23 - Ovary and uterus pathology

Question 1

The normal ovary?

Answer 1

At birth born with 400 000 primordial follicles that are dormant until puberty. After puberty up to 20 follicles start to mature under the influence of the hormones FSH and LH. Only one reaches maturity and is released down the fallopian tubes.

Question 2

Neoplasm?

Answer 2

New and abnormal tissue growth

Question 3

Cycle of the follicles?

Answer 3

primordial, primary, secondary mature, ruptured, corpus luteum (residual follicle), corpus albicians

Question 4

Malignant (cancerous growth) of follicles?

Answer 4

Germ cell tumour = teratoma

Question 5

Tumour in the stroma?

Answer 5

Sarcoma as is mesenchymal/fibrous tissue

Question 6

Benign tumour of the germ cells/follicles?

Answer 6

Teratoma

Question 7

Sex cord stromal tumours?

Answer 7

Fibroma (benign)

Question 8

Where do the majority of tumours in the ovaries arise from?

Answer 8

Either the surface or the fimbrial end of the fallopian tubes

Question 9

Non-neoplastic in ovary

Answer 9

• polycystic ovarian syndrome

- functional ovarian cysts

Question 10

Benign ovary neoplams?

Answer 10

• epithelial (mucinous/serous cystadenomas
• germ cell (dermoid/teratoma)
• stromal tumour (fibroma)

Question 11

Malignant ovarian neoplasms

Answer 11

primary - ovarian carcinoma

secondary - metastatic carcinoma

Question 12

Normal fallopian tube?

Answer 12

The free fimbrial end is composed of fingerlike projections that are adjacent to but not connected to the ovary. They open into the intra-abd cavity
The fimbriae align over the rupturing ovarian follicle at ovulation
Ovum enters the lumen of the FT where fertilisation occurs
The blastocyte then moves down the tube and implants into the uterus

Question 13

What are the fallopian tubes lined with

Answer 13

Ciliated epithelial cells that push the ovum towards the uterus

Question 14

Fallopian tubes - non-neoplastic

Answer 14

• saplingitis (can cause infertility)

- ectopic pregnancy

Question 15

Fallopian tubes - pre-malignant

Answer 15

Tubal intraepithelial carcinoma

Question 16

Fallopian tubes - benign neoplasm

Answer 16

Adenomatoid tumour

Question 17

Fallopian tubes - malignant

Answer 17

primary carcinoma

secondary metastatic carcinoma

Question 18

Normal uterus?

Answer 18

Is composed of the fundus, body and cervix
Consists of a thick muscular wall (myometrium - expands during pregnancy to contract during birth) that is lined by endometrium which contains glands and stroma. Outer surface is the serosal/mesothelial layer.

Question 19

Cervix runs from … to…

Answer 19

Internal to external os

Question 20

Structure and function of endometrium?

Answer 20

The endometrium contains hormone RECEPTORS for oestrogen and progesterone
The endometrium develops and sheds under the influence of these hormones
Following menopause the endometrium becomes inactive

Question 21

Menstrual cycle summary

Answer 21

• as estrogen increases the endometrium is proliferative is that it becomes suited for implantation. The other hormones are relatively static (LH and FSH do increase a little)
• after ovulation estrogen drops and progesterone increases steeply to promote the secretory phase
• if no fertilisation occurs then the luteal phase ends when progesterone decreases and shedding of the endometrium occurs (menstruation)

Question 22

Normal cervix?

Answer 22

Is inferior narrow part of uterus. Protrudes through into the upper vagina.

Question 23

What 3 components of the cervix are we interested in and want to get all of when we do a smear?

Answer 23

1 - outer squamous epithelium (ectocervix)
2 - endocervix (lining of the canal)
3 - transformation zone in the middle of the ectocervix and endocervix

Question 24

CIN 1/2/3?

Answer 24

1 - only basal layer
2 - midway
3 - full thickness of epithelium (carcinoma in situ > has not invaded so isn’t cancer)

Question 25

What does the grade of the pre-cancer/dysplasia/cervical intraepithelial neoplasia/squamous intraepithelial lesion depend on?

Answer 25

Depends on the severity and extent of the atypia (abnormality of the cells)

Question 26

How does CIN/SIL become cancer?

Answer 26

accumulation of mutations that allows invasion of BM into the stroma i.e. neoplastic cells can now invade lymphatics or BVs and metastasise.

Question 27

Congenital abnormalities?

Answer 27

• intersex abnormalities
• malformation of the uterus (bicornuate uterus)
• abnormalities of ovary development