Week 3: Path of uterus, fallopian tubes, and ovaries

Question 1

Endometrial aberrations: estrogen-related

Answer 1

1. metaplasias
2. hyperplasias: abnormal proliferations of the glandular component of the endometrium
   - can have atypic that progresses to adenocarcinoma
3. adenocarcinoma: related to unopposed estrogen
   - irregular thickening, hemorrhage, necrosis of endometrium. Overgrowth of endometrium by back to back glands without intervening stroma.

Question 2

Endometrial aberrations: Non-estrogen related

Answer 2

• these are mostly high grade and have bad prognosis
  1. Serous Endometrial carcinoma
  2. Clear Cell Ca.
  3. Carcinosarcomas
  4. Leiomyosarcoma: malignant SM cells
  5. Endometrial Stromal Sarcomas

Question 3

Diseases of the fallopian tubes

Answer 3

1. Congenital/developmental
2. benign cysts and rests
3. Infections: neisseria gonorrhea, chlamydia, enteric gram- bacilli
   - salpingitis: inflammation, hyperemia, congestion, can lead to abscess
   - chronic salpingitis: can lead to obliteration of lumen, resulting in infertility
4. Ectopic pregnancy
   - PID predisposes
5. neoplasms: primary tubal neoplasms are rare
   - adenocarcinoma
   - B9 adenomatoid tumor

Question 4

Ovarian epithelial tumors

Answer 4

• benign neoplasms most common and seen in young women. Malignant neoplasms generally seen in older women
  1. classification: benign, low malignant potential, malignant
  2. types
• serous (tubal)
• endometrioid (endometrial)
• mucinous (endocervical)
• clear cell
• transitional

Question 5

Non-neoplastic ovarian cysts

Answer 5

-most common causes of enlargement of ovary
TYPES
-epithelial inclusion
-solitary follicular cyst
-corpus luteal cyst
-theca lutein cyst
-polycystic ovary
-endometriotic cyst

Question 6

Differentiating benign, boderline, malignant ovarian tumors

Answer 6

1. Benign
   - predominantly cystic appearance, lined by smooth flat lining
   - minimal atypia, rare mitotic activity
2. borderline
   - simple cysts lined by abundant papillary fronts of multi cystic configuration
   - moderate atypia, slight to moderate mitotic activity
   - no invasion of stroma
3. Malignant
   - solid and cystic areas
   - hemorrhage and necrosis. stratified cells, malignant atypic, epithelial invasion of stroma

Question 7

Germ cell tumors

Answer 7

1. mature cystic teratomas: most common
   - benign. filled with sebaceous material and hair. contain elements of all three germ layers
2. Immature teratoma: malignant counterpart of mature cystic teratoma.
   - express primitive elements
3. Dysgerminoma: most common malignant germ cell tumor of ovary. elevation of LDH.
   - brain like appearance
   - occur between puberty and 35 yo
4. yolk sac tumors: serum elevation of AFP. unilateral. large, lobulated, solid, with necrosis.

Question 8

Ovarian sex cord and stromal tumors

Answer 8

1. fibroma/thecoma
   - benign, solid. late reproductive age or menopausal women
   - can produce steroid hormones
2. Granulosa cell tumors
   - low grade malignant. late reproductive age or older.
   - frequently produces estrogen.
   - Call-Exner bodies: primordial follicle look alike
3. Sertoli-Leydig Cell tumors
   - rare. Produce androgens, cause virilization. occur in all ages.
   - Sertoli cells arranged in tubes. Lydia cells in small clusters around the tubules.