Ovarian Pathology

Question 1

What can ovarian pathology cause?

Answer 1

Pain
Swelling
Endocrine effects

Question 2

What are the main pathologies that occur with the ovary?

Answer 2

Cysts
Endometriosis
Tumours

Question 3

From what structure can ovarian cysts arise from?

Answer 3

Follicular; pcos
Luteal
Endometriotic 
Epithelial
Mesothelial

Question 4

When do follicular cysts form?

Answer 4

When ovulation doesn’t occur
Follicle doesn’t rupture but grows until it becomes a cyst
Can grow up to several cm in size

Question 5

What is the structure of a follicular cyst?

Answer 5

Thin walled

Lined by granulosa cells

Question 6

What is endometriosis?

Answer 6

Endometrial glands and stroma outside the uterine body

Question 7

What can endometriosis cause?

Answer 7

Pelvic inflammation
Infertility
PAin
Adhesions; increased risk of ectopic pregnancy

Question 8

What is the pathogenesis of ovarian endometriosis?

Answer 8

Regurgitation
Metaplasia
Vascular or lymphatic dissemination

Question 9

What are the macroscopic appearances of ovarian endometriosis?

Answer 9

Peritoneal sports or nodules
Fibrous adhesions
Chocolate cysts

Question 10

What are the microscopic appearances of ovarian endometriosis?

Answer 10

Endometrial glands and stroma
Haemorrhage
Inflammation
Fibrosis

Question 11

What are known complications of endometriosis?

Answer 11

Pain
Cyst formation 
Adhesions
Infertility 
Ectopic pregnancy; scarring of fallopian tubes
Malignancy

Question 12

What ovarian malignancy does endometriosis increase the risk of?

Answer 12

Endometrioid and clear cell carcinoma

Question 13

What are the classification subtypes of ovarian tumours?

Answer 13

Epithelial - most common 
Germ cell - young women
Sex cord/ stromal 
Metastatic
Miscellaneous

Question 14

What are the different forms of epithelial ovarian tumours?

Answer 14

Serous
Mucinous
Endometrioid
Clear cell
Brenner
Undifferentiated carcinoma

Question 15

How are epithelial ovarian tumours subdivided?

Answer 15

Histopathological examination; benign/ borderline/ malignant

Question 16

What is the commonest form of ovarian cancer?

Answer 16

High grade serous carcinoma

Question 17

What is the histopathological appearance of a benign epithelial ovarian tumour?

Answer 17

No cytological abnormalities
Proliferative activity absent or scant
No stromal invasion

Question 18

What is the histopathological appearance of a borderline epithelial ovarian tumour?

Answer 18

Cytological abnormalities
Proliferative
No stromal invasion

Question 19

What is the histopathological appearance of a malignant epithelial ovarian tumour?

Answer 19

Stromal invasion

Question 20

What is the precursor to high grade serous carcinomas of the ovary?

Answer 20

Serous tubal intraepithelial carcinoma (STIC)

Tubal in origin

Question 21

What is the precursor to lo grade serous carcinoma of the ovary?

Answer 21

Serous borderline tumour

Question 22

What ovarian tumour type is assoc with BRCA?

Answer 22

High grade serous; important in primary prevention to remove ovary and fallopian tube

Question 23

What do endometrioid and clear cell carcinoma of the ovary have a strong assoc with?

Answer 23

Endometriosis of the ovary

Lynch syndrome

Question 24

How is the primary diagnosis of ovarian cancer often made?

Answer 24

Ascitic tap

Question 25

What makes a mass highly suspicious of a malignancy?

Answer 25

Extensive solid growth | Some cystic features

Question 26

What is a brenner tumour?

Answer 26

Tumour of transitional type epithelium, usually benign, borderline and malignant warients

Question 27

What structure does transitional epithelium typically line?

Answer 27

Bladder

Question 28

What is the commonest germ cell tumour of the ovary?

Answer 28

Mature benign cystic teratoma

Question 29

What do dermoid cysts contain?

Answer 29

Cystic Sebum Hair Ectoderm, mesoderm and endoderm

Question 30

What is a good diagnostic tip for a dermoid cyst?

Answer 30

If any mass on the ovary has fat = dermoid cyst

Question 31

What are other rare germ cell tumours of the ovary aside from dermoid cyst?

Answer 31

``` Immature teratoma Dysgerminoma Yolk sac tumour Choriocarcinoma Mixed germ cell tumour ```

Question 32

What is a dysgerminoma?

Answer 32

Most common malignant primitive germ cell tumour | Almost exclusively children and young women

Question 33

What are the 3 types of sex cord/ stromal tumours seen in the ovaries?

Answer 33

Fibroma/ thecoma - benign, produces oestrogen causing uterine bleeding Granulosa cell tumour - potentially malignant. Oestrogenic manifestations Sertoli-Leydig cell - can produce androgens

Question 34

What is the macroscopic appearance of an ovarian fibroma?

Answer 34

White blob | Potato like

Question 35

From what primary site can cancers metastasize to the ovary?

Answer 35

Stomach Colon Breast Pancreas

Question 36

When should mets be considered in ovarian tumours?

Answer 36

Bilateral | Small

Question 37

What is the FIGO staging of ovarian ca?

Answer 37

1A; limited to one ovary 1B; limited to both ovaries 1C; cancer involves ovarian surface/ rupture/ surgical spill/ tumour in washings 2A; extension or implants on uterus/ fallopian tube 2B; extension to other pelvic intraperitoneal 3A; cancer cells in lining of abdomen microscopically 3B; tumours of 2cm or smaller are lining of abdomen 3C; cancer in lymph nodes of >2cm in dimension 4; distant mets

Question 38

What are common pathologies of the fallopian tubes?

Answer 38

``` Inflammation; salpingitis Cysts and tumours Serous tubal intraepithelial carcinoma Endometriosis Ectopic ```

Question 39

What is an ectopic pregnancy?

Answer 39

Implantation of a conceptus outside endometrial cavity | Commonest site is ampulla of fallopian tube

Question 40

When should ectopic pregnancy be considered?

Answer 40

In any female of reproductive age with amenorrhoea and acute hypotension or an acute abdomen