Pathology of the Adnexa
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Transcript of Pathology of the Adnexa
Pathology of the Adnexa
Dr. Soekimin, SpPA ; dr. Jessy Chrestella, SpPADept. Patologi Anatomi Fakultas Kedokteran Universitas Sumatera UtaraMedan 2010
PATHOLOGY OF FALLOPIAN TUBES
Congenital Anomalies Parametritis/Salphingitis Ectopic pregnancy Hydrosalpinx Endometriosis Para ovarian cyst Carcinoma
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Ectopic Pregnancy:
Tubal – common. implantation allows
early placental development, secretion of hCG, and maintainance of the corpus luteum.
Clinically features of a normal pregnancy and the embryo may also complete the early embryonic stages of development.
Pathology of Ovary
Inflam/Infections - rare Ovarian cysts - common.
Non-Neoplastic▪ Follicular, epithelial, Luteal, etc.▪ Polycystic ovary syndrome▪ Ovarian Hyperstimulation synd.▪ Stromal Hyperplasia*▪ Endometriosis
Neoplasms▪ Benign (Cysts)▪ Malignant (Solid)
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OV. NEOPLASMA Serous cystadenoma Cystoma Papillary cystadenoma serosum Surface papilloma Serous adenofibroma Serous cystadenofibroma Pseudomucinous cystadenoma Teratoma
- dermoid cyst- Solid teratoma.
OV. NEOPLASMA Granulosa cell tumor Theca cell tumor Arrhenoblastoma Adrenal rest tumor Dysgerminoma Brenner tumor Fibroma Meigs syndrome Sarcoma Carcinoma (ad.Carcinoma) Metastase carcinoma.
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Ovary:
Cysts – Common – benign very large. Solid – rare – malignant – high mortality. 5th common cause of female cancer. But carcinomas of the ovaries account for
more deaths than do cancers of all other female malignancies together. (US stat).
Nulliparity & family history (BRCA) - Risk factor.
Polycystic Ovary Synd Amenorrhoea, hyperoestrogenism
and multiple follicular cysts. Stromal hyperplasia &
anovovulation Important cause of infertility, Endometrial
hyperplasia/Carcinoma. Clinical features:
Acne, alopecia, hirsutism, Hypertension, Insulin resistance, Type 2 DM. Obesity – Syndrome X.
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PCOS- Low power view
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Note: capsule thickening, cystic follicles without ova, thecal hyperplasia.
Endometriosis: chocolate cysts Metastases of hyperplastic
endometrium into ovary. Retrograde
menstruation /Metaplasia. Estrogen related. Pouch of Douglas, the
pelvic peritoneum and the ovary - 'chocolate cysts'.
Periodic Pain, pelvic inflammation, infertility.
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Endometriosis:Chocolate Cysts
Endometriosis:
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Chocolate Cysts
Neoplasms of Ovary
Common, produce estrogen. 80% are benign, cystic, young (20-45) 20% are Malignant, solid - older (>40) 6% of all cancers in women. 50% deaths due to late detection. The rule:
Cystic tumors are commonly benign
Solid tumors are commonly malignant.16
Risk Factors
Less clear than other Null parity Gonadal Dysgenesis Family History Ovarian cancer genes
BRCA1 (17q12) & BRCA2(13q12)
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Classification of Ovarian Tumours
Epithelial tumors Coelomic mesothelium
Serous (tubal) Mucinous (Cx) Endometrioid (End) Transitional (UT)
90% of malignant tumors of ovary Morphologically
Cystic – Cystadenomas - Benign Solid/cystic – Cystadenoma - Borderline. Solid –Cystadenocarcinoma – Malignant.
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Serous Tumors
Frequently bilateral (30-66%). 75% benign/bord., 25% malignant. One or few cysts, papillary/solid. Tall columnar ciliated epithelium. Papillary, solid, hemorrhage, necrosis or
adhesions – malignancy. Extension to peritoneum – bad prog.
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Mucinous Tumors
Less common 25%, very large. Rarely malignant - 15%. Multiloculated, many small cysts. Rarely bilateral – 5-20%. Tall columnar, apical mucin. Pseudomyxoma peritonei.
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Serous Cystadenoma
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Serous Cystadenoma
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Serous Cystadenoma
Borderline / Intermediate grade: note larger papillary growth.
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Serous Cystadenoma
multiloculated, 24cm cystic ovary with attached fallopian tube and uterus. – benign serous cystadenoma.
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Mucinous Cystadenoma
Note: papillary growths on inner surface
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Mucinous Cystadenoma
Note: Multi-loculated cystic tumor with some cysts showing hemorrhage.
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Serous - Cystadenoma - Mucinous
Cuboidal simple – Columnar Mucous
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Serous Cystadeno-carcinoma
High grade: note large papillary growth extending and covering the cyst.
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Serous Cystadenoma Borderline
High grade: note large papillary growth extending and covering the cyst.
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Papillary cystadenoma (bor)
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Papillary serous cystadenoma (solid/cystic)
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Serous Cystadeno-carcinoma
High grade: note large papillary growth extending and covering the cyst.
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Papillary cystadenoma (bor)
Infiltration
Papillary projections
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Serous cystadeno Ca – bilateral
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Serous cystadeno Ca.
Solid tumor with atypical cells forming sheets and gland like structures without stroma. (back to back arrangement of
glands)
Germ cell Tumors:
Teratoma – Benign cystic (dermoid cyst) Solid immature Monodermal – struma ovarii, carcinoid
DysgerminomaYolksac tumorMixed germ cell tumor
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Dermoid Cyst:
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Cystic Teratoma
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Dermoid Cyst:
Granulation
tissue lin
ing
Skin lin
ing
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Dermoid Cyst:
Cartilage
Resp. Epith
Sweat Gl.
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Dermoid Cyst:
Sebaceous Gl.Thyroid
MucosaSq. Epithel
M.A.L.T.Cyst Lumen
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Dermoid Cyst:
Black arrow: Stratified squamous Keratinizing epithelium. Blue arrow: Abundant sebaceous glands.
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Immature/Malignant teratoma:
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Immature/Malignant teratoma:
Any type of carcinoma, sarcoma or germ cell malignancy.
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Staging of Ovarian Ca:
Complications of Dermoid cyst Torsion - infarction, perforation,
hemoperitoneum, and autoamputation
Bacterial infection of the cyst Perforation - sudden acute
abdomen, Slow granulomatous peritonitis
Hemolytic anemia – clears after removal.
<5% malignancy – Sq. carcinoma. 48
Other Tumors of Ovary:
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Endometrioid Ca:
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Granulosa Cell Tumor:
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Ovary: Dysgerminoma
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Ovary: Dysgerminoma
• Teenage / young, 2% of ovarian neoplasms.• 1/2 of malignant germ cell neoplasms• Gonadal dysgenesis – risk factor.
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Ovary: Dysgerminoma
Note the pale brown appearance of the parenchyma, along with some central collagenous scar. The gross and microscopic appearance of an ovarian dysgerminoma is essentially same as a seminoma of the testis in a male.
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Granulosa Cell Tumor:
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Granulosa Cell Tumor:
Steroid cell tumour of the ovary. A well-circumscribed benign ovarian stromal tumour that caused virilisation in the patient
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Krukenberg Tumor
Metastases of adenocarcinoma to ovary.
Summary
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