Pathology of the Ovary and Fallopian Tube Flashcards
What are the four portions of the fallopian tube?
Infundibulum with fimbria, Ampulla, Isthmus, and Intramural division (cornua)
What types of cells make up the lumen of the Fallopian tube (mucosa)
Simple columnar epithelium with cilia and non-ciliated secretory cells
What are the effects of estrogen and progesterone in the fallopian tube?
- Estrogen promotes ciliogenesis and mitosis
- Progesterone stimulates secretory activity
What are the benign conditions of the Fallopian tube?
- Salpingitis
- Ectopic pregnancy
- Endometriosis
What is Salpingitis and in what disease is it commonly seen?
Inflammation of the fallopian tube (commonly seen in Pelvic Inflammatory Disease)
What are the long term consequences of salpingitis?
Scarring and abnormal motility
What is an ectopic pregnancy?
Pregnancy implanted outside of the endometrial cavity (usually in the fallopian tube)
What is endometriosis?
What is it a risk factor for?
The presence of glands and stroma outside of the uterus (dysfunction/scarring affects motility)
Risk factor for ectopic pregnancy
Tumors of the fallopian tube tend to be associated with what gene mutation?
BRCA
What are the primary tumors of the Fallopian tube?
Serous carcinoma in-situ and invasive serous carcinoma
Describe the formation of an inclusion cyst in the ovary due to transfer of tubal epithelial cells
- The fimbria envelops the ovary
- Ovulation: The fimbria is in intimate contact with the ovary at the site of rupture
- Tubal epithelial cells from the fimbria are dislodged and implant on the denuded surface of the ovary resulting in the formation of an inclusion cyst
What are the three main structures of the ovary?
Surface epithelium
Cortex
Medulla/Hilum
What types of tumors can form in the surface epithelium of the ovary?
Serous, Mucinous, Transitional, Endometrioid, and Clear cell tumors
Most surface epithelium tumors of the ovary are derived from…?
Coelomic epithelium (mesothelial lining)
What structures/cells are present in the cortex of the ovary?
- Follicles
- Germ cells
- Sex cords (granulosa cells, luteinized cells)
- Stromal cells
- Smooth muscle
- Fat
What is found in the medulla/hilum?
Hilar cells, Rete Ovarii (mesonephric tubules), blood vessels, lymphatics and nerves surrounded by loose connective tissue
What are hilar cells?
Cells in the ovary that are similar to Leydig cells – secrete testosterone
What are the most common masses found in the ovary?
Functional cysts
What are the four types of functional cysts found in the ovary?
- Follicular
- Luteal (corpus luteum)
- Inclusion cyst (cortical)
- Hemorrhagic (corpus luteum)
What are risk factors for tumors of the ovarian surface epithelium?
- Risk factors:
- Obesity
- Estrogen usage for > 10 yrs
- Family history
- Germ line mutation in tumor suppressor genes
What are protective factors for tumors of the ovarian surface epithelium?
Oral contraceptive pills
Nulliparity
What are the three types of serous tumors in the ovary?
Which ones are cystic, which ones are solid, and which are both?
- Benign serous tumors (60%)
- Usually cystic
- Borderline serous tumor (15%) aka serous tumor of low malignant potential
- Can be solid and cystic in nature
- Serous carcinoma (25%)
- Can have solid and cystic components.
What is the appearance of a high grade serous tumor?
- Solid and Papillary
- Pleomorphic high grade nuclei
- Mitosis
What are the two grades of serous carcinoma and what gene mutations are associated with each?
- Low grade: KRAS, BRAF, ERBB2 mutations
- High grade: TP53 mutation
What are the three types of mucinous tumors of the ovarian surface epithelium? How prevalent is each?
- Benign mucinous tumor (80%)
- Borderline mucinous tumor (10%)
- Mucinous cystadenocarcinoma (10%)
At what age is a person most likely to have an Ovarian Surface Epithelial Tumor?
Reproductive Age (20-65 years)
What does a bilateral mucinous tumor usually indicate?
Indicates metastasis until proven otherwise
How do mucinous tumors of the ovary usually appear?
Multicystic and lined by mucin secreting cells
Mostly unilateral
What are the two tumorogenesis pathways?
- Type I - Low grade indolent neoplasms; stepwise development from borderline tumors
- Type II - – High grade carcinoma, rapidly evolving
Are endometrioid tumors usually benign or malignant?
Malignant
What often is found concurrent with endometrioid tumors?
What mutation is associated with an endometrioid tumor?
- What often is found concurrent with endometrioid tumors?
- Endometrial carcinoma (15-30%)
- What mutation is associated with an endometrioid tumor?
- Mutation of PTEN suppressor gene
Are Brenner tumors usually benign or malignant?
How do they appear histologically?
Mostly benign (although borderline and malignant exist)
Nests of transition type epithelium
What structures can germ cells differentiate toward?
- Oogonia (dysgerminoma),
- Primitive embryonal tissue (embryonal carcinoma)
- Yolk sac (endodermal sinus tumor/yolk sac tumor)
- Placental tissue (choriocarcinoma)
- Multiple fetal tissues (teratoma) or combination
What 3 layers make up a teratoma?
Ectoderm, Endoderm, Mesoderm
What is another name for a teratoma?
Is it more likely to be benign or malignant?
In what age group are malignant (immature) teratomas most likely found?
- What is another name for a teratoma?
- Dermoid cyst
- Is it more likely to be benign or malignant?
- Benign (mature)
- In what age group are malignant (immature) teratomas most likely found?
- < 18 years old
What are the two types of sex cord derived tumors?
Can be estrogen (granulosa cells) or androgen secreting (sertoli cells)
At what age do granulosa cell tumors occur?
What structures are present on histology?
Can occur at any age (but mostly postmenopausal)
- Call Exner bodies (mimic follicles)
- Mixture of lipid laden theca cells
What are the stromal derived tumors?
- Theca cell
- Lutein cell
- Leydig cell
Which cancer often metastasizes to the ovaries?
Breast cancer
