Benign Ovarian Pathology
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Grossly will appear as ovoid, smooth or nodular surface with a dense, white fibrotic cut surface +/- small simple cysts
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Should see ovarian follicles & dense spindled stroma
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Often will see corpus luteum or corpora albicantia (left over from previous menstrual cycles)
Normal Ovarian Histology
Endometriosis/ Endometrioma
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Twisting of the ovary (especially large, cystic ovaries) can disrupt the blood supply
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Doppler will show decreased/no blood flow to the ovary
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Medical emergency! Must operate immediately & untwist the ovary to reduce ischemia. May require removal (oophorectomy)
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Grossly, the ovary will be dark & dusky with hemorrhagic
Ovarian Torsion
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Small, atrophic, not properly developed ovaries --> DEC estrogen
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Associated with Turner Syndrome (45 XO)
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Delayed puberty & Premature menopause
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Histology: Lack of follicle development - will not see ova (eggs/follicles) in the ovarian stroma
Streak Ovaries
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Multiple cysts (often, but not required for clinical diagnosis)
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Clinical= Obesity, Hirsutism, Diabetes/Insulin resistance, secondary amenorrhea
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Histology: Thick capsule, multiple follicular cysts +/- luteinization
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Stein Leventhal syndrome
Polycystic Ovaries
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Most often in fallopian tube, but could occur in ovary
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Clinical pic= +/- hx of PID, Amenorrhea, Vaginal bleeding, Pain
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Diagnosis = elevated/abnormal HCG levels & ultrasound
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D&C (of endometrium) would NOT have fetal parts
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Requires emergency surgery
<-- Click to examine this slide demonstrating an ectopic tubal gestation. Notice the chorionic villi present and abundant hemorrhage from rupture of the tube.
Ectopic Pregnancy
Ovarian Neoplasms
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Ovarian tumors can be either primary (arising from the ovary) or metastatic.
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Primarily discovered late after disease has already spread to the pelvic surfaces
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25,000 women annually; Kills 3/5 of those affected
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Risk factors:
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Protective factors (decrease the risk of ovarian cancer)
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Birth control
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Tubal ligation
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Low dose aspirin
Primary Ovarian Tumors: An Overview
Surface Epithelial Tumors
#1- Surface Epithelial Tumors
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TYPICAL CHARACTERISTICS
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CLASSIFICATION
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Benign
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Borderline
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Invasive
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TYPES
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MOLECULAR
Type 1 Surface Epithelial Tumors
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TYPICAL CHARACTERISTICS
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TYPES
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MOLECULAR
Type 2 Surface Epithelial Tumors
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Most common type (25-50%)
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Unicystic or Multilocular Cysts filled with serous fluid
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Look for/sample any solid areas
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Look for any papillary projections
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Is there surface involvement?
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Clues on Histology:
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Spectrum of Disease (click to open virtual slide):
Serous Tumors
#2- Germ Cell Tumors
#3- Sex Cord- Stromal Tumors
Practice Questions
QUESTION ANSWER
What is the most common form of hereditary colorectal cancer syndromes?
A. Familial Adenomatous Polyposis (FAP)
B. Lynch Syndrome (HNPCC)
C. Juvenile polyposis
D. Cowden syndrome
E. Gardner syndrome
ANS: B
What is the most common extra-colonic malignancy in Lynch syndrome?
A. Endometrial cancer
B. Gastric cancer
C. Pancreatic cancer
D. Ovarian cancer
E. Biliary cancer
ANS: A
What germline mutation is present in Lynch Syndrome?
ANS: DNA mismatch repair genes (MMR)
Female patients with Peutz-Jeghers syndrome are also at inc risk of which GYN tumor?
A. Dysgerminoma
B. Clear cell carcinoma of ovary
C. Leydig cell tumor
D. Germ cell tumors of the ovary
E. Cervical adenoma malignum
ANS: E
What is the manner of inheritance for Peutz-Jeghers syndrome?
ANS: Autosomal dominant
What is the hallmark finding of a Peutz-Jeghers intestinal polyp?
A. Absence of lamina propria around glands
B. Desmoplasia
C. Arborizing smooth muscle in lamina propria
D. Monomorphic cells
E. Mucus retention cysts
ANS: C
REFERENCE:
Dr. Anwar. Online lecture. Osler.org. AP Pathology Review. Female Reproductive Tract.