Chap. 20: Pathology of the ovary Flashcards

1
Q

Chap. 20: Pathology of the ovary

Functional cysts

Types of functional cysts

A

• Follicular cysts: a follicle can not reach out to ovulation: a process of ovulation failure can give rise to a functional cysts. In fact, a follicle, if not burst, may continue to grow, becoming a functional cyst. So, the follicular cyst is the distension of a follicle to increase the follicular fluid, secondary to degeneration of the oocyte contained in it
• luteal cysts: is developed for the formation of a hematoma or for the collection of a liquid serum
blood in the corpus luteum after ovulation

• Cysts tecoluteinica: is due to a follicle luteinization not broke, resulting accumulation of fluid in its interior

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2
Q

Functional cysts. follicular cysts. features.

A

Features
Unilocular with anechoic content
Diameter
• Up to 7-8 cm: cystic follicle
• From 10 cm: follicular cyst itself
Prognosis
• Spontaneous regression in a few weeks: often just wait for the
next menstruation for regression
• Magnification and pain

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3
Q

functional cysts. causes of follicular cysts

A

Causes
Exaggerated ovarian response to stimulation hormone Abnormalities of ovulation or the corpus luteum

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4
Q

Functional cysts. symptoms of follicular cysts.

A

Symptoms: Most cysts are asymptomatic. Possible symptoms are:
Pain in the iliac fossa: is similar to that of a renal colic with Jordan positive (From space occupation pelvic) Irregularities of the cycle: it is one of the main indicators of the cyst. It is due to excessive production of estrogen or to altered secretion of gonadotropins
Infertility: the functional activity may result in blocking ovulation for excessive negative feedback on gonadotropin

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5
Q

functional cysts. diagnosis and therapy of follicular cysts

A

Diagnosis: ultrasound
or therapy:
Progestogens for 4-6 months
Surgery for cysts larger than 5 cm and painful

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6
Q

functional cysts. features and symptoms of luteal cysts

A

Features
Unilocular
Maximum diameter of 4-5 cm
Content transonic because rich clots
Higher density and vascularity
or Symptoms:same as follicular cysts

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7
Q

functional cysts. diagnosis and therapy of lutheal cysts.

A

or Diagnosis: ultrasound: the sonographic appearance is jagged with a hyperechoic area, which
represents menstrual blood
or therapy if not recede, we proceed to the estrogen-progestin therapy

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8
Q

PCOS definition. ultrasound, diagnosis

A

PCOS
It is a syndrome characterized by the presence of numerous cysts on the ovarian surface, and by alterations endocrine borne mainly by the ovary and adrenal gland.

Ultrasound and the diagnosis is simple: you are having, in fact,
more cysts like a crown on the ovarian surface, on which are found also more follicles in growth
which do not undergo maturation.
The ovaries, in fact, fail to ovulate because the surface epithelium is thickened, covered by a capsule
consistency pearly, and avascolarizzato.

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9
Q

PCOS features

A

Features are:
• Hormonal pattern: the hormonal assays should be carried out immediately after menstruation
or Elevated levels of LH
or Low levels of FSH (with inversion of the relationship FSH / LH) stimulates the growth of new
follicles, which however does not undergo ovulation
or High levels of androgens: cause symptoms such as
Hirsutism
Acne
Irritability
or Low levels of estrogen: determine oligo / chronic anovulation
or High levels of SHBG
or High levels of adrenal hormones (such as 17-hydroxyprogesterone)

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10
Q

PCOS clinical picture

A

Clinical picture
or hirsutism
or Acne
or Infertility: the ovary, in fact, does not have regular ovulation
or Metabolic Syndrome: recently has given great importance to this aspect:

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11
Q

PCOS clinical picture. metabolic syndrome details

A

or Metabolic Syndrome: recently has given great importance to this aspect:
Hyperglycemia: you determine insulin resistance and hyperinsulinemia
Hypertriglyceridemia
Hypercholesterolemia
Hypertension
Overweight (especially between 18 and 20) or obesity

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12
Q

PCOS therapy.

A

Therapy
or regularization of ovulation(in detail in other slide)

or Elimination of imperfections due to acne and irustismo: antiandrogen therapy:
flutamide, finasteride, cyproterone acetate
or reduction of cysts: ovarian drilling: production of micro-cracks on the surface of the ovary
or reduction in prolactin levels: gabergolina or bromocriptine
or NB: progestogens mask the symptoms, but does not give any benefit

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13
Q

Pcos therapy. regularization of ovulation

A

or regularization of ovulation
Clomiphene to stimulate the production of FSH
GnRH analogues
Recombinant gonadotropins

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14
Q

pathology of the ovary.
Benign neoplasms
features. forms.

A

Forms:
Solid
Cystic
Mixed

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15
Q

Pathology of the ovary. diagnosis of benign neoplasms.

A

Diagnosis
Gynecological examination: the cyst appears as a mass (while a malignant cyst
appears as mass):
• Mobile (fixed)
• Do not sore (sore)
• A smooth surface (irregular surface)
• As a taut elastic consistency (hard consistency)
Abdominal ultrasound or transvaginal color Doppler: sonographic findings
suggestive of malignancy are:
• echostructure solid
• Neoangiogenesis
• Presence of vegetations and / or septa
Hormonal assays
Search of tumor markers

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16
Q

Pathology of the ovary. symptoms of benign neoplasms.

A

Symptoms: may be missing entirely and lead to the discovery of the tumor only forms very advanced. However, most frequent manifestations are:

  • Meteorism
  • Abdominal pains
  • Slowed digestion
  • Sense of tenderness and weight
17
Q

Pathology of the ovary. complications of benign neoplasms.

A

complications:
Rupture of the cyst tumor in the peritoneum: is due to cystic tumors and causes
acute abdomen
Ovarian torsion of the pedicle with stenosis of the vessels and subsequent necrosis of
cysts: occurs for large tumors
Hemorrhage endocystic
Malignant degeneration: especially cysts borderline

18
Q

Pathology of the ovary. therapy of benign neoplasms.

A

or therapy
Of women of childbearing age: enucleation of the cyst by laparoscopy or
laparotomy, trying to preserve the ovary
Of postmenopausal women: annessectomia

19
Q

pathology of the ovary. Types of benign neoplasms.

A

or Cystadenoma serous:

or Cystadenoma mucinous:

or Teratomas:

Brenner tumor

ovarian fibroma

20
Q

pathology of the ovary. Types of benign neoplasms. serous cystadenoma

A

Cystadenoma serous: originates from epithelial tissue. It is the most common benign tumor, can
be bilateral, but does not reach large dimensions. Has a content and a fluid
aspect serous and may undergo malignant degeneration (in 25% of cases)

21
Q

pathology of the ovary. Types of benign neoplasms. Cystadenoma mucinous

A

Cystadenoma mucinous: mucinous epithelial ovarian arises from the cells. Less frequently the previous one, can become very large (up to 40-50 cm) and can be multiloculato. Has a content opalescent consists of mucin and appearance slimy; is also equipped with a capsule of smooth and translucent and has a colorful gray-
bluish. May undergo malignant degeneration

22
Q

pathology of the ovary. Types of benign neoplasms. teratomas

A

or Teratomas: the most frequent is the cyst dermaoide, which originates from the germinal tissue. It is a training round, smooth, white-grayish, monoloculare, diameter 5-15 cm. Contains residues embryonic (sebum, hair, hair, teeth, thyroid remnants,
and mandibular bone)

23
Q

pathology of the ovary. Types of benign neoplasms. Brenner tumor

A

Brenner tumor is a rare tumor, with a diameter variable (from a few up to 20 cm), solid,
covered by a capsule, more frequent towards the 50 years, with symptoms poor

24
Q

pathology of the ovary. Types of benign neoplasms. ovarian fibroma

A

ovarian fibroma: is a solid tumor connective tissue, agenesis, with a smooth surface, of whitish color and variable diameter (from a few mm to 40 cm)

25
Q

Pathology of the ovary. benign neoplasms.
Par. II: malignant ovarian tumor. main features. risk factors.

A

Main Features
• Risk factors
or Alteration of BRCA 1 and 2
or Familiarity
or late menopause
or early menarche
or Endometriosis
or nulliparity
or previous pelvic irradiation
or obesity and hypertension
or prolonged estrogen therapies
or breast cancer

26
Q

Pathology of the ovary. benign neoplasms.
Par. II: malignant ovarian tumor. main features. protective factors

A

Protective factors
or use of contraceptive progestogens
or Polycystic Ovarian Syndrome
or Intervention hysterectomy
or Pregnancy

27
Q

Pathology of the ovary. benign neoplasms.
Par. II: malignant ovarian tumor. main features. Classification

A

Classification
or epithelial tumors (85%)

or germ cell tumors (10%)
Embryonal carcinoma
Choriocarcinoma
or ovarian stromal tumors (4%): especially granulosa cell tumors
or mesenchymal tumors (1%)

28
Q

Pathology of the ovary. benign neoplasms.
Par. II: malignant ovarian tumor. main features. classification: epithelial tumours

A

epithelial tumours (85%):

Serous cystadenocarcinoma
Mucinous cystadenocarcinoma
Cystadenocarcinoma endometrial
Cystadenocarcinoma clear cell
Carcinoma of Brenner
Undifferentiated carcinoma

29
Q

Pathology of the ovary. benign neoplasms.
Par. II: malignant ovarian tumor. main features. clinic.

A

• Clinic: the tumor can stay long symptomatic and, when symptomatic, may present with:

  • or increase the volume of the abdomen (tumor, ascites)
  • or signs of compression (intestinal disorders, constipation)
  • or pain (torsion of the pedicle, hemorrhage, rupture)
  • or menstrual irregularities
  • or Metrorrhagia
  • or Cachexia facies ovarian tumor with the classic: emaciated face, profile elongated nose,
  • pale mucous membranes
30
Q

Pathology of the ovary. benign neoplasms.
Par. II: malignant ovarian tumor. main features. Mode of spread

A

• Mode of spread
or peritoneal dissemination: enables cancer cells to arrive up to the diaphragm
(Along with the bowel loops one of the sites most affected by metastases). One of the most
frequent plant is metastatic diaphragmatic pleural effusion, which sleeps for
oozing trans-diaphragmatic in the pleural cavity.
or lymphatic Via: the pelvic lymph nodes and para-aortic
or Via intratubal: come to affect the uterus
or hematogenous Via: liver, lungs, pleura, bones and brain

31
Q

Pathology of the ovary. benign neoplasms.
Par. II: malignant ovarian tumor. main features. Diagnosis.

A

Diagnosis
or gynecological(more detailed in next slide)
or diagnostic laparoscopy
or CT, MRI, PET: useful for staging
or dosage of tumor markers
CA125: serous carcinoma
CA19, 9 and CEA: mucinous carcinoma

32
Q

Pathology of the ovary. benign neoplasms.
Par. II: malignant ovarian tumor. main features. Diagnosis. gynecological diagnosis.

A

or gynecological
Palpable mass solid, fixed, sore, with irregular surface (on which you can
appreciate nodularity) and hard consistency
Abdomen globose for the presence of ascites, and with signs of occlusion
or trans-abdominal ultrasound and trans-vaginal Doppler velocimetry