Ovarian pathology

This is a brief video on neoplastic and nonneoplastic diseases of the ovaries.

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ADDITIONAL TAGS:
Polycystic ovary syndrome
Cause: thought to be hyperinsulinemia-related
High insulin decreases SHBG, increases LH, increases androgen production
Obesity causes decreased SHBG, increased androgens
Exclude: CAH, hypothyroidism, hyperprolactinemia, Cushing's
Increased risk of endometrial carcinoma (from high estrone)
Treatment
Hirsutism - flutamide (androgen receptor compet inhibitor), finasteride (5 alpha reductase inhibitor), spironolactone (inhibits steroid binding and syn enzymes), OCPs (lower androgens), metformin (increase insulin sensitivity)
Infertility - clomiphene (SERM in brain), letrozole (aromatase inhibitor)
Endometriosis
Endometrium growing outside of the uterus
Endometrial glands and stroma in ectopic locations
Most often in the ovaries
Occurs via four proposed mechanisms:
Retrograde menstruation
Dissemination through lymph or blood
Iatrogenic (from surgery)
Spontaneous (metaplastic differentiation)
Histo: need two of the following to diagnose:
endometrial stroma
endometrial glands
hemorrhage and/or hemosiderin-laden macrophages
Can progress to endometrioid carcinoma and clear cell adenocarcinoma
Cystadenoma
Histo: single cells (simple layer), flat lining of non stratified serous or mucinous adenoma
Benign bc just single layer of cells
Brenner tumor
Usually contains urothelium-like cell type (yellow-tan, pale color)
Borderline tumor
AKA tumor of low malignant potential (LMP)
Cystadenocarcinoma
Gross: thick, jagged lining; internal papillary excrescences
Can also be serous or mucinous
Histo: proliferative, malignant lining (invasive),
Serous: nuclear hobnailing, psammoma bodies (dystrophic calcification)
Mucinous: grey-purple mucin inside cell cytoplasm
Clinical: most common in 60s to 70s (postmenopausal women); present late; abdominal/pelvic pain/fullness
Serum marker is CA-125 → levels used to guide treatment and recurrence
Serous variant is most common malignant ovarian neoplasm
Poor prognosis
Spreads locally to peritoneum
BRCA1 mutation → increased risk for serous variant … BRCA2 and Lynch syndrome also associated
Endometrioid variant
Usually malignant
Can arise from or is associated with endometriosis
Granulosa cell tumor
Epi: all ages but predominantly women in 50s, late recurrence
Low grade malignancy
Gross: solid, lobulated
Histo: Call-Exner bodies
Thecal cell tumor
Thecoma
Sertoli-Leydig cell tumor
Sertoli cells form tubules, derived from male sex cord cells
Malignant
Leydig cells contain Reinke crystals (rod-like inclusions)
Can produce androgens → hirsutism and virilization
Can produce estrogen → excess estrogen symptoms Fibroma
Benign tumor of fibroblasts
Meigs syndrome: pleural effusion and ascites
Gorlin syndrome: fibromas of PTCH gene
Teratoma
When benign: Mature cystic teratoma
AKA dermoid cyst
Epi: most common germ cell tumor
Derived from fetal tissue and 2 or 3 embryologic layers (endoderm, mesoderm, ectoderm)
Gross: cystic, 10% bilateral
Can contain anything… teeth, hair, bone, thyroid, gut
Histo: squamous keratinizing epithelium (if skin), follicles (if hair)
Clinical: presents with pain from ovarian enlargement or torsion
Benign as long as there are no immature tissues (like neural ectoderm)
Immature teratoma
Gross: solid
Histo: primitive neuroepithelial rosettes (small round layer of blue cells)
Struma ovarii
Yolk sac tumor
AKA endodermal sinus tumor
Histo: Schiller-Duval bodies
Clinical: increased serum AFP
Dysgerminoma
Epi: most common malignant germ cell tumor
Histo: large cells, central nuclei (with large nucleoli), clear cytoplasm containing glycogen, monotonous cells → “fried egg†cells
Clinical: elevated LDH, elevated hCG
seminoma
Choriocarcinoma
Tumor developed from trophoblasts and syncytiotrophoblasts but NO chorionic villi
: spreads hematogenously (one of four tumors that do); specifically to lungs
Epi: can occur in mother or baby; rare
Clinical: hemoptysis, shortness of breath, increased hCG
Embryonal carcinoma
Krukenberg tumor
Consists of mucin filled signet ring cells
Gross: glistening surface, because of mucin production
Polycystic ovary syndrome
Pseudomyxoma peritonei
Malignant cancer that spreads from ovaries to intraperitoneal organs
Can produce abundant mucin or gelatinous ascites
Can fill abdominal cavity, obstruct digestion or organ function
Malignancy comes from mucinous adenocarcinoma in ovary
Can also come from appendiceal tumor