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Ovary pathology


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Urogenital ridge cells of origin
yok sac, endoderm
epithelium and sex cords and stroma of ovary embryological origin
urogenital ridge
fallopian tubes embryological origin
mullerian ducts
acute salpingitis definition
suppurrative inflammatory disorder of bacterial etiology that is a component of pelvic inflammatory disease
cause of 60% of PID
gonococcus. remaining due to chlamidia and enteric bacteria.
Sequela of salpingitis
fibrous obliteration of the tube lumen with consequent infertility; obliteration at several foci causing cyst in place of tube anatomy (hydrosalpinx); intestinal obstruction from peritoneal adhesions
ectopic pregnancy
implantation of embryo somewhere other than endometrium
ectopic pregnancy most common site
fallopian tube
ectopic pregnancy predisposing factors
prior PID w/ chronic salpingitis; other peritubal adhesions
ectopic pregnancy presentation
severe abdominal pain 6 weeks after onset of LMP
clinical course of ectopic pregnancy
rupture of tubal pregnancy, hemorrhage into the peritoneal cavity – medical emergency; less common regression;
Tx tubal pregnancy
methotrexate, involution of tubal gestations
paratubgal cysts
small unilocular cysts filled with clear serous fluid and lined by mullerian or transitional epithelium
hyatid cyst of morgagni
large cyst of mullerian duct located at the fimbriated end of the tube
adenomatoid tumor of fallopian tube
benign neoplasm derived from mesotheliun occurring in the subserosal region of the tube, similar tumors occur in the epididymis
adenocarcinoma of fallopian tube
rare, primary malignant neoplasm of fallopian tube epithelium, usually showing either serous or endometrioid differentiation, similar to lesions of the same histologic types arising in the ovary.
inflammatory disorders of the overies
tubo-ovarian abscess in association with pelvic inflammatory disease; other infectious oophoritis (mumps, CMV, actinomyces, fungus, TB); autoimmune Oophoritis
presence of endometrial tissue in sites other than uterus.
presence of endometrial glands and stroma within the myometrium.
sites of endometriosus
ovaries, uterine ligaments, rectovaginal septum, pelvic peritoneum, laparotomy scars, rarely in umbilicus, vagina, vulva, GI tract, pleura
clinical presentation, complications of endometriosus
reproductive age, infertility; pelvic pain; abnormal bleeding; pain with menses (dysmenorrheal). 10% women affected, some asymptomatic
theories of endometriosus pathogenesis
regurgitation theory: retrograde menses thru fallopian tubes, endometrim into peritneum; metaplasia; lymphovascular dissemination
Endometriosis gross appearance
responsive to physiologic hormonal cycle. undergo periodic bleeding, producing dark nodules (gun powder appearance). lesions produce cystic masses filled with hemorrhagic material (chocolate cysts) and organization results in adhesions
endometriosis histologic appearance
three important features: endometrial glands, endometrial stroma, hemosiderin pigment. Most severe dicfficult to identify microscopically b/c of fibrosis
Follicular cysts
multiple, originate from unruptured graafian follicules or ruptured follicles with seal, smooth lining of granulose cells, filled with serous fluid
luteal cysts
single enlarged corpus luteum +/- hemorrhage. distinct bright yellow to orange lining composed of luteinized granulose cells
polycystic ovary disease clinical features
3-6% women of reproductive age. bilateral ovarian enlargement from multiple follicle cysts. oligomenorrhea, w/ persistent anovulation, obesity, hirsutism, virilism (rarely)
pathogenesis polycystic ovary disease
increased LH, stimulates theca-lutein cells to produce androstenedione, converted to estrogen and testosterone; associated insulin resistence, hyperprolactinemia
histo of polycystic ovary disease
enlarged ovaries, numerous cystic follicles; fibrous thickening of cortex; hyperplasia of follicular theca cells; variable absence of corpora lutea; ENDOMETRIAL HYPERPLASIA AND CARCINOMA OCCUR IN A SIGNIFICANT PROPORTION OF PATIENTS DUE TO UNOPPOSED ESTROGEN PRODUCTION ASSOCIATED WITH ANOVULATORY CYCLES
Ovarian tumors epidemiology
80 % benign; benign in women under fifty; malignant in postmenopausal women
clinical presentation ovarian tumor
mild symptoms until large; symptoms and signs include abdominal pain, increasing abdominal girth; ascites; urinary and gastrointestinal tract disturbances; vaginal bleeding; rare hormonal activity
Classification of ovarian tumors
surface epithelial tumors; sex cord stromal tumors; germ cell tumors
surface epithelium of ovary embryological origin
embryologically derived from coelomic epithelium; embryonic coelomic epithelium gives rise to muellerian epithelium which differentiates into fallopian tube endometrial or endocervical
sex cord – stromal cells
embryonic precursors of the ovarian endocrine apparatus (theca and granulose cells)
germ cells embryonic origins
oocytes, which migrate from yolk sac, totipotential
epithelial ovarian tumor affected age group
over 20 yrs
germ cell ovarian tumor age group
0 to 25
sex cord ovarian tumor age group
all ages, often middle age or elderly
metastasis to the ovary age group affected
variable; tendency for older adults
histologic subtypes of epithelial ovarian tumor
serous; mucinous, GI type, endocervical type; endometrioid; clear cell; transitional (Brenner
histo subtypes of germ cell ovarian tumor
teratoma, mature, immature; dysgerminoma; yolk sac; choriocarcinoma
histo subtypes of sex cord ovarian tumor
granulose cell tumor; fibroma/fibrothecoma; sertoli-leydig cell tumor
most common primary sties of metasteses to ovary
opposite ovary; endometrium; colon; pancreas; stomach; breast
90% of malignant ovarian tumors what cell type?
ovarian surface epithelial tumors, embryology, differentiation
ovarian surface epithelium, coelomic mesothelium, differentiation towareds mullerian types of epithelium
differentiation subclassification of ovarian surface epithelial tumors
by type of epithelial differentiation: serous (like fallopian tube); mucinous (like endocervical or gastrointestinal); endometroid (like proliferative endometrial glands); clear cell (has glycogen making it clear looking); transitional; squamous; mixed; undifferentiated
architecture subclassification of ovarian surface epithelial tumor
cystic (cystadenoma or cystadenocarcinoma); cystic and fibrous (cystadenofibroma); predominately fibrous, minimal cyst formation (adenofibroma)
clinical behaviour subclassifications of ovarian surface epithelial tumor
benign (minimal epithelial proliferation and no stromal invasion); borderline (pronounced proliferation without stromal invasion); malignant (stromal invasion)
serous epithelial ovarian tumors appearance
benign are unilocular, with clear fluid and smooth internal lining; malignant are complex with papillary and solid areas, stromal invasion and necrosis; bornderline have complex epithelial growth with surface papillations, no stromal invasion
mucinous tumors of oivarian epithelium subtypes
endocervical (mullerian) features similar to serous tumors, high incidence of bilaterality, assoc with endometriosis/endosalpingiosis ; and gastrointestinal (resembling lining of stomach or bowel, may be assoc with pseudomyxoma peritonei (mucinous ascites w. implants on peritoneal surfaces) perhaps from GI source
pseudomyxoma peritonei
mucinous ascites with implants on peritoneal surfaces from gastrointestinal subtype of mucinous tumor of ovarian epithelium
mucinous tumors of ovarian epithelium appearance
multilocualted, more complex than serous, contain thick, viscous fluid
endometrioid tumors of ovarian epithelium appearance
adenofibromatous architecture more solid than cystic with much fibrous stroma
type of ovarian epithelium tumor associated with synchronous endometrial adenocarcinoma
endometrioid ovarian epithelial tumor 30% associated with this
transitional tumors of ovarian epithelium (Brenner) appearance, associations, incidence
benign, adenofibromatous architecture, associated with mucinous cystadenomas, this type very rare
mode of spreads of malignant ovarian surface epithelial tumors
primary mode of spread is by penetration of ovarian capsule and rowth on peritoneal surfaces in pelvis and abdomen (assoc with ascites w/ malignant cells); lymph node and metasteses occur after established abdominopelvic deisease
tumor marker in 80% of advanced stage ovarian carcinoma (esp serous and endometrioid)
CA-125; useful in monitoring postoperative therapy and detecting recurrences
treatment of malignant ovarian epithelial tumors
resection of visible disease, platinum based chemotherapy
sex-cord stromal tumors cells of origin, clinical
arise from stromal cells (fibroblasts, smooth muscle) and or sex cord cells of male or female type (granulose, theca, sertoli, leydig), all age groups, can produce feminizing or masculinizing hormones, unpredictable clinical behavior
granulose theca cell tumors susceptible age
post menopausal women
appearance of granulose theca cell tumors
unilateral, cystic and hemorrhagic, yellow, histo appearance of granulose cell component, coffee bean nuclei eosinophilic Call-exner bodies.
granulose theca cell tumors clinical
hormonally active usually estrogen; precocious puberty; endometrial hyperplasia, fibrocystic changes in breast, endometrial carcinoma; potentially malignant
fibrothecoma and fibroma appearance
prominent theca component, solid white gross appearance scattered yellow from theca component
fibrothecoma and fibroma clinical
benign; assoc with ascites and right sided pleural effusion (meig’s syndrome) common in patients with basal cell nevus syndrome
ovarian tumor associated with basal cell nevus syndrome
fibrothecoma nad fibroma
sertoli leydig celll tumors of ovary
usually mixture of sertoli and leydig cells, may produce androgens
major sex cord stromal tumors
granulose theca cell tumors; fibrothecoma and fibroma; sertoli leydig cell tumors
Germ cell tumors of ovaries comparison with testicles
1 second most common type in ovary vs most common in testis;; bilateral 15%; seminoma in overy termed dysgerminoma; usually pure form vs mixed in testis; mature teratoma most common vs seminoma
characteristics of mature teratoma of ovary
ectodermal derivatives; sometimes thyroid (struma ovarii) or neuroendocrine (carcinoid); karyotime of benign teratomas 46XX
Krukenburg tumor
bilateral metastatic tumor to the ovaries composed of signet ring cells usually of gastric origin

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