Ovarian Pathology

Question 1

What can ovarian pathology cause?

Answer 1

Pain

Swelling

Endocrine effects

Question 2

What are the main pathological groups of the ovary?

Answer 2

Cysts

Endometriosis

Tumours

Question 3

When can follicular cysts form?

Answer 3

When ovulation doesn’t occur (PCO)

Follicle doesn’t rupture but grows until it becomes a cyst

Question 4

Describe the histology of follicular cysts?

Answer 4

Thin-walled, lined by granulosa cells

Question 5

How long do follicular cells take to resolve?

Answer 5

A few months

Question 6

What is endometriosis

Answer 6

Endometrial glands and stroma outside the uterine body

Question 7

What are the common sites of endometriosis?

Answer 7

• ovary (chocolate cyst)
• pouch of douglas
• peritoneal surfaces, including uterus
• cervix, vulva, vagina
• bladder, bowel

Question 8

What is the pathogenesis of ovarian endometriosis?

Answer 8

• regurgitation
• metaplasia
• vascular or lymphatic dissemination

Question 9

What is the macroscopic appearance of ovarian endometriosis?

Answer 9

Peritoneal spots or nodules

Fibrous adhesions

Chocolate cysts

Question 10

What is the microscopic appearance of ovarian endometriosis?

Answer 10

Endometrial glands and stroma

Haemorrhage, inflammation, fibrosis

Question 11

What are the complications of endometriosis?

Answer 11

• pain
• cyst formation
• adhesions
• infertility
• ectopic pregnancy
• malignancy (endometroid carcinoma)

Question 12

Ovarian tumours can be;

_____ vs _____

______ vs __________

Answer 12

Ovarian tumours can be;

solid vs cystic

benign vs malignant

Question 13

What is the classification of ovarian tumours?

Answer 13

• epithelial
• germ cell
• sex-cord/stromal
• metastatic
• miscellaneous

Question 14

What are the epithelial ovarian tumours?

Answer 14

• serous*#
• mucinous*
• endometrioid*
• clear cell*
• brenner*
• undifferentiated carcinoma

* subdivided on histopathological examination into benign/borderline/malignant

malignant serous carcinomas are typed as low grade or high grade

Question 15

What are benign epithelial ovarian tumours?

Answer 15

No cytological abnormalities, proliferative activity absent or scant

No stromal invasion

Question 16

What are borderline epithelial ovarian tumours?

Answer 16

Cytological abnormalities, proliferative

No stromal invasion

Question 17

What are malignant epithelial ovarian tumours?

Answer 17

Stromal invasion

Question 18

What is serous carcinoma?

Answer 18

Epithelial ovarian tumour with two distinct entities and two different precursor lesions

High grade serous carcinoma

• serous tubal intraepithelial carcinoma (STIC)
• • most cases are essentially tubal in origin*

Low grade carcinoma

• serous borderline tumour

Question 19

What do endometroid and clear cell carcinoma have a strong association with?

Answer 19

Endometriosis of the ovary

Lynch syndrome

Question 20

How is endometroid and serous carcinoma often diagnosed?

Answer 20

Primary diagnosis often made on ascitic fluid

Question 21

What is a brenner tumour?

Answer 21

A tumour of transitional type epithelium, usually benign, borderline and malignant variants are rare

Question 22

Germ cell tumours make up __-__% of all ovarian tumours

Answer 22

Germ cell tumours make up 15-20% of all ovarian tumours

Question 23

What are the types of germ cell tumours?

Answer 23

• Teratoma
• Mature (benign, cystic)- dermoid cyst
  *

Question 24

What percentage of germ cell tumours are dermoid cysts?

Answer 24

95%

Question 25

What are the germ cell tumours other than teratomas and dermoid cysts?

Answer 25

Immature teratoma Dysgerminoma Yolk sac tumour Choriocarcinoma Mixed germ cell tumoure

Question 26

what is the commonest malignant primitive germ cell tumour?

Answer 26

Dysgerminoma

Question 27

Who do dysgerminomas affect?

Answer 27

Children and yound women, average age 22

Question 28

What are the sex cord/stromal tumours?

Answer 28

* fibroma/thecoma * granulosa cell tumour * sertoli-leydic cell tumours

Question 29

Describe fibromas/thecomas?

Answer 29

Benign May produce oestrogen causing uterine bleeding

Question 30

Describe granulosa cell tumours?

Answer 30

Potentially malignant Associated with oestrogenic manifestations

Question 31

Describe sertoli-leydig cell tumours

Answer 31

Rare, may produce androgens

Question 32

When should a metastatic tumour be considered?

Answer 32

in all cases, particularly when tumours are bilateral and small

Question 33

Describe figo staging of ovarian cancer

Answer 33

**1A-** tumour limited to one ovary **1B**- tumour limited to both ovaries **1C**- Cancer involving ovarian surface/rupture/surgical spill/tumour in washings **2A**- Extension or implants on uterus/fallopian tube **2B**- Extension to other pelvic intraperitoneal **3A**- Retroperitoneal lymph node metastasis or microscopic extrapelvic peritoneal involvement **3B**- Macroscopic peritoneal metastasis beyond pelvis up to 2cm in dimension **3C**- Macroscopic peritoneal metastasis \>2cm in dimension **4**- Distant metastasis

Question 34

List the pathologies found in the fallopian tubes?

Answer 34

* inflammation * salpingitis due to infection * cysts and tumours * serous tubal intraepithelial carcinoma * endometriosis * ectopic pregnancy

Question 35

When should ectopic pregnancy diagnosis be considered?

Answer 35

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