Ovary

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The ovary has a wealth of pathology. It has benign tumours and malignant ones. It is a significant part of gynecologic pathology.

Normal ovary

  • Corpora albicans - pale/white body with lobulated contour.
    • Involuted corpus luteum.
    • Not seen pre-pubertal.
    • Number increase with age.
  • Ovarian follicles.
  • Stroma - hyperchromatic - spindle morphology, whorling.
    • If the cells have a round morphology... think about endometriosis.

Images

www:

  • Corpus albicans. (WC)

Cysts - overview

General

  • Very common.

Most common:

  • Serous cystadenoma.
    • Usually uniloculated.
    • Morphology: ciliated, columnar.
  • Mucinous cystadenoma.
    • Usually multiloculated.[1]
      • Memory device: multiloculated = mucinous.
  • Endometrioma (see endometriosis).
  • Simple cyst.
  • Corpus luteum cyst.
  • Cancerous cyst (see ovarian cancer).

Notes:

  • Epithelium is often lost in processing - may make interpretation challenging
  • Ovarian surface epithelium (previously call germinal epithelium) - covers the ovary
    • Cuboidal/flat epithelium.[2]
    • Has ovarian stroma underneath.
    • Nobnail morphology (free surface larger than basement membrane surface).[3]

Ovarian surface vs. mesothelium:

Specific benign diagnoses

Endometriosis

Main article: Endometriosis

Corpus luteum cyst

General

  • Normal in childbearing age women.

Gross

  • Classically yellow.

Microscopic

Features:

  • Pseudocyst lined by stratified, pale staining (luteinized) cells.
  • +/-Hemorrhagic centre.

Images:

Benign mesothelial inclusion cyst

General

  • May be found incidentally, e.g. during C-section.

Epidemiology:

  • Associated with previous surgery.

Gross

  • May mimic mucinous tumour - to unexperienced.[5]
  • Thin-wall.[6]
  • Clear/translucent fluid.

Microscopic

Features:

  • Benign mesothelium.
    • Single layer of squamoid or cuboid mesothelial cells.[6]

DDx:

Image:

IHC

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OVARY, LEFT, BIOPSY:
- BENIGN CORTICAL INCLUSION CYST.

Ovarian infarct

Main article: Ovarian infarct

Pregnancy luteoma

General

  • Tumour of pregnancy.
  • Benign.
  • Regress after pregnancy; thus, conservative management.[8]

Clinical:

  • Increased serum testosterone.[9]
  • Increased CA125.[10][11]

Gross

  • Solid.
  • Yellow.

Images:

Microscopic

Features:

  • Sheets of cells.
  • Cells with eosinophilic cytoplasm, round nuclei and prominent nucleoli.

DDx:

Images

IHC

Ovarian tumours

Main article: Ovarian tumours

For a very brief overview of gynecologic tumours see: Gynecologic pathology.

See also

References

  1. ↑ IAV. 6 February 2009.
  2. ↑ Auersperg N, Wong AS, Choi KC, Kang SK, Leung PC (April 2001). "Ovarian surface epithelium: biology, endocrinology, and pathology". Endocr. Rev. 22 (2): 255–88. PMID 11294827. http://edrv.endojournals.org/cgi/pmidlookup?view=long&pmid=11294827.
  3. ↑ ALS. 5 February 2009.
  4. ↑ Feeley, KM.; Wells, M. (Feb 2001). "Precursor lesions of ovarian epithelial malignancy.". Histopathology 38 (2): 87-95. PMID 11207821.
  5. ↑ GAG 26 Feb 2009.
  6. ↑ 6.0 6.1 6.2 Urbanczyk K, Skotniczny K, Kucinski J, Friediger J (2005). "Mesothelial inclusion cysts (so-called benign cystic mesothelioma)--a clinicopathological analysis of six cases". Pol J Pathol 56 (2): 81-7. PMID 16092670.
  7. ↑ Asch, E.; Levine, D.; Kim, Y.; Hecht, JL. (Mar 2008). "Histologic, surgical, and imaging correlations of adnexal masses.". J Ultrasound Med 27 (3): 327-42. PMID 18314510.
  8. ↑ Masarie, K.; Katz, V.; Balderston, K. (Sep 2010). "Pregnancy luteomas: clinical presentations and management strategies.". Obstet Gynecol Surv 65 (9): 575-82. doi:10.1097/OGX.0b013e3181f8c41d. PMID 21144088.
  9. ↑ Kao, HW.; Wu, CJ.; Chung, KT.; Wang, SR.; Chen, CY.. "MR imaging of pregnancy luteoma: a case report and correlation with the clinical features.". Korean J Radiol 6 (1): 44-6. PMID 15782020.
  10. ↑ Rodriguez, M.; Harrison, TA.; Nowacki, MR.; Saltzman, AK. (Nov 1999). "Luteoma of pregnancy presenting with massive ascites and markedly elevated CA 125.". Obstet Gynecol 94 (5 Pt 2): 854. PMID 10546765.
  11. ↑ 11.0 11.1 Wang, Y.; Zhou, F.; Qin, JL.; Qian, ZD.; Huang, LL. (2015). "Pregnancy luteoma followed with massive ascites and elevated CA125 after ovulation induction therapy: a case report and review of literatures.". Int J Clin Exp Med 8 (1): 1491-3. PMID 25785161.
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