Gynae - fallopian tube and ovary

Question 1

diseases affecting fallopian tubes

Answer 1

- Inflammations:
Suppurative (Gonococcus & 
chlamydiae), TB salpingitis and actinomycosis (IUCD)
- Ectopic pregnancy and endometriosis
- Tumours and cysts:
Hydatids of Morgagni
adenomatoid tumour adenocarcinoma

Question 2

hydatids of Morgagni

Answer 2

benign cystic structures - remnants of mullerian duct

Question 3

hydrosalpinx

• definition
• cause

Answer 3

blocked fallopian tube that is filled with fluid
- tubal blockage caused by previous pelvic infection (pelvic inflammatory disease)/ endometriosis (endometrium cells growing in FT)

Question 4

pyosalpinx

• definition
• cause
• clinical symptom/ complication
• treatment

Answer 4

pyo = pus
fallopian tube filled w/ pus 
- Caused by infection by  Chlamydia, NG, E. Coli, Staphylococci, Streptococci
- Pelvic pain
Infertility
- treatment: Antibiotics/surgery

Question 5

actinomycotic salpingitis

• cause
• who does it affect (increased risk)
• treatment

Answer 5

• infection by filamentous branched clubbed organism, gram-positive, non-acid fast
• IUCD (Intrauterine Contraceptive Device) users have increased risk
• antibiotics treatment

Question 6

adenomatoid tumour

• benign/malignant
• symptoms
• micro appearance

Answer 6

Most common benign tumour of fallopian tube
- Usually asymptomatic
- Invagination of visceral mesothelium
Tubular spaces of varying sizes composed of flattened cells

Question 7

Salpingitis Isthmica Nodosa

• complications
• location

Answer 7

• infertility, ectopic pregnancy - cause the lumen of the FT gets constricted and small
• Bilateral in 80% of cases with nodular swellings
  swelling caused by diverticulae communicating with lumen cause swellings

Question 8

Non-neoplastic ovarian cysts (4)

Answer 8

• Follicular cysts
• Multiple follicular cysts (polycystic ovary syndrome)
• Corpus luteal cysts (after ovulation)
• Endometriotic cysts

Question 9

Follicular cysts

- cause

Answer 9

• Arise from unruptured
  follicles or from follicles that ruptured and sealed immediately
  -> Filled with serous fluid

big sized cysts may mimick tumour

Question 10

corpus luteal cyst

- associated cause

Answer 10

yellowish thick cyst lining the ovary

Associated with menstrual irregularities

Question 11

polycystic ovary

• clinical symptoms
• pt physical appearance
• histo appearance

Answer 11

• Amenorrhoea + Persistent anovulatory state
• physical appearance:
  Obese, hirsute (hair on chest), acne
• Multiple cysts & stromal hyperplasia

high estrogen and androgen levels

Question 12

ovarian neoplasms (4)

Answer 12

- surface epithelial stromal cell tumours (most common)
(EOT)
- germ cell tumour
- sex cord stroma tumours
- tumours metastasised to ovary

Question 13

ovarian germ cell tumours (5)

Answer 13

• seminoma (m)
• dysgerminoma (m)
• yolk sac tumour (m)
• choriocarcinoma (m)
• teratoma (mature - b, immature - m)

Question 14

dysgerminoma

• gross appearance
• histo appearance

Answer 14

• large and firm/ soft and fleshy
  monotonous tumour cell w/ clear glycogen filled cytoplasm
  fibrous septa w/ lymphocytes

Question 15

mature teratomas

Answer 15

mature teratomas form majority of germ cell tumours

benign: cystic teratoma (colour resembles thyroid follicles w/ colloid),
Struma ovarii
malignant: SCC, thyroid

(immature teratomas are all malignant)

Question 16

yolk sac tumour

• affects who
• malignancy
• characteristics

Answer 16

• Children and young women
• Highly malignant
• Differentiation towards yolk sac
  Rich in alpha-fetoprotein -> tests strongly for AFB
  Schiller-Duval bodies - central fibrovascular space

Question 17

surface epithelium tumours

Answer 17

- Endocervical differentiation: 
Mucinous tumours - cystadenoma (B) and cystadenocarcinoma (M)
- Tubal differentiation: 
Serous tumours - cystadenoma (B) and cystadenocarcinoma (M)
- Endometrial differentiation: 
endometrioid and clear cell (M) type 
- Transitional/urothelial: 
Brenner tumour (B)

B = beign
M = malignant

Question 18

pathogenesis of ovarian epithelial tumours (2 types)**

Answer 18

Type 1 tumours: progress from benign through borderline tumours that give rise to low-grade carcinomas.
Type II tumours: arise from inclusion cysts/FT epithelium that show high grade features (serous)
- majority of malignant epithelial tumours are serous!!**

Question 19

mucinous cystadenoma histo features

Answer 19

lined by mucin epithelium

locule containing mucin

Question 20

borderline ovarian neoplasms histo criteria

Answer 20

• Epithelial hyperplasia – stratification, tufts
• Atypia –mild to moderate
• Minimal mitotic activity
• Absence of destructive stromal invasion

Question 21

mucinous tumours

• clinical presentation
• complications

Answer 21

• massively enlarged abdomen

- rupture -> release mucin into peritoneal cavity

Question 22

endometroid ovarian tumour

• malignancy
• histo features
• prognosis

Answer 22

most of them are malignant

• Contain tubular glands resembling endometrium
• prognosis better than serous carcinoma

Question 23

clear cell ovarian adenocarcinoma

- gross and histo appearance

Answer 23

uncommon
- Grossly solid/cystic
- Large sheets of epithelial cells with clear cytoplasm and tubules with hobnail nuclei (bulbous nuclei w/ projections into cytoplasm)
cystic spaces lined by nucleus

Question 24

brenner tumour

• malignancy
• size
• histo appearance

Answer 24

• Benign
• 1-8cm
• Nests of urothelial-like cells in a dense fibrous stroma

Question 25

sex cord/stromal tumours - malignancy - types

Answer 25

mainly benign - low grade malignancy - thecomas (fibroma) - granulosa cell (most common)

Question 26

thecoma (fibroma) - malignancy - histo features - clinical presentation

Answer 26

- benign - Stromal tumours with fibroblasts (fibroma) or plump spindle cells with lipid droplets (thecoma) - Meig’s syndrome: Fibroma, ascites, pleural effusion

Question 27

granulosa cell tumour - malignancy - gross and histo appearance

Answer 27

- malignant: spreads locally - large tumour (cystic/solid). yellow areas (lipid laden luteinized cells) - Follicular pattern (call-exner bodies) Cleaved, elongated nuclei (coffee bean shape)

Question 28

spread of malignant ovarian neoplasms (4 ways)

Answer 28

``` - Local infiltration into broad ligament: Urethral obstruction Bladder involvement - Peritoneal spread Ascites with malignant cells in fluid Peritoneal nodules - Lymphatic spread - Hematogenous spread Lung nodules ```

Question 29

ovarian tumours caused by metastasis (from other sites) - 2 types (from where it comes from) - location it affects - gross appearance

Answer 29

- Mullerian: Uterus, FT, peritoneum Extramullerian (outside genitalia tract): breast, GIT (GIT - Krukenberg**) - Bilateral - Friable and necrotic with vascular invasion invades through ovarian surface

Question 30

where can teratomas occur

Answer 30

``` - germ cell origin: (sexual gametes) testes/ovaries sacro-coccyx brain mediastinum ```

Question 31

metastatic tumour from GIT | - micro appearance

Answer 31

krukenberg tumour | diffused, signet ring cells