W2L3 - Ovarian Cysts

Question 1

Ovarian Cysts

Answer 1

Small fluid filled sacs which develop on the ovaries
Most are harmless
But some may rupture, bleed or cause pain and surgery may be required to remove these

Question 2

Most Common Ovarian Cysts

Answer 2

Follicular
Corpus luteum cyst
Haemorrhagic cyst
Dermoid cyst
Endometroid cysts
Polycystic ovaries
Cystadenoma

Question 3

Luteinised Follicular Cyst

Answer 3

Cyst that forms when ovulation doesn’t occur or when a mature follicle involutes
Can grow ~ 4.5 cm in diameter
Rupture can cause severe pain on side of ovary on which the cyst appears
Usually produce no symptoms and disappear by themselves
Cytology
- clusters of granulosa cells
- luteinised cells with abundant granular or vacuolated cytoplasm
- nuclei eccentric with fine granular chromatin
- small prominent nucleoli

Question 4

Corpus Luteum Cyst

Answer 4

Functional ovarian cyst that forms after an egg has been released from a follicle
If pregnancy doesn’t occur, the corpus luteum breaks down and disappears
It may fill with blood or fluid and persist however
Cytology
- numerous luteinised granulosa cells
- background of fresh blood
- haemosiderin laden macrophages
- fibrin and fibroblasts

Question 5

Haemorrhagic/Endometriotic Cyst

Answer 5

Functional cyst that occurs when bleeding occurs within a cyst
Symptoms of abdominal pain on one side of the body may be present with this type of cyst
Cytology
- usually haemorrhagic and contain hemosiderin laden macrophages

Question 6

Dermoid Cyst

Answer 6

Benign tumour sometimes referred as cystic teratoma
Abnormal cyst that usually affects younger women
May grow to 15cm in diameter
Contains other types of body tissue including hair, cartilage, teeth and bone
These cysts can become inflamed and cause torsion resulting in severe abdominal pain
Cytology:
- usually viscous, oily substance
- amorphous debris
- numerous anucleate sq, superficial sq
- hair

Question 7

Serous Cystadenoma

Answer 7

Benign tumour arising from ovarian tissue
May be filled with mucous type material
May become very large
Cytology:
- aggregates of uniform cuboidal or columnar epithelium
- sometimes papillary and lacking atypia

Question 8

Mucinous Cystadenoma

Answer 8

Characterised by presence of columnar mucin-secreting cells arranged in honeycomb or picket-fence pattern in mucinous background
Cytology:
- cytoplasm contains many small vacuoles or single large vacuole displacing nucleus
- nuclei homogenous and have finely granular evenly distributed chromatin
Patients with borderline mucinous neoplasm may have associated pseudomyxoma peritonei

Question 9

Serous Cystadenocarinoma

Answer 9

Characterised by presence of cuboidal to low columnar cells with moderate amounts of homogenous basophilic cytoplasm arranged in syncitial and branching papillary groups
Cytology:
- eccentric, hyperchromatic nuclei with irregular chromatin dispersion
- nuclear pleomorphism and nucleoli inconspicuous
- psammoma bodies

Question 10

Metastatic Bowel Cancer

Answer 10

Metastatic tumours from the colon/rectum are rare however can spread to the vagina/cervix
Tumour cells frequently have columnar appearance
Large hyperchromatic nuclei and high N/C ratio
Isolated cells may have a signet ring appearance
Bg of smears usually dirty/necrotic

Question 11

Melanoma

Answer 11

Common in vulva and can arise in vagina and less frequently cervix
Vaginal melanomas occur in elderly and usually aggressive
Malig cells usually isolated
Large cells with round/oval nuclei
Prominent nucleoli
Scant cytoplasm
Evidence of brown pigment in cytoplasm of melanophages