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REGUB: Pathology of the Fallopian Tubes and Ovaries (i) (Ovarian cysts…
REGUB: Pathology of the Fallopian Tubes and Ovaries (i)
Ectopic pregnancies
implantation of embryo outside uterus
tubal = 90%
a/w PID, peritubal adhesions, often no cause detected
ovarian
cornual: in 1 of the 2 upper horns of a bicornuate uterus (congenital malformation, heart-shaped, 2 conjoined cavities)
abdo (in mesentery)
Fallopian tubes
inflamm
PID (suppurative, TB)
endometriosis
Ectopic pregnancy
neoplasms
benign
paratubal cysts (e.g. cysts of Morgagni)
salpingitis isthmica nodosa (divertiuclae)
endosalpingiosis (ectopic cystic glands outside the tubes that are lined with fallopian tube-type ciliated epithelium - may occur in ovaries, uterus, myometrium, tube serosa or peritoneum)
adenomatoid tumour
most common benign tumour
derived from mesothelium
looks glandular
many others
Malignant
Adenocarc
same types as ovary
serous
endometrioid
serious
precursor = STIC (serous tubal intraepithelial carc)
primary adenocarc rare - 1% of all genital tract malignancies, but incidence may be underestimated
a/w BRCA 1/2 mutation on chromo 17q
lost p53
a/w 70% of fallopian tube carc
we now know most ovarian epithelial cancers do not arise from overly, actually fallopian tubes
fimbriae get into ovary when cortical surface ruptures to release an egg (cortical inclusion cysts - malignant transformation)
if mutations similar to CRC (e.g. KRAS) - borderline/low grade tumours (endometrioid, clear cell-often a/w retrograde menstruation due to endometriosis)
if mutation in P53 (e.g. BRCA) - high grade, serous
pleomorphism, hyperchromatic, increased mitosis, high N:C ratio
Ovarian cysts
ovary is naturally cystic
not all cysts are neoplastic
physiological/variants
follicle cysts (cystic follicles)
luteal cysts
Simple cysts
inclusion cysts (can lead to cystadenoma)
PCOS
specific entity
multiple cysts
a/w oligomenorrhoea, excess androgen (due to thickened stroma), subfertility
Ovarian torsion
can occur with any ovarian mass: functioning cysts, benign neoplasms, malignant tumours (cystic of solid)
twists on its blood supply - painful, common, necrotic
disorders of the ovary can result in hormonal disturbance and subfertility/infertility
endometriosis
increased risk of ovarian carc (x1.9 - 4.2)
ovarian tumour types a/w endometriosis
endometrioid
clear cell
mucinous
serous