Ovary and Fallopian Tube Pathology 1 Flashcards
Describe the tumor classification for four types of "ovarian tumors."
1
Q
List the four major types of ovarian tumors.
A
- Surface epithelial neoplasms
- Sex-cord stromal tumors
- Germ cell tumors
- Metastatic tumors
2
Q
What are the major non-neoplastic ovarian cysts?
A
-
Follicular cyst
- common lesions of Graafian follicle origin
- usually multiple and <2cm
- may produce increased estrogen if theca component is luteinized
- increased serum estrogen, pain, or hemoperitoneum
- consist of granulosa and theca cells
- polycystic ovarian syndrome
-
Corpus lutein cysts (CLC)
- non-pregnant CLC
- pregnancy CLC
- corpus luteum may appear as ovarian neoplasm
- rupture may cause peritoneal inflammation
-
Non-neoplastic epithelial cysts
- ovarian surface epithelial cyst
- ciliate tubal inclusion cyst/Paratubal cyst
- remnant cyst
3
Q
What is the clinical presentation, pathophysiology, histology, and long-temr sequelae of PCOS?
A
-
Clinical
- 5% of reproductive age women
- obese
- hirsute (rarely virilized)
- diabetic (insulin-resistant)
-
Pathophysiology
- persistent anovulation
- oligomenorrhea
- high level of LH & estrogen
- LH and insulin result in overproduction of androgens that are converted in peripheral tissue to estrogen
-
Histology
- multiple follicles
- fibrosis
- absence of corpus luteum
-
Long-term sequelae
- endometrial hyperplasia/carcinoma
4
Q
What are the common sources of ovary/FT surface epithelial tumors?
A
- Glands of endometriosis
- Remnants: rete ovary, walthard and mesonephric ducts (secondary Mullerian system)
- Endosalpingiotic, paraovarian, and paratubal cysts
- The fimbriated end of secretory epithelia (FTE)
- gives rise to significant percentage of hihg-grade serous carcinomas
- fimbria responsible for deposition of neoplastic cells on the surface of the ovary
- Ovarian surface epithelia?
5
Q
What are the sources of “sex-cord” stromal tumors?
A
- Stroma of the ovary: fibroblasts and myofibroblasts
- Sex cord: the non-germ cell elements of the Graafian follicle
6
Q
What are the common sources off germ cell neoplasias?
A
germ cells within the follicle are the progenitor cells
7
Q
What are the major epithelial ovarian tumor classifications?
A
-
Serous:
- epithelium of tumor resembles fallopian tube epithelium , the most common neoplasms in ovary
-
Mucinous:
- resembles endocervical (associated with endometriosis and teratoma) or colonic mucosa
-
Endometrioid:
- resembles proliferative endometrial glands; 30% associated with endometriosis
-
Clear Cell:
- similar histology at all sites; ~50% to 70% associated with endometriosis
-
Transitional:
- Brenner tumor most common type; cells resemble transitional (urothelial) cells
8
Q
What is the detection rate and death rate of ovarian carcinoma?
A
- Accounts for 50% of female genital tract deaths; The death rate for OC has not changed in the past 50 years.
- 75% of OC are detected in late stages and 50% are high grade serous carcinoma
- Recent studies, however, have raised a compelling hypothesis that fallopian tube secretory epithelial cells (FTSECs) may harbor a cell of origin for most high grade serous carcinoma.
9
Q
What are the major subdivisions of serous epithelial tumors and what are the major features of each?
A
-
Benign (60%):
- serous Cystadenoma and Cystadenofibroma
-
Borderline or Low Malignant Potential (15%)
- intraepithelial proliferation
- 30% to 40% have extra-ovarian spread, called “implants” in omentum, peritoneum or lymph nodes
-
Malignant: Invasive (25%)
- 50% bilateral; represents 50-60% of all malignant ovarian tumors
- can be divided into low grade and high grade
10
Q
Describe the histology of serous cystadenoma.
A
- Multiple cysts with smooth lining
- Showing serous cyst adenofibroma (top) and cyst adenoma with simple papillary architecture (bottom).
- high-power (right) showing fallopian tube-like epithelium
- Lesion usually lined with a pseudostratified row of tall ciliated columnar cells - resembles fallopian tube epithelium
11
Q
Describe the histology of serous papillary “borderline” tumors.
A
-
Gross
- solid and cystic mass
- yellow tan papillary fronds
-
Typical Histology
- intraepithelial proliferation
- pseudo- and true stratified
- tufting
- mild to moderate nuclear atypia
- non or microinvasive
- hierarchical papillary/micropapillary epithelial proliferation
- 30-40% have “implants” of serous tumor on extra-ovarian peritoneal surfaces
- Progression to low-grade invasive serous adenocarcinoma on recurrance has high mortality rate
12
Q
In serous “borderline” tumors what are important considerations for involvement of extra-ovarian sites?
A
-
Implants vs Metastasis
- common in omentum, pelvic sidewall, diaphragm and uterine serosal surface
- can be found in pelvic lymph node
- can progress to low grade serous carcinoma
13
Q
What are some features of malignant serous tumors?
A
- Solid component with invasion into ovarian stroma
- Increased cellular proliferation with cytologic atypia
- Cytologic atypia and psamomma bodies
- High-grade serous carcinomas can also come from mucosa lining fibriated end of the fallopian tube
- spread diffusely throughout peritoneal cavity
14
Q
What are some important features of ovarian mucinous tumors?
A
-
Middle-aged adults
- rare before puberty / after menopause
-
Three groups:
- endocervical
- usually benign
- cystic neoplasms lined by talkk mucin-filled cells
- associated with endometriosis
- intestinal
- maybe benign, LMP, or malignant
- usually large and multicystic
- lined by intestinal-type mucosa with goblet cells
- Mullerian
- endocervical
- Can be heterogeneous and consist of benign borderline and malignant components with on tumor
- Malignant tumors are more solid and complex with stromal invasion
- Must exclude appendiceal or colonic metastasis!
15
Q
What are the major histologic findings of mucinous cystadenocarcinoma?
A
-
Major histologic features:
- columnar cells with abundant intracytoplasmic mucin and cytologic atypia
- Stromal invasion;
- more solid growth, loss of glandular architecture,
- necrosis
-
Differentiation:
- glands are mostly intestinal type
- endocervical type usually
- Carcinoma often merges with borderline or benign mucinous tumors
18
Q
What are the important histological features of Brenner cell tumors?
A
- Presents in middle-aged or older adults
- Commonly, an incidental finding (tumor < 2cm.).
- 10% to 25% of tumors associated with mucinous cystadenoma
- Rare “borderline” tumors resemble papillary transitional cell tumors of the bladder
- Nests of epithelial cells (resembling urothelial cells) with bland, “grooved” nuclei in a cellular fibrous stroma (red arrows)
19
Q
What are the common histologic features of small cell carcinoma of the ovary?
A
- High-grade carcinoma; affects patients <40 years of age
- Small pleomorphic cells
- Nearly 50% are bilateral.
- About 2/3s of tumors are associated with hypercalcemia.
- Poor prognosis
