affects ovarian tubes too
Complications of Salpingitis:
- adherence of tube to ovary (needs incised)
- tubo-ovarian abscess (collection of pus)
- damage to tube can mean infertility
- ruptured tubal ectopic pregnancy can be life threatening
- endometriosis commonly affects ovarian tubes too
Fallopian tube malignancies:
- Primary adenocarcinomas arisng from FT are rare
- Most common is _______ _____ _______ / _____ _______
- E________ carcinomas also seen
These carcinomas occur in women with BRCA1 mutations. They also commonly affect the peritoneum and omentum.
Fallopian tube malignancies:
- Primary adenocarcinomas arsing from FT are rare
- Most common is papillary serous carcinoma / serous carcinoma
- Endometriod carcinomas also seen
These carcinomas occur in women with BRCA1 mutations. They also commonly affect the peritoneum and omentum.
‘STIC’
= _____ ____ ________ ______
- this is abnormal epithelium in ____ FT (where it opens near the ovary)
- limited by _______ _______ so technically ‘carcinoma in situ’
- In STIC nuclear atypia clearly seen
- Precursor for high grade serous carcinoma / papillary serous carcinoma
‘STIC’
= serous tubal intraepithelial carcinoma
- this is abnormal epithelium in distal FT (where it opens near the ovary)
- limited by basement membrane so technically ‘carcinoma in situ’
- In STIC nuclear atypia clearly seen
- Precursor for high grade serous carcinoma / papillary serous carcinoma
Pathology of Ovaries 1
Non-neoplastic cysts include:
- _______/______ cyst (ovarian cyst covered in mature squamous epithelium)
- _______ cyst (egg isn’t released from follicle and becomes fluid-filled cyst)
- _____ _____ cysts (corpus luteum doesn’t breakdown and fills with blood or fluid)
Pathology of Ovaries 1
Non-neoplastic cysts include:
- inclusion/epidermoid cyst (ovarian cyst covered in mature squamous epithelium)
- follicular cyst (egg isn’t released from follicle and becomes fluid-filled cyst)
- corpus luteal cysts (corpus luteum doesn’t breakdown and fills with blood or fluid)
Pathology of Ovaries 2
Polycystic ovaries:
- ___________ (irregular/infrequent periods)
- ovaries enlarged (x2)
- many subcortical cysts
- thick fibrotic surrounding cysts
- cysts lined by granulosa cells and have core of hypertrophic + hyperplastic theca interna (produced lots of androgens)
Pathology of Ovaries 2
Polycystic ovaries:
- oligomenorrhea (irregular/infrequent periods)
- ovaries enlarged (x2)
- many subcortical cysts
- thick fibrotic surrounding cysts
- cysts lined by granulosa cells and have core of hypertrophic + hyperplastic theca interna (produced lots of androgens)
Pathology of Ovaries 3
Ovarian Neoplasms:
Can come from:
- ______ (coelomic) ________
- ____ cells
- ___ ____/_____ ___
Pathology of Ovaries 3
Ovarian Neoplasms:
Can come from:
- surface (coelomic) epithelium
- germ cells
- sex cord/stromal cells
Surface epithelial tumours of ovaries 1
(although thought to arise from coelomic mesothelium on surface of ovary)
Risks:
- _______ (not having children) _______ risk
- ___ _________ use can ______ risk
Surface epithelial tumours of ovaries
(although thought to arise from coelomic mesothelium on surface of ovary)
Risks:
- nulliparity (not having children) increases risk
- oral contraceptive reduces risk
Ovarian cancer genes
- ____ mutations
- ____ mutations (poor prognosis)
- ____ mutations mostly in mucinous cystadenocarcinomas
- ____ mutations (common, and usually in high grade serous cancers)
Ovarian cancer genes
- BRCA mutations
- Her2 mutations (poor prognosis)
- KRAS mutations mostly in mucinous cystadenocarcinomas
- p53 mutations (common, and usually in high grade serous cancers)
Surface epithelial tumours of ovaries 2
Benign lesions:
- cystic (_________)
- cystic + stromal (___________)
Borderline/intermediate:
inbetween
Malignant lesions:
- cystic (_____________)
- solid (___________)
These carcinomas can be:
- > _____ (high grade or low grade)
- > ________
- > endometrioid
Surface epithelial tumours of ovaries 2
Benign lesions:
- cystic (cystadenoma)
- cystic + stromal (cystadenofibroma)
Borderline/intermediate:
inbetween
Malignant lesions:
- cystic (cystadenocarcinoma)
- solid (adenocarcinoma)
These carcinomas can be:
- > serous (high grade or low grade (HGSC/LGSC) )
- > mucinous
- > endometrioid
High grade serous carcinoma
(HGSC), usually ___ and _____ are affected.
For Low grade serous carcinoma (LGSC) and borderline tumours, usually ____ and ____ are affected.
High grade serous carcinoma
(HGSC), usually p53 and BRCA1 are affected.
Low grade serous carcinoma (LGSC), usually KRAS and BRAF are affected.
Serous ovarian tumours (type of surface epithelial tumour)
- most frequent ovarian tumour
- 30-40 y/os usually benign
- 45-65 y/os usually malignant
Morphology:
- ______ serous: large + filled with clear fluid + smooth + shiny + lined by single layer of tall ________ epithelium
- ________ serous: mild cell atypia + no stromal invasion
- serous ________: a_______ of cells (poor cellular differentiation) and stromal invasion
Common in serous tumours in general: ________ _____ (concentrically laminated calcified hard masses)
Serous ovarian tumours (type of surface epithelial tumour)
- most frequent ovarian tumour
- 30-40 y/os usually benign
- 45-65 y/os usually malignant
Morphology:
- Benign serous: large + filled with clear fluid + smooth + shiny + lined by single layer of tall columnar epithelium
- borderline serous: mild cell atypia + no stromal invasion
- serous carcinoma: anaplasia of cells (poor cellular differentiation) and stromal invasion
Common in serous tumours in general: Psammoma bodies (concentrically laminated calcified hard masses)
Prognosis of serous tumours (type of surface epithelial tumour)
Benign and borderline = good
Invasive serous carcinomas = poor
Yeah, pretty simple.
Mucinous ovarian tumours (type of surface epithelial tumour)
- metastases to ovary from GI tract can mimic primary ovarian mucinous carcinoma (‘_________’ tumours = ovary tumours from a primary site)
Morphology:
- large + many cavitites + no ________ bodies + cells lining cyst have lots of ________ cytoplasm
Mucinous ovarian tumours (type of surface epithelial tumour)
- metastases to ovary from GI tract can mimic primary ovarian mucinous carcinoma (‘Krukenberg’ tumours = ovary tumours from a primary site)
Morphology:
- large + many cavitites + no psammoma bodies + cells lining cyst have lots of mucinous cytoplasm
Ovarian endometrioid carcinoma (type of surface epithelial tumour)
- n______ t_____ g____ similar to those in endometrium
- usually ________
- low grade
- arise from _________ (when endometrial lining is outwith uterus)
- usually loss of ____ tumour suppressor gene (____ = phosphatase and tensin homolog), same as in endometrial cancer
Ovarian clear cell carcinoma (type of surface epithelial tumour)
- also associated with endometriosis
Ovarian endometrioid carcinoma (type of surface epithelial tumour)
- neoplastic tubular glands similar to those in endometrium
- usually malignant
- low grade
- arise from endometriosis (when endometrial lining is outwith uterus)
- usually loss of PTEN tumour suppressor gene (PTEN = phosphatase and tensin homolog), same as in endometrial cancer
Ovarian clear cell carcinoma (type of surface epithelial tumour)
- also associated with endometriosis
Germ cell tumours (from germ cells in ovary)
- most are ‘______ ______ _____’ / ‘______ ____’ = tumour where totipotent germ cell differentiate into all 3 germ cell layers
- grossly: smooth capsule + often filled with sebaceous secretion and tangled hair + bits of bone/cartilage + bronchial/GI epithelium + teeth, etc
- can also have ‘_______ ____ ______’ which has immature neuroectodermal elements - these are more aggressive
These cystic teratomas are prone to torsion = acute surgical emergency
Pics in folder.
Germ cell tumours (from germ cells in ovary)
- most are ‘mature cystic teratoma’ / ‘dermoid cyst’ = tumour where totipotent germ cell differentiate into all 3 germ cell layers
- grossly: smooth capsule + often filled with sebaceous secretion and tangled hair + bits of bone/cartilage + bronchial/GI epithelium + teeth, etc
- can also have ‘_______ ____ ______’ which has immature neuroectodermal elements - these are more aggressive
These cystic teratomas are prone to torsion = acute surgical emergency
Pics in folder.
Ovarian sex cord-stromal tumours (from sex-cord stroma of ovary)
- Granulosa cell tumours, theca cell tumours, ovarian fibroma, these 3 often secrete _______
- Granulosa cell tumours are common in postmenopausal women
- Over-production of oestrogen may lead to endometrial _________ or endometrial _______
Ovarian sex cord-stromal tumours (from sex-cord stroma of ovary)
- Granulosa cell tumours, theca cell tumours, ovarian fibroma, these 3 often secrete oestrogen
- Granulosa cell tumours are common in postmenopausal women
- Over-production of oestrogen may lead to endometrial hyperplasia or endometrial carcinoma
Meig’s syndrome
= combination of _ + _ + _ _
- removal of the tumour cures the problem
- patho is not clear
- ovarian tumour + ascites is usually carcinoma
Meig’s syndrome
= combination of ovarian fibroma + ascites + pleural effusion
- removal of the tumour cures the problem
- patho is not clear
- ovarian tumour + ascites is usually carcinoma
______ tumours
- uncommon
- mixed epithelial-stromal tumours
- benign
- unilateral, solid, yellowish
- histo: nests of ________ epithelium and fibrous _____
Brenner tumours
- uncommon
- mixed epithelial-stromal tumours
- benign
- unilateral, solid, yellowish
- histo: nests of transitional epithelium and fibrous stroma
Ovarian tumours
- _________ until well advanced - so this is bad
- presentations: ___, GI complaints, urinary freq
- _____ causes severe ab pain
- functioning tumours often come to attention because of the ________ they produce
- _____ common with ovarian malignancy
Ovarian tumours
- asymptomatic until well advanced - so this is bad
- presentations: pain, GI complaints, urinary freq
- torsion causes severe ab pain
- functioning tumours often come to attention because of the hormones they produce
- ascites common with ovarian malignancy
