Pathology of Ovary and Fallopian Tube

Question 1

Inflammation of the Fallopian Tube

1. How do most infections get there?
2. Caused by which organisms?

Answer 1

1. ascending routes: vaginal vault, curetting, intra-uterine device
2. Gonococcus (60%), chlamydiae, tuberculous salpingitis (1.2%) of all cases

Question 2

Acute Salpingitis

1. Histo look

Answer 2

1. neutrophils within mucosa and lumen
2. acute inflammatroy debris within lumen
3. may be transmural to serosal surface

Question 3

Cysts of Fallopian Tube

1. Common finding
2. Malignant or benign?
3. What are paratubal cysts?

Answer 3

1. cystic structures filled with clear serous fluid
2. benign
3. cyst with thin wall and containing serous fluid

Question 4

Fallopian Tube Tumors

1. Benign
2. Malignant
3. How common?
4. What does it look similar to?

Answer 4

1. adenomatoid tumor (mesothelial origin)
2. adenocarcinoma (papillary serous type or endometrioid)
3. rare
4. uterine tumors

Question 5

Carcinomas of Fallopian Tube

1. How common?
2. What risk is increased? (3)
3. Location
4. What else may tumor involve?

Answer 5

1. rare, <1% of all GYN cancers
2. ovary, breast, endometrium cancer
3. ampullary/isthmic; 2:1, but most BRCA-related tumors occur in fimbria
4. ipsilateral ovary

Question 6

Carcinomas of Fallopian Tube

1. Most common type
2. Where must tumor be attached?
3. Histo look

Answer 6

1. serous carcinoma
2. in the tube attached to the lining mucosa
3. similar to uterus cancer

Question 7

Follicular Cyst (ovary)

1. Who gets it?
2. How many follicules?
3. What is it lined by?

Answer 7

1. reproductive women
2. usually multiple, < 2 cm
3. granulosa and theca cells

Question 8

Corpus Leuteal Cysts

1. What is it?
2. Gross look

Answer 8

1. delayed resolution of the central cavity of a corpus luteum
2. cyst lined by a rim of bright yellow luteal tissue

Question 9

Polycystic Ovaries

1. Gross look:
2. Clinical manifestations (3)

Answer 9

1. enlarged ovary, thick cortex, and innumberable follicular cysts
2. oligomenorrhea, presistent anovulation, infertility
3. endometrial hyperplasia
4. obesity, hirsutism (rarely, virilism)

Question 10

Polycystic Ovaries

1. Stein-Leventhal Syndrome
2. Etiology

Answer 10

1. PCO w/ oligomenorrhea
2. disturbance of the hypothalamic/pituitary function
3. leading to asynchronous release of LH
4. Stimulating theca cells to produce excessive androgen which converts to estrogen

Question 11

Ovarian Tumors

1. 80% are
2. 20% are
3. Risk factors
4. Where is it common?

Answer 11

1. benign
2. malignant
3. nulliparity and Fx history
4. gonadal dysgenesis
5. Genetic mutations in BRCA-1 and BRCA-2
6. industrialized countries (except Japan)

Question 12

Clinical Manifestations of ovarian tumors

Answer 12

No early warning signs (early spread)
Abdominal pain, bloating, and increased abdominal girth
Regular pelvic examination is the only general screening test for tumor

Question 13

Classification of Ovarian Neoplasms

1. 70% are
2. 20% are
3. 5% are
4. 5% are

Answer 13

1. Surface epithelial tumor
2. germ cell tumors
3. sex-cord stromal tumors
4. metastatic tumors

Question 14

Ovarian Tumors: Tumors of Surface Epithelium: 5 types

Answer 14

Serous (most common)
mucinous
endometroid
Clear Cell
Brenner tumor (resemble transitional epithelium of the urinary bladder)

Question 15

Biological behavior of epithelial tumors

1. Benign
2. Borderline tumors
3. Malignant

Answer 15

1. most common (serous cystadenoma, mucinous cystadenoma)
2. low malignant potential, highly proliferative and atypical lining epithelium, no stromal invasion
3. malignant cells forming glands or papillary structures with destructive stromal invasion including serous papillary carcinoma, mucinous carcinoma, endometrioid carcinoma, and clear cell carcinoma

Question 16

Benign Serous Cystadenoma

1. gross look
2. histo look

Answer 16

1. cyst with thin and smooth surface

2. single layer of lining cells similar to that of fallopian tube mucosa, not cytologic atypia, no invasion

Question 17

Papillary Serious Borderline tumor

1. histo look (3)

Answer 17

1. pseudostratified nuclei, mild cytologic atypia, no invasion into stroma

Question 18

Papillary Serous Carcinoma

1. histo look

Answer 18

1. high grade tumor cells, stromal invasion, abnormal mitosis, pleomorphic nuclei

Question 19

Benign Mucinis Cystadenoma

1. gross look
2. histo look (4)

Answer 19

1. smooth mass (?)
2. single layer of uniform mucin containing epithelial cells
3. multiloculated cysts, single nuclear layer,
4. no atypia
5. no invasion

Question 20

Borderline Mucinous Tumor

1. HIsto look

Answer 20

1. lining cells with pseudostratified nuclei, mild to moderate cytologic atypia, no invasion

Question 21

Mucinous Carcinoma

1. Histo look of intraepithelial carcinoma
2. Histo look of non-invasive carcinoma
3. Histo look of invasive carcinoma
4. Gross look/cut surface

Answer 21

1. high grade nuclear atypia, epithelial stratification (more than 3 layers)
2. Cribriform or confluent growth pattern > 5 mm
3. Stromal invasion
4. Solid and cystic cut surface

Question 22

Metastatic Mucinous Carcinoma

1. Gross look; Which ovaries?
2. What has been invaded?
3. Histo (4)

Answer 22

1. bilateral; <13 cm, multinodular with surface involvement
2. lymphatics/vasculature
3. signet ring cell or single cell invasion with desmoplastic stroma
4. pseudomyxoma peritonei
5. colloid pattern
6. bland cytology and invasive pattern

Question 23

1st Mucinous Carcinoma

1. Gross look/size
2. Prognosis
3. Histo

Answer 23

1. > 13 cm, smooth external surface
2. Benign or borderline
3. complex papillary architecture, can have multiple histologic patterns (teratoma, Brenner, Sertoli-Leydig cell tumor)

Question 24

Pseudomyxoma Peritonei

1. What is it/ Where is it from? (5)

Answer 24

carcinoma of ovary:
mucinous lesion of appendix(99%), 
urachal mucinous ca, 
mucinous ca of renal pelvis, 
intraductal papillary mucinous tumor of pancreas
colonic polyp

Question 25

Germ Cell Tumors 1. What % of ovarian tumors 2. Who gets them? 3. What are most of them?

Answer 25

1. 15-20% of all ovarian tumors 2. children and young adults 3. 90% are benign (mature cystic teratoma), 10% malignant (including Immature teratoma, dysgerminoma, endodermal sinus tumor, embryonal carcinoma, mixed germ cell tumor

Question 26

Mature Cystic Teratoma 1. AKA 2. Who is it most common in? 3. Gross look 4. Histo look 5. Prognosis

Answer 26

1. Dermoid Cyst 2. ppl 10-20 y/o 3. cystic mass containing hair. teeth, and sebaceous material 4. adult tissue derived from all 3 germ cell layers (endoderm, mesoderm, ectoderm) 5. benign

Question 27

Immature Termatoma 1. how common? 2. What kinds of cells? 3. Who gets it? 4. Prognosis 5. Gross look

Answer 27

1. uncommon tumor 2. mature and immature embryonal type tissues 3. prepubertal girls, adolescents, and young women 4. rapidly growing tumor 5. bulky solid mass w/ smooth capsular surface, and foci of necrosis and hemorrhage

Question 28

Immature Teratoma 1. Histo look (2) 4. What is grading based on?

Answer 28

1. mixed mature and immature tissue 2. mature elements: cartilage, glands, bone, muscle tissue 3. immature tissue: predominantly neuroepithelial elements 4. Proportion of the neuroepithelium (grades 1-3)

Question 29

Dysgerminoma 1. How common is it? 2. When does it occur? 3. What is a predisposing factor? 4. Gross look 5. Histo look 6. What treatment is effective?

Answer 29

1. most common malignant germ cell tumor of ovary 2. childhood, second, and third decades of life 3. gonadal dysgenesis 4. solid, unilateral 5. primordial germ cells admixed w/ lymphocytes 6. radiotherapy

Question 30

Endodermal Sinus Tumor (yolk sac tumor) 1. How common is it? 2. Who gets it? 3. Clinical Presentation 4. Gross look 5. Histo look 6. What do these cells produce?

Answer 30

1. second most common malignant germ cell tumor 2. children/young females 3. abdominal pain, pelvic mass 4. unilateral, large necrotic tumor 5. composed of primitive germ cells that form glomeruloid (Schiller-Duval bodies) or embryonal-like structures; has PAS positive hyaline bodies 6. alpha fetoprotein

Question 31

What is a Schiller Duval Body

Answer 31

structure seen in endodermal sinus tumor consisting of a central vessel surrounded by tumor cells

Question 32

Embryonal Carcinoma 1. How common? 2. who gets it? 3. How does it present? 4. What are elevated? 5. Histo 6. Immuno histo stains

Answer 32

1. very rare 2. 4-28 year old women 3. unilateral adnexal mass 4. serum hCG and AFP 5. solid/glandular arrangement, pleomorphic with lots of necrosis 6. CD30+; AGP-

Question 33

Sex Cord Stromal Tumor 1. What % of ovarian neoplasms? 2. Malignant potential? 3. What can they produce? 4. Types (3)

Answer 33

1. 5-8% 2. mostly benign, low malignant potential 3. hormones 4. thecoma-fibroma, granulosa cell tumor, Sertoli-Leydic cell

Question 34

Thecoma-Fibromas 1. Account for what % of all ovarian tumors? 2. Bilateral or unilateral? 3. Who tends to get it? 4. What is it associated with?

Answer 34

1. 4% 2. unilateral- arises in ovarian stroma 3. post-menopausal women 4. benign, Meig's syndrome: hydrothorax and ascites