Ovarian Pathology

Question 1

Name five types of ovarian cyst

Answer 1

Follicular 
Luteal 
Endometriotic 
Epithelial 
Mesothelial

Question 2

Describe a follicular cyst

Answer 2

Very common, can occur when ovulation does not e.g PCOS

Follicle doesn’t rupture and instead becomes a cyst with thin wall of granulosa cells

Question 3

What is endometriosis?

Answer 3

Endometrial glands/stroma outside of the uterine body

Question 4

What symptoms can endometriosis cause?

Answer 4

Painful heavy periods
Infertility
Pelvic inflammation

Question 5

Name the common sites of endometriosis

Answer 5

Ovary - chocolate cyst 
Pouch of Douglas 
Peritoneal Surfaces 
Cervix, vulva, vagina
Bladder, bowel

Question 6

What is thought to be the pathogenesis behind endometriosis?

Answer 6

• regurgitation of endometrium through uterine tubes
• metaplastic transformation of epithelium
• vascular/lymphatic dissemination of tissue

Question 7

Describe the macroscopic appearance of endometriosis

Answer 7

Peritoneal spots/nodules, fibrous adhesions due to inflammation

Question 8

Describe the microscopic appearance of endometriosis

Answer 8

Endometrial gland and stoma with surrounding haemorrhage, inflammation and fibrosis

Question 9

State the complications that can occur due to endometriosis

Answer 9

Pain, cyst formation (obstruction of surrounding tissue - ovary), adhesions, infertility (tubal inflammation and scarring), increased risk of ectopic pregnancy and malignancy

Question 10

What cancers does endometriosis increase your risk of?

Answer 10

Endometrioid carcinoma

Clear cell carcinoma

Question 11

How are ovarian tumours graded?

Answer 11

Benign
Borderline
Malignant

Question 12

What type of cell do ovarian tumours arise from?

Answer 12

Mesothelium

Question 13

Describe benign ovarian tumours

Answer 13

No cytological abnormality, proliferative activity absent and no stromal invasion

Question 14

Describe borderline ovarian tumours

Answer 14

Cytological abnormality, increased proliferative activity and risk of progression but no stromal invasion

Question 15

Describe malignant ovarian tumours

Answer 15

Clear evidence of stromal invasion

Question 16

Where do serous carcinomas arise from?

Answer 16

Fallopian tube

Question 17

What is the precursor to high grade serous carcinoma?

Answer 17

Serous tubal intraepithelial carcinoma (STIC)

Question 18

What causes high grade serous carcinomas?

Answer 18

p53 mutation

Question 19

What is the precursor to low grade serous carcinoma?

Answer 19

Serous borderline tumour

Question 20

Name two risk factors for endometrioid and clear cell ovarian carcinoma

Answer 20

Endometriosis

Lynch syndrome

Question 21

What pathological factors suggest malignancy?

Answer 21

Cystic spaces, predominantly solid yellow/tan coloured tumour with friable edges and peritoneal deposits

Question 22

Is a brenner tumour benign or malignant?

Answer 22

Benign

Question 23

What does a brenner tumour look like?

Answer 23

Transitional type epithelium, nests of cells in a fibrous stroma

Question 24

What is the commonest germ cell tumour?

Answer 24

Mature cystic teratoma - dermoid cyst

Question 25

What is characteristic of a dermoid cyst?

Answer 25

Pleuripotent potential - sebum, hair, cartilage, bone, teeth

Question 26

What rare malignancy can arise from a dermoid cyst?

Answer 26

Somatic malignancy - SCC, thyroid cancer

Question 27

What is an immature teratoma?

Answer 27

Immature foetal elements present in a tumour

Question 28

Are germ cells usually benign or malignant?

Answer 28

Benign

Question 29

What are the malignant germ cell tumours?

Answer 29

Dysgerminoma | Choriocarcinoma

Question 30

Describe a dysgerminoma

Answer 30

Seminoma equivalent | Most common malignant germ cell tumour, lots of lymphocytes surrounding an abnormal cell

Question 31

Who most commonly has dysgerminoma?

Answer 31

Children and young women

Question 32

Name three sex cord/stromal tumours

Answer 32

Fibroma/thecoma Granulosa cell Sertoli-Leydig

Question 33

Describe a fibroma/thecoma

Answer 33

Arises from cells in the ovarian stroma (fibroblast/theca cells). Solid tumour, collagenous (potato like), produces oestrogen

Question 34

Describe granulosa cell tumours

Answer 34

Line the follicles which make up the corpus luteum and produce hormones - not often aggressive but all potentially malignant

Question 35

What do sertoli-leydig tumours do?

Answer 35

Produce androgens

Question 36

What tumours commonly metastasise to the ovary?

Answer 36

Stomach Colon Breast Pancreas

Question 37

Describe the figo staging

Answer 37

IA - limited to one ovary IB - both ovaries IC - involves ovarian surface/rupture/surgical spill 2A - extension on uterus/fallopian tube 2B - extension to pelvic intraperitoneal 3A - microscopic mets, retroperitoneal lymph nodes 3B - macroscopic mets <2cm 3C - macroscopic mets >2cm 4 - distant mets

Question 38

What pathology can occur in the fallopian tubes?

Answer 38

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

Question 39

What is hydrosalpinx?

Answer 39

Dilatation and fluid filled tubes

Question 40

How are epithelial tumours treated?

Answer 40

Surgery - debunk aim for <1-2cm Chemo Fertility preservation

Question 41

Name two types of chemotherapy

Answer 41

Adjuvant | Neoadjuvant

Question 42

How are non-epithelial tumours treated?

Answer 42

Surgery and chemotherapy