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Week 4 - female GU/breast > Pathology of the ovary and fallopian tube > Flashcards

Pathology of the ovary and fallopian tube Flashcards

1
Q

Describe a normal fallopian tube

A
  • 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
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2
Q

Describe the internal aspect of the Fallopian tube (microscopically)

A

It has a complex arrangement of plical folds which are covered by serous epithelium which contains cuboidal cells with cilia and secretory cells

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3
Q

Where are the ova in the ovaries?

A

In the peripheral cortex in the follicles

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4
Q

What is seen in the ovaries during menstruation?

A
  • Corpus lutea

* corpus albicantes

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5
Q

What remains in the ovaries in post menopausal women?

A

Corpora albicantes

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6
Q

What is contained in the central medulla in the ovaries?

A

Stroma, blood vessels and sometimes leydig cells

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7
Q

What is contained in the stroma in the ovaries?

A

Spindle shaped cells and collagen fibres

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8
Q

What forms the peritoneal lining in the ovaries?

A

Mesothelial cells

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9
Q

Atretic follicles

A

Kind of look like blank spaces under the microscope, they are what remains when the follicle has broken down

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10
Q

Where do germ cells originate from?

A

The yolk sac

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11
Q

What happens to the germ cells by week 5-6 of gestation?

A

They migrate to the urogenital ridge and become embedded into the epithelium and stroma of the ovary which form from the ridge

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12
Q

What happens at around week 6 of gestation?

A

Invagination and fusion of the coelomic epithelium forming two laterally. located mullerian ducts that grow downwards into the pelvis

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13
Q

Which embryological structure forms the Fallopian tubes?

A

The unfused portions of the mullerian ducts

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14
Q

What does the fused potion of the mullerian ducts and urogenital sinus become?

A

the uterus and vagina

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15
Q

What are the non neoplastic ovarian cysts?

A
  • Follicular cysts
  • Luteal cysts
  • Inclusion cysts
  • Polycystic ovarian syndrome
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16
Q

Describe polycystic ovarian syndrome

A
  • 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
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17
Q

What is ovarian stromal hyperplasia?

A

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

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18
Q

What is the difference between ovarian stromal hyperplasia and stromal hyperthecosis?

A

In ovarian stromal hyperplasia there are no luteinised cells present, in stromal hyperthecosis there are

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19
Q

What is salpingitis?

A

Inflammation of the Fallopian tubes

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20
Q

What is the underlying cause of salpingitis

A
  • 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
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21
Q

What is the normal presentation of pelvic inflammatory disease?

A
  • Abdominal/pelvic pain
  • Adnexal tenderness
  • Fever
  • Vaginal discharge
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22
Q

How is pelvic inflammatory disease treated?

A

Antibiotics

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23
Q

What is seen microscopically in PID?

A

Aggregates of neutrophils

24
Q

What can happen if PID is left untreated?

A
  • Tube-ovarian abscess formation

* Fusion of the tubal plicae results in an increased risk of infertility and ectopic pregnancy

25
Q

What should you look for microscopically when looking for evidence of ectopic pregnancy?

A

Chorionic villi in the Fallopian tube/out of the uterus

26
Q

What is endometriosis?

A

When endometrial constituents (glands and stroma) occur outwit he endometrial cavity

27
Q

What can occur in ovarian endometriosis?

A

The formation of blood filled cysts called endometriomas

28
Q

What causes the symptoms in endometriosis?

A

The abnormally located endometrium continues to bleed and can result in scarring and adhesion formation in the adjacent tissue s

29
Q

What are the symptoms of an ovarian neoplasia?

A
  • Abdominal distension
  • Urinary symptoms
  • GI symptoms (Due to compression by the ovarian mass)
  • Larger neoplasms can result in torsion causing severe abdominal pain
30
Q

What are the majority of ovarian neoplasms?

A

Epithelial tumours

31
Q

What is a benign serous cyst adenoma and what is the treatment?

A
  • Thin walled cyst lined by epithelium resembling the normal Fallopian tube epithelium.
  • No cytological atypia
  • Removal of the cyst is the only treatment required
32
Q

What are borderline serous cystadenomas?

A
  • Some cytological atypia
  • Frank evidence of invasion is absent
  • A small proportion of these develop into low grade serous carcinomas
33
Q

Why do low grade serous carcinomas not respond well to chemotherapy?

A

Because it doesn’t divide rapidly

34
Q

What molecular abnormalities are associated with low grade serous carcinomas?

A

BRAF or KRAS mutation

35
Q

Which patient groups are you more likely to see a high grade serous carcinoma in?

A
  • Peri menopausal or post menopausal women

* Younger patients with BRCA mutations

36
Q

Which molecular abnormalities are associated with a high grade serous adenoma?

A

p53 mutation

37
Q

Where are the high grade serous carcinomas likely to originate from?

A

A precursor lesion in the Fallopian tube called STIC (serous tubal intraepithelial carcinoma)

38
Q

How are high grade serous carcinomas treated?

A

With a combination of surgery and chemotherapy depending on the extent of the disease

39
Q

Which ovarian tumours can be difficult to differentiate from metastases from the GI tract?

A

Malignant mucinous tumours

40
Q

Describe the histology of a benign mucinous carcinoma

A
  • Cuboidal nuclei along the basement membrane

* Mucin vacuoles

41
Q

What is the treatment of clear cell carcinomas?

A

Surgery

42
Q

What chemotherapy drug are clear cell carcinomas resistant to?

A

Platinum based chemotherapy

43
Q

How can you differentiate clear cell carcinoma to high grade serous carcinoma?

A

Clear cell carcinomas don’t have mutations in p53

44
Q

Describe histology of a clear cell carcinoma

A
  • 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)
45
Q

What is the endometrial carcinoma associated with?

A

Endometriosis

46
Q

Which ovarian neoplasms arise from the surface epithelium?

A
  • Clear cell carcinoma
  • Mucinous cystadenoma
  • Benign/ borderline serous cystadenoma
  • low grade/high grade serous carcinoma
  • Endometrioid carcinoma
47
Q

Which ovarian neoplasms arise from the germ cells?

A
  • Mature teratoma (also called dermoid cysts)

* Other more rare ones e.g. yolk sac tumour, embryonal carcinoma, choriocarcinoma

48
Q

Which ages are mature teratomas found in?

A

Usually in reproductive age (20-50)

49
Q

What do mature teratomas consist of?

A

•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

50
Q

Which germ cell tumour is malignant and can metastasise

A

Immature teratomas

51
Q

What do the sex cord/stromal tumours develop from?

A
  • Cells surrounding the germ cells (granulosa cells, theca cells)
  • Sertoli or leydig cells
  • Fibroblast cells within the stroma
52
Q

What are the most common sex cord/stromal tumours?

A
  • Fibroma - benign

* Adult granulosa cell tumour (low grade malignancy)

53
Q

What are the presenting symptoms of ovarian fibroma?

A

Non specific symptoms e.g. abdominal pain if the mass is larger

54
Q

If an ovarian fibroma is associated with ascites, what syndrome is the patient likely to have?

A

Meig’s syndrome

55
Q

Describe the histology go ovarian fibromas

A

Small bland spindle shaped cells and collagen

56
Q

What is the most common presenting age of an adult granulosa cell tumour?

A

Between age 45-55

57
Q

Describe feature of an adult granulosa cell tumour

A
  • 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

Week 4 - female GU/breast (7 decks)

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