Vijesh Patel Female reproductive system III Normally histology: o As an embryo the ovary contains 1 million oocytes 1/400

will remain in the infant 1/40 1/50 are released o Graafian follicle contains the maturing oocyte and is surrounded by 2 tissue types Outer supportive Theca cells Flattened cells Inner supportive Granulosa cells Cuboidal cells Produce estrogen o Corpus luteum forms after the release of the oocyte There is leutinization in which the graunolsa cells take up more lipid and become plump Yellow and produces progesterone
Follicular cysts of ovary Epi Most common ovarian mass Pathogenesis / Antibodies 1) Unruptured Graafian follicles 2) Ruptured follicles that resealed S/S Unilocular cysts (single cavity) - 5-10 cm size - Filled w/ clear serous fluid - No hemorrhage Hyperestrogenism (granulosa cells) Precocious puberty (in child) Endometrial hyperplasia (in adult) Yellow outlined cyst - Hemorrhage Elevated progesterone (lutenized
granulosa cells)

* Rx Wait + watch Surgery (if pain)

Corpus luteal cysts (Granulosa-lutein cysts)

MCC of ovarian enlargement in pregnancy

Delay / failure of involution of corpus luteum

*Risk of adnexal torsion @ 1 tri. + rupture hemoperitoneum

st

Theca luteum cysts

1) Response to high hCG 2) Response to ovulation inducing meds

Elevated body temperature Amenorrhea Pelvic pain Bilateral cysts (Luteinized theca cells) - Straw coloured fluid

*Ass w/ choriocarcinoma (malignant) + hydatidiform mole (benign) Rx Spontaneous regression w/ correction of underlying cause *Ass w/ cancer: - endometrioid carcinoma - clear cell carcinoma Rx Spontaneous regression *Ass w/ endometrial hyperplasia + cancer Rx Wedge biopsy

Endometriosis

Most commonly at the ovary

Endometrial tissue is outside the uterus (Glands + stroma) - Hemosiderin laden M

Chocolate cysts - Dark blood

Polycystic ovarian disease (PCOD) Stein-Leventhal Syndrome

Low FSH + High LH - More androgen production - 17 ketosteroids (hirsutism) - Fat will lead to conversion: Androgen Estrogen 1) 17 hydroxylase is poorly controlled in adrenal medulla 2) Obestiy = DM-11 = insulin = supress SHBG = androgen

Multiple bilateral follicular cysts - No corpus luteum Oligomenorrhea / Amenorrhea Obesity Infertility Hirsuitism Virilism

restore fertility

Ovarian cancer

#3 cancer (#1 cervical, #2 endometrial) 40-65 years of age Nulliparity (constant replication + no dormancy phase) Gonadal dysgenesis (germ cell tumor) Family history (BRCA 1, 2) can occur w/ breast cancer

NOT linked w/ estrogen - OCP may protect from this

High mortality rate (late detection)

Vijesh Patel
Epi Surface Coelomic Epithelium Derived Tumors - All are further subdivided into benign, borderline & malignant Serous tumors Most common Pathogenesis / Antibodies S/S *

Ciliated columnar cells of fallopian tube

Mucinous tumors

Non-ciliated columnar cells of cervix

Uniloculated / multicoluated - Large cyst filled w/ clear fluid - Bilateral (2/3) - Psammoma bodies (dystrophic calcification) - Stratification + hemorrhage + necrosis Multiloculated - Large size (ie. 200 lbs) = abdominal distention - Sticky gelatinous fluid - Psuedomyxoma peritonei = bowel obstruction
- Stratification + hemorrhage + necrosis

CA125

CEA

Endometriod tumors

Endometrial lining glands of uterus

- Bilateral (40%)

CA125 *Ass w/ ovarian tumors + 1/3 occur w/ carcinoma of endometrium Best prognosis Benign

Brenner tumor

Walthards rests Nests of epithelium resembling transitional cells

Solid growth (not cyst like) - Mostly unilateral

Cystadenocarcinoma (Cystadenofibroma) Germ cell Teratoma 1. Mature benign

CEA

#3 MCC of malignant GC tumor Young women Ecto/ medo / endoderm - Unilocular cysts - Bone / tooth / hair formation - Lots of tissue types - Dermatoid cysts w/ stratified squamous tissue + sebaceous glands Unilateral

Specialized teratoma a. Struma ovarii b. Carcinoid tumor 2. Immature malignant

Unilateral DDX: Metastasis = bilateral Cystic - Resemble fetal tissue - Small blue cells - Ribbon like cancer #1 MCC of malignant GC tumor Risk w/: Turners syndrome Dysgenic gonads Pseudohermoproditism #2 MCC of malignant GC tumor Solid tan tumors - Unilateral - Nests of germ cells + background of lymphocytes (Like seminoma)

Hyperthyroidism If there is thyroid follicle that develops - Thyroid gland is normal Carcinoid syndrome amounts of serotonin = flushing + diarrhea Grading based on amount of immature tissue

Dysgerminoma

Prognosis = - Radiosensitive

Yolk sac

Schiller Duval bodies - Blood vessels surrounded by germ cells - Resemble primitive glomeruli Trophoblast (cytotrohoblast + syncytiotrophoblast) - Hemorrhage + necrosis Hyperestremia Endometrial hyperplasia (adult) - Postmenopausal bleeding Precocious puberty (young) Hormone producing

AFP

Embryonal carcinoma Choriocarcinoma

Most aggressive

AFP + hCG hCG Worst prognosis

Sex cord (Stromal) Granulosa Theca cell tumor

FEMINIZING Postmenopausal women

Granulosa cell tumors

Theca-Fibroma

Sertoli Leydig cell tumor (Androblastomas) Leydig cell tumors (Hilar cell tumors)

MASCULINIZING 2nd + 3rd decade

Solid yellow mass - Call-exner body: cystic cavity w/ granulosa cells + filled w/ E fluid - Coffee bean nucleus Thecoma plump spindle cells - Produce estrogen - PAS / Lipid (+) Fibromas fibroblasts - Bilateral Tubules w/ sertoli cells + stroma + leydig cells Unilateral tumor - Reinke crystalloids (rod shaped)

Meigs syndrome - Hydrothroax + ovarian tumor (fibroma) + ascites

Hypersecretion of androgens Virilization, hyrsutism (beard), defeminisation Hypersecretion of androgens

Benign

Benign

Vijesh Patel
Epi Metastatic tumors to ovary Tumors of mullerian origin (FGT) Metastatic breast cancer (Extra mullerian) Krukenberg tumors Pathogenesis / Antibodies Small tumors Small tumors Large tumors - Signet ring type - PAS (+) - BILATERAL b/c of retrograde flow from gastric LN (Gastric origin) S/S *

Most common