Pathology of the ovary and fallopian tube Flashcards
Describe a normal fallopian tube
- Tubular structure with a muscular wall
- Covered by a peritoneum
- Has a fimbrial end with finger like projections
- the epithelium covering the fimbrae is in continuity with the lining of the tube
Describe the internal aspect of the Fallopian tube (microscopically)
It has a complex arrangement of plical folds which are covered by serous epithelium which contains cuboidal cells with cilia and secretory cells
Where are the ova in the ovaries?
In the peripheral cortex in the follicles
What is seen in the ovaries during menstruation?
- Corpus lutea
* corpus albicantes
What remains in the ovaries in post menopausal women?
Corpora albicantes
What is contained in the central medulla in the ovaries?
Stroma, blood vessels and sometimes leydig cells
What is contained in the stroma in the ovaries?
Spindle shaped cells and collagen fibres
What forms the peritoneal lining in the ovaries?
Mesothelial cells
Atretic follicles
Kind of look like blank spaces under the microscope, they are what remains when the follicle has broken down
Where do germ cells originate from?
The yolk sac
What happens to the germ cells by week 5-6 of gestation?
They migrate to the urogenital ridge and become embedded into the epithelium and stroma of the ovary which form from the ridge
What happens at around week 6 of gestation?
Invagination and fusion of the coelomic epithelium forming two laterally. located mullerian ducts that grow downwards into the pelvis
Which embryological structure forms the Fallopian tubes?
The unfused portions of the mullerian ducts
What does the fused potion of the mullerian ducts and urogenital sinus become?
the uterus and vagina
What are the non neoplastic ovarian cysts?
- Follicular cysts
- Luteal cysts
- Inclusion cysts
- Polycystic ovarian syndrome
Describe polycystic ovarian syndrome
- Common, approx 1 in 5
- Ovaries contain a large number of follicular cysts, may of which lack a central oocyte
- Patients have irregular periods (often anovulatory) and androgen excess which can result in hirsutism, acne and weight gain
- Can result in fertility problems
What is ovarian stromal hyperplasia?
A benign condition resulting in uniform enlargement of the ovary. There will be ill defined white/yellow node;es macroscopically, microscopically there is replacement of the cortex and medulla by nodules of ovarian stroma
What is the difference between ovarian stromal hyperplasia and stromal hyperthecosis?
In ovarian stromal hyperplasia there are no luteinised cells present, in stromal hyperthecosis there are
What is salpingitis?
Inflammation of the Fallopian tubes
What is the underlying cause of salpingitis
- usually sexually transmitted chlamydia trachomatis or neisseria gonorrhoea which enters the gynaecological tract via the vagina and initially causes cervical inflammation. Ascending infection then causes salpingitis
- TB is an uncommon cause
What is the normal presentation of pelvic inflammatory disease?
- Abdominal/pelvic pain
- Adnexal tenderness
- Fever
- Vaginal discharge
How is pelvic inflammatory disease treated?
Antibiotics
What is seen microscopically in PID?
Aggregates of neutrophils
What can happen if PID is left untreated?
- Tube-ovarian abscess formation
* Fusion of the tubal plicae results in an increased risk of infertility and ectopic pregnancy
What should you look for microscopically when looking for evidence of ectopic pregnancy?
Chorionic villi in the Fallopian tube/out of the uterus
What is endometriosis?
When endometrial constituents (glands and stroma) occur outwit he endometrial cavity
What can occur in ovarian endometriosis?
The formation of blood filled cysts called endometriomas
What causes the symptoms in endometriosis?
The abnormally located endometrium continues to bleed and can result in scarring and adhesion formation in the adjacent tissue s
What are the symptoms of an ovarian neoplasia?
- Abdominal distension
- Urinary symptoms
- GI symptoms (Due to compression by the ovarian mass)
- Larger neoplasms can result in torsion causing severe abdominal pain
What are the majority of ovarian neoplasms?
Epithelial tumours
What is a benign serous cyst adenoma and what is the treatment?
- Thin walled cyst lined by epithelium resembling the normal Fallopian tube epithelium.
- No cytological atypia
- Removal of the cyst is the only treatment required
What are borderline serous cystadenomas?
- Some cytological atypia
- Frank evidence of invasion is absent
- A small proportion of these develop into low grade serous carcinomas
Why do low grade serous carcinomas not respond well to chemotherapy?
Because it doesn’t divide rapidly
What molecular abnormalities are associated with low grade serous carcinomas?
BRAF or KRAS mutation
Which patient groups are you more likely to see a high grade serous carcinoma in?
- Peri menopausal or post menopausal women
* Younger patients with BRCA mutations
Which molecular abnormalities are associated with a high grade serous adenoma?
p53 mutation
Where are the high grade serous carcinomas likely to originate from?
A precursor lesion in the Fallopian tube called STIC (serous tubal intraepithelial carcinoma)
How are high grade serous carcinomas treated?
With a combination of surgery and chemotherapy depending on the extent of the disease
Which ovarian tumours can be difficult to differentiate from metastases from the GI tract?
Malignant mucinous tumours
Describe the histology of a benign mucinous carcinoma
- Cuboidal nuclei along the basement membrane
* Mucin vacuoles
What is the treatment of clear cell carcinomas?
Surgery
What chemotherapy drug are clear cell carcinomas resistant to?
Platinum based chemotherapy
How can you differentiate clear cell carcinoma to high grade serous carcinoma?
Clear cell carcinomas don’t have mutations in p53
Describe histology of a clear cell carcinoma
- Hobnailing: nuclei bulge into the lumen of the gland
- Eosinophilic globules
- Lots of cells have a clear cytoplasm
- If p53 stain is applied some will be brown but not all (negative result)
What is the endometrial carcinoma associated with?
Endometriosis
Which ovarian neoplasms arise from the surface epithelium?
- Clear cell carcinoma
- Mucinous cystadenoma
- Benign/ borderline serous cystadenoma
- low grade/high grade serous carcinoma
- Endometrioid carcinoma
Which ovarian neoplasms arise from the germ cells?
- Mature teratoma (also called dermoid cysts)
* Other more rare ones e.g. yolk sac tumour, embryonal carcinoma, choriocarcinoma
Which ages are mature teratomas found in?
Usually in reproductive age (20-50)
What do mature teratomas consist of?
•Mature tissues derived from one or more of the embryonic germ layers
- ectoderm
- mesoderm
- endoderm
•Most are cystic but some can have solid areas depending on the tissues that have been developed
Which germ cell tumour is malignant and can metastasise
Immature teratomas
What do the sex cord/stromal tumours develop from?
- Cells surrounding the germ cells (granulosa cells, theca cells)
- Sertoli or leydig cells
- Fibroblast cells within the stroma
What are the most common sex cord/stromal tumours?
- Fibroma - benign
* Adult granulosa cell tumour (low grade malignancy)
What are the presenting symptoms of ovarian fibroma?
Non specific symptoms e.g. abdominal pain if the mass is larger
If an ovarian fibroma is associated with ascites, what syndrome is the patient likely to have?
Meig’s syndrome
Describe the histology go ovarian fibromas
Small bland spindle shaped cells and collagen
What is the most common presenting age of an adult granulosa cell tumour?
Between age 45-55
Describe feature of an adult granulosa cell tumour
- Can be oestrogen secreting tumours or androgen secreting tumours
- Usually unilateral
- Usually confined to the ovary
- Most don’t recur or metastasise
- Solid/cystic appearance
