Pathology Of The Ovary And Fallopian Tubes Flashcards
1
Q
What gynaecological organs are covered in peritoneum?
A
All except the cervix
2
Q
Describe the normal anatomy of the Fallopian tube
A
- muscular wall with fimbrial end
- internally the tube is arranged in plical folds covered in serous epithelium (cuboidal cells with cilia and secretory cells with a clear vacuole around the nucleus)
3
Q
Describe the anatomy of the normal ovary
A
- cortex contains follicles (ova)
- medulla contains stroma, blood vessels and sometimes Leydig cells
- appearance is dependent on age, menopausal status and pregnancy
- during menstruation the corpora lutea (yellow body with haemorrhagic centre) and corpora albicantes can be seen
- the corpora albicantes (white dots in cortex) remains post-menopausal
- the stroma is compact containing spindle shaped cells with not much cytoplasm and nuclei that stains blue
4
Q
Describe the development of the ovary and Fallopian tube
A
- germ cells originate from yolk sac (week 5-6) of gestation and migrate to urogenital ridge
- mesodermal epithelium forms this ridge which forms the epithelium and stroma of the ovary - the germ cells embed themselves
- invagination and fusion of the coelomic epithelium forms 2 Müllerian ducts which grow downward into pelvis and fuse forming the urogenital sinus
- unfused portions form the Fallopian tube and fused parts become the uterus and vagina
5
Q
What are the types of non-neoplastic ovarian cysts?
A
- follicular cysts and luteal cysts (part of normal menstrual cycle)
- inclusion cysts (infoldings of surface peritoneum that become trapped in stroma)
- PCOS (large follicular cysts with no egg)
6
Q
Describe ovarian stromal hyperplasia
A
- uniform enlargement of ovary with no lutenised cells usually
- if lutenising cells can result in stromal hyperthecosis (higher incidence of hyperandrogenism)
- ill-defined white/yellow macroscopic nodules
- microscopy shows replacement of cortex and medulla by nodules of ovarian stroma
7
Q
Describe PID
A
- salpingitis: inflammation of the Fallopian tube (can cause an abscess resulting in fusion with the ovary = tubo-ovarian abscess)
- underlying cause is usually STI (chlamydia or gonorrhoea) causing cervical inflammation
- presents with abdominal/pelvic pain, adnexal tenderness, fever and vaginal discharge (requires antibiotics)
- microscopic aggregates of neutrophils and inflammatory cells
- consequences: turbo-ovarian abscess, fusion and fibrosis of plical folds of the Fallopian tube (increased risk of infertility and ectopic pregnancy)
8
Q
Describe endometriosis
A
- presence of endometrial constituents occurring out-with the endometrial cavity
- can cause blood filled cysts (endometriomas) = chocolate cysts
- endometrium will bleed causing scarring and adhesion to adjacent tissues
- rarely tumours can form
9
Q
Describe the different origins that ovarian neoplasia can arise from and the symptoms
A
- surface epithelia
- germ cells
- ovarian stroma
- secondary from elsewhere in the body (most commonly the stomach)
Symptoms: abdominal distension, urinary symptoms, GI symptoms
10
Q
List the surface epithelium tumours
A
- benign serous cyst adenoma
- borderline serous cyst adenoma
- low grade serous carcinoma
- high grade serous carcinoma
- clear cell carcinoma
- endometriod carcinoma
- mucinous adenocarcinoma
11
Q
Describe benign serous cyst adenomas
A
- thin walled
- lined by epithelium 1 cell thick that resembles the epithelia of the Fallopian tube
- no tufts, papillary areas or solid growth, no atypia
- removal is only required treatment
- no risk of recurrence or malignant transformation
12
Q
Describe borderline serous cyst adenomas
A
- some cytological atypia with more complex growth pattern (difficult to predict)
- evidence of invasion absent
- can only involve ovary or have implants elsewhere in system
- monitoring required for recurrence/development into low grade carcinoma
13
Q
Describe low grade serous carcinoma
A
- slow and progressive
- can recur after excision and don’t respond well to chemo
- usually in ovaries with areas of borderline serous tumour
- associated with BRAF/KAS mutations
- not associated with BRCA/p53 mutations
14
Q
Describe clear cell carcinomas
A
- associated with endometriosis but can occur without
- surgery is main treatment (but resistant to platinum based chemo)
- usually large, solid/cystic
- many different growth patterns and don’t always have a clear cytoplasm
- no p53 mutation
- histology shows hobnailing and eosinophil globules
15
Q
Describe endometriod carcinomas
A
- associated with endometriosis
- resembles endometriod carcinomas of the endometrium
16
Q
What is important to note about mucinous adenocarcinomas
A
They are rare and have usually differentiated from another primary metastases
17
Q
Describe germ cell tumours
A
- Eg. Teratoma (mature germ cell tumour)
- consists of mature tissue derived from 1+ embryonic germ cell layers
- most cystic but can have solid areas depending on tissue development
- contain hairy and greasy sebaceous material, sometimes cartilage, bone, teeth
- microscopically different tissues identified
- immature elements are malignant and can recur/metastasise
18
Q
Describe features of stromal tumours
A
- cells surrounding germ cells
- sertoli/leydig cells
- fibroblasts cells from within stroma
- can be benign/malignant
- common eg. Fibroma (benign) or granulosa cell tumour (low grade malignancy)
19
Q
Describe Fibromas
A
- present with non-specific symptoms or incidental findings
- minority have Meig’s syndrome where the tumour is associated with ascites
- vary in size, white and firm lobuled surface
- microscopy shows small bland spindle shaped cells and collagen
20
Q
Describe adult granulosa cell tumours
A
- secretes oestrogen (stimulates symptoms - earlier presentation)
- presents with abnormal vaginal bleeding, menorrhoea/amenorrhoea
- occasionally androgen secreting
- usually confined to ovary and does not recur/metastasise
- variable size, solid/cystic
