Uterine Tube & Ovaries Flashcards
Identify the 4 components of the uterine tube.
- Isthmus
- narrowest area
- attaches to the uterus
- Ampulla
- long central portion
- Infundibulum
- Wide, outermost part
- Fimbriated End (fingers)
- catches the oocyte at ovulation
The provided cross section is from what section of the uterine tube?
ampulla
prominent tubal plica
The provided cross section is from what section of the uterine tube?
Fimbria
where plicae are suspended from the infundibulum in a frond-like appearance
The provided cross section is from what section of the uterine tube?
Isthmus
contains both an inner longitudinal & outer circular muscle layer
What condition is shown in the provided image?
Acute salpingitis
- Dilated, inflamed uterine tube with pus
The provided histological slide is a sample of a uterine tube with what pathology?
Acute Infectious Salpingitis
- lots of neutrophils (both in epithelium & stroma)
- pus
What condition is depicted in the provided image of the gross sample?
Pyosalpinx
- dilated uterine tube filled with pus
What are the possible outcomes that can result after a person develops pyosalpinx?
can progress to an abscess (walled off with fibrous wall)
can resolve causing scarring w/ loss of fimbria (possible closing of tube)
What condition is shown in the provided image?
Chronic Infectious Salpingitis
- acute salpingitis that has been incompletely treated or not treated at all
- or, can be caused by less virulent organisms
- lymphocytes, plasma cells & variable numbers of neutrophils
Chronic infectious salpingitis can lead to what serious complication?
pelvic inflammatory disease
The provide microscopic slide is an sample from what pathology?
Hydrosalpinx
scarred tube w/ variable loss of plicae with relatively smooth mucosal surface without folds
lots of fibrosis in the wall & it may be cystically dilated
What condition is shown in the provided image?
Hydrosalpinx
uterine tube dilation that is smooth both on the inside & outside
due to blockage of uterine tube by inflammation & scarring
What pathology is shown in the provided image?
Ectopic Pregnancy
ruptured tubal pregnancy with extensive hemorrhage - tiny embryo (white) is present in the center of the clot
What is an ectopic pregnancy?
When implantation occurs at a location other than the uterine cavity
What are the consequences of an ectopic pregnancy?
- fetus will not get vey large b/c not much room nor is it a nurturing environment
- can cause a life-threatening hemorrhage
Describe the components of this histological slide of an ectopic pregnancy.
- lower left: chorionic villi
- middle: rupture (hemorrhage)
- right: tubal plicae
What structures are shown in the provided image?
Normal ovaries & uterine tubes of an individual of reproductive age
- sometimes will see cysts, little areas of hemorrhage (ruptured corpus luteum) – perfectly normal
The provided histological slide was provided from what structure?
normal ovary
C: ovarian cortex
M: medulla
H: hilus
CL: corpus luteum
CF: cystic follicle
LF: leutinized follicle
What condition produced the sample shown in the provided image?
Tubo-Ovarian (Adnexal) Torsion
dusky, dark red appearance - hemorrhagic cystic & solid cut surface
- solid white arrow: ovary
- open white arrow: uterine tube
Which blood supply is more affected by adnexal torsion? Why?
venous blood leaving the structure because it has thinner walls & is more easily compressible - leads to combination of congestion that will eventually impede the inflow of blood & ischemia
What is the difference between a follicular cyst & a cystic follicle?
size (basically)
thin-walled cyst filled with clear cystic fluid
What histology would you expect to see in a follicular cyst?
normal
single layer of granulosa cells resting on a thick theca layer
What type of pathology is shown in the provided image?
Corpus Luteum Cyst
- cyst with smooth yellow lining & hemorrhagic material in the lumen
The provided histological slide is an example of what kind of cyst?
Corpus Luteum Cyst
- Pink corpus luteum appearance (though much larger)
- central hemorrhage (red)
The provided image is an example of what type of pathology?
Endometriotic Cyst
“chocolate” cyst
old, clotted blood is dark brown
What is the most common presentation of an endometriotic cyst? It can cause what potential complication?
pelvic pain
infertility - no increased risk of malignancy
The provided images are example of what condition?
Polycystic ovaries
- Left:
- large ovaries with many superficial cysts
- central stroma is homogeneous (lacking corpora lutea)
- Right:
- multiple superficial cysts
- thickened cortex
- absent corpora lutea or corpora albicantia
The provided images are example of what condition?
Polycystic ovaries
- Left:
- large ovaries with many superficial cysts
- central stroma is homogeneous (lacking corpora lutea)
- Right:
- multiple superficial cysts
- thickened cortex
- absent corpora lutea or corpora albicantia
What is Stein Leventhal syndrome?
also - Polycystic Ovarian Syndrome (PCOS)
characteristic of elevated androgens and infrequent/absent ovulation (infertility) – often leading to ovaries with multiple cysts, insulin resistance (Type II Diabetes)
Patients with PCOS have an increased risk of what serious condition?
endometrial carcinoma
Patients with PCOS have an increased risk of what serious condition?
endometrial carcinoma
Describe the most affected ages for benign, borderline & malignant tumors of the ovaries.
- Benign
- young, mainly 20-45
- Borderline
- slightly older
- Malignant
- older women, mainly 45-65
What type of malignant tumor is most commonly found on the ovaries? Is it a good prognosis?
5 leading cause of cancer deaths in women
90% are carcinomas
80% have spread beyond ovaries upon diagnosis
What factors increase the risk of ovarian cancer?
- BRCA1 or BRCA2
- childhood gonadal dysgenesis
- clomiphene use
- family history
- nullparity (b/c increased number of menstrual cycles)
- hereditary nonpolyposis colin cancer (HNPCC, Lynch syndrome)
What are factors that reduce the risk of developing ovarian cancer
- history of oral contraceptive use
- late menarche or early menopause
- multiparity
- prophylactic oophorectomy
- first pregnancy before 25
- tubal ligation
Ovarian tumors can arise from what 4 precursor tissues?
- surface epithelial-stroma tumors
- germ cell tumors
- sex cord-stromal tumors
- metastatic carcinomas
What is the term for tumors present with glands and cysts?
cystadenoma
cystadenocarcinoma
What is the term for tumors present with glands and fibrotic stroma?
adenofibroma
adenocarcinofibroma
What is the term for tumors present with glands,cystic areas & fibrotic stroma?
cystadenofibroma
cystadenocarcinofibroma
What is the difference in pathogenesis of ovarian epithelial tumors: Type I and Type II
- Type I:
- progress from benign to borderline tumors
- may then progress to low-grade carcinoma
- Type II:
- arise from inclusion cysts/fallopian tube epithelium via intraepithelial precursors
- (serous tubal intraepithelial carcinomas, STIC)
The provided histological slide is an example of what type of ovarian tumor?
Serous tumor
Are serous tumors usually unilateral or bilateral?
Where are the most common locations that serous carcinomas spread?
Prognosis?
bilateral is common
spread to peritoneal surfaces & omentum
high grade carcinomas usually have poor prognosis
Serous carcinomas ar commonly associated with what other symptom?
ascites
What type of ovarian tumor is shown in the provided image?
serous cystadenoma
smooth external & internal surfaces
characteristically contain straw-colored fluid & have a minimal stormal component
may have thick walls w/ internal folds when collapsed
Are serous cysadenoma usually bilateral or unilateral?
unilateral
Serous cystadenomas are lined by what type of cells?
can be columnar, ciliated, or flattened cells
diagnostic cell type: ciliated mullerian epithelium
The provided histological slide is a sample form what type of ovarian tumor?
serous cystadenoma
single layer of bland-looking epithelium lining cells
The provided image is an example of what type of ovarian tumor?
Serous Borderline Tumor
cyst cavity lined by delicate papillary tumor growth
The provided histological sample is from what type of ovarian tumor?
Serous Borderline Tumor
increased architectural complexity and epithelial cell stratification
stratification of epithelial cells
still NO invasion
The provided histological sample is from what type of ovarian tumor?
Serous Borderline Tumor
increased architectural complexity and epithelial cell stratification
stratification of epithelial cells
still NO invasion
What type of ovarian tumor is shown in the provided image?
Serous Carcinoma (Adenocarcinoma)
gross appearance - cyst opened to show bulky tumor
The provided histological sample is from what type of ovarian tumor?
Serous Carcinoma (adenocarcinmoa)
stromal invasion is circled
complex capillary structures w/ more atypical cells
Identify which of the following pictures are examples of serous cystadenoma, borderline serous tumor, low-grade “micropapillary” serous carcinoma, and high-grade serous carcinoma
What percent of serous tumors of the ovaries are malignant?
What about mucinous tumors of the ovaries?
serous: 25%
mucinous: 10%
Are mucinous tumors more likely to be unilateral or bilateral?
unilateral - only 5% are bilateral
What mutation is frequently seen in mucinous tumors of the ovary?
KRAS protooncogene mutations
What type of ovarian tumor is shown in the provided image?
mucinous cystadenoma
multicystic mass, delicate septa & glistening mucin within the cysts
The provided histological sample is likely from what type of ovarian tumor?
mucinous cystadenoma
columnar cell lining the cysts, similar to endocervical cells
benign cells with basally placed nucleus, producing a lot of mucin
(can also be lined by epithelial cells that look like foveolar cells of the stomach/intestine)
What type of ovarian tumor is shown in the provided image?
mucinous borderline tumor - endocervical type
unilocular cyst containing variable number of soft, delicate papillary excrescences
tend to have more solid areas
typically filled with gelatinous contents
The provided histological sample is likely from what type of ovarian tumor?
mucinous borderline tumor - endocervical type
hierarchical branching of papillae is characteristic
more complex architecture than totally benign lesions
What type of ovarian tumor is shown in the provided image?
Mucinous Carcinoma (adenocarcinoma)
solid and cystic mass containing soft, fleshy nodules & mucoid contents
can also get invasion of the stroma
a lot of areas of solid & some cystic areas
The provided histological sample is likely from what type of ovarian tumor?
mucinous carcinoma (adenocarcinoma)
confluent growth of closely packed complex gland with little intervening stroma
papillary architecture with more nuclear atypia than borderline tumors (bigger nuclei, more pleomorphism, chaotic/disorderly architecture)
What condition is depicted by the provided samples?
Endometrioid Adenocarcinoma
can look like endometriosis – difference is the back to back glands
- Gross
- cystic tumor with solid areas & cysts the contain hemorrhagic, chocolate-colored fluid
- tumor surface is usually smooth
- Microscopic
- pattern of back-to-back glands w/ little stroma
- labyrinthine outline (chaotic archetecture) and smooth luminal contours
What type of ovarian tumor is shown in the provided image?
Transitional Cell “Brenner” Tumors
solid, tan, well-circumscribed
The provided histological sample is likely from what type of ovarian tumor?
Transitional Cell “Brenner” Tumors
characteristic epithelial nests within the ovarian stroma
The provided histological sample is likely from what type of ovarian tumor?
Transitional Cell “Brenner” Tumors
characteristic epithelial nests within the ovarian stroma
What type of ovarian tumor is shown in the provided image?
Benign (mature) cystic teratoma
inside of the cysts may show hair, teeth, & a variety of different tissues microscopically
What type of ovarian tumor is shown in the provided image?
Monodermal (specialized) teratomas
tan to yellow areas (carcinoid) juxtaposed to “beefy” red areas with secondary cystic change (think goiter)
The provided histological slide is an example of what type of pathology? It is most commonly seen in what demographic?
Immature cystic teratoma
primitive neuroepithelium is present (dark blue cells) & may contain immature cartilage, bone / other elements
young women & pre-adolescent girls
What ovarian tumor is shown in the provided image?
Dysgerminoma
lobulated appearance with solid, soft, and tan cut surface
The provided histological slide is from what type of ovarian tumor?
Dysgerminoma
alveolar growth composed of irregular tumor cell nests separated by delicate fibrous septa (that contain lymphocytes)
The provided histological slide is from what type of ovarian tumor?
Yolk Sac (Endodermal Sinus) Tumor
- Left
- lace-like network of medium-sized cells tha tmay contain Schiller-Duvall bodies
- Right
- Schiller-Duval body (central blood vessel surrounded by layers of tumor cells)
Yolk Sac tumors are positive for what protein?
alpha-fetoprotein (AFP) +
What is Pseudomyxoma peritonei?
the entire peritoneal cavity is occupied by innumerable mucinous nodules
The provided histological slide is characteristic for what type of pathology?
Pseudomyxoma peritonei
clusters of well-differentiated mucin-producing glands floating in a sea of mucin
What is the name for bilateral ovarian involvement of metastatic tumors?
Krunkenberg Tumor
The provided histological slide is a sample from what type of ovarian tumor?
Embryonal Carcinoma
- Sheets of undifferentiated cells & primitive glandular structures
- large, pleomorphic cells with hyperchromatic nuclei & prominent nucleoli
- frequent mitoses
- almost always occur as part of a mixed germ cell tumor
The provided histological slide is a sample from what type of ovarian tumor? It is composed of what 2 cell types?
choriocarcinoma
- growth pattern in cords / sheet of cells
- Cell types
- Syncytiotrophoblasts
- Cytotrophoblasts
What are Syncytiotrophoblasts? What are Cytotrophoblasts? They are found in what type of tumor?
Choriocarcinoma
-
Syncytiotrophoblasts
- large, multinucleated cells with cytoplasm that contains HCG
-
Cytotrophoblasts
- regular / polygonal cells with distinct borders & clear cytoplasm
- each with single, fairly uniform nucleus
