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Female GU / Breast > Pathology of Fallopian tubes and ovaries > Flashcards

Pathology of Fallopian tubes and ovaries Flashcards

1
Q

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
A

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
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2
Q

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.

A

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.

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3
Q

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

A

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

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4
Q

Fallopian tubes / oviducts / uterine tubes

  • lined by ______ ______ ________
  • has complex plicae
  • layers of _____ muscle
  • outer layer of peritoneum
A

Fallopian tubes / oviducts / uterine tubes

  • lined by ciliated columnar epithelium
  • has complex plicae
  • layers of smooth muscle
  • outer layer of peritoneum
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5
Q

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
A

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
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6
Q

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
A

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
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7
Q

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.

A

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.

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8
Q

‘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
A

‘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
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9
Q

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)
A

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)
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10
Q

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)
A

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)
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11
Q

Pathology of Ovaries 3

Ovarian Neoplasms:

Can come from:

  1. ______ (coelomic) ________
  2. ____ cells
  3. ___ ____/_____ ___
A

Pathology of Ovaries 3

Ovarian Neoplasms:

Can come from:

  1. surface (coelomic) epithelium
  2. germ cells
  3. sex cord/stromal cells
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12
Q

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
A

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
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13
Q

Ovarian cancer genes

  • ____ mutations
  • ____ mutations (poor prognosis)
  • ____ mutations mostly in mucinous cystadenocarcinomas
  • ____ mutations (common, and usually in high grade serous cancers)
A

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)
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14
Q

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
A

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
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15
Q

High grade serous carcinoma
(HGSC), usually ___ and _____ are affected.

For Low grade serous carcinoma (LGSC) and borderline tumours, usually ____ and ____ are affected.

A

High grade serous carcinoma
(HGSC), usually p53 and BRCA1 are affected.

Low grade serous carcinoma (LGSC), usually KRAS and BRAF are affected.

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16
Q

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)

A

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)

17
Q

Prognosis of serous tumours (type of surface epithelial tumour)

Benign and borderline = good

Invasive serous carcinomas = poor

A

Yeah, pretty simple.

18
Q

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
A

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
19
Q

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
A

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
20
Q

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.

A

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.

21
Q

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 _______
A

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
22
Q

Meig’s syndrome
= combination of _ + _ + _ _

  • removal of the tumour cures the problem
  • patho is not clear
  • ovarian tumour + ascites is usually carcinoma
A

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
23
Q

______ tumours

  • uncommon
  • mixed epithelial-stromal tumours
  • benign
  • unilateral, solid, yellowish
  • histo: nests of ________ epithelium and fibrous _____
A

Brenner tumours

  • uncommon
  • mixed epithelial-stromal tumours
  • benign
  • unilateral, solid, yellowish
  • histo: nests of transitional epithelium and fibrous stroma
24
Q

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
A

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

Female GU / Breast (4 decks)

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