![Page 1: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/1.jpg)
SALPINX: SALPINGITISSALPINX: SALPINGITIS
Cause: chlamydia and gonococcus = mostCause: chlamydia and gonococcus = most
Route: cervix Route: cervix lymphatics lymphatics adnexae adnexae
Complications: Complications:
abscess tubes, ovaries, tubo-ovarian, peritonitis,abscess tubes, ovaries, tubo-ovarian, peritonitis,
tubal scarring, hydrosalpinx, adhesions, bowel tubal scarring, hydrosalpinx, adhesions, bowel
obstruction, ectopic pregnancy, infertilityobstruction, ectopic pregnancy, infertility
Tuberculosis: usually part of endometritisTuberculosis: usually part of endometritis
![Page 2: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/2.jpg)
Supprative salpingitis with massively swollen fallopian tube
![Page 3: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/3.jpg)
Purulent exudate flowing from transected fallopian tube
![Page 4: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/4.jpg)
Wall and lumen of fallopian tube is filled with PMNs
![Page 5: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/5.jpg)
Bilateral hydrosalpinx dwarfs uterus: hydrosalpinx may be end result of resolution of infection
![Page 6: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/6.jpg)
Hydrosalpinx
![Page 7: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/7.jpg)
SALPINX: NEOPLASMSSALPINX: NEOPLASMS
Adenomatoid tumors (mesothelioma) Adenomatoid tumors (mesothelioma) subserosally on tube subserosally on tube Incidental finding Incidental finding Small nodules of benign appearing glands within muscular wallSmall nodules of benign appearing glands within muscular wall
Paratubal cysts & hydatid cysts of Morgagni Paratubal cysts & hydatid cysts of Morgagni common serous common serous filled cysts usually near fimbriafilled cysts usually near fimbria
Adenocarcinoma: Adenocarcinoma: Sx late, so prognosis poor Sx late, so prognosis poor
![Page 8: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/8.jpg)
Adenomatoid tumor as seen at surgery in wall of fallopian tube
![Page 9: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/9.jpg)
Adenomatoid tumor of fallopian tube
![Page 10: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/10.jpg)
PREGNANCY-RELATED LESIONS (1)PREGNANCY-RELATED LESIONS (1)
Ectopic pregnancyEctopic pregnancy
Frequency: 1% of all pregnancies!Frequency: 1% of all pregnancies!
Sites: Sites: tube (85%)tube (85%), ovary (14%), abdomen (1%), ovary (14%), abdomen (1%)
Cause: Cause: PIDPID (50%), endometriosis, leiomyomas, (50%), endometriosis, leiomyomas,
I.U.D., adhesionsI.U.D., adhesions
Course: tube and ovary: Course: tube and ovary: placenta perforates wall placenta perforates wall hemorrhage hemorrhage
bleeding is often life-threateningbleeding is often life-threatening
![Page 11: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/11.jpg)
PREGNANCY-RELATED LESIONS (2)PREGNANCY-RELATED LESIONS (2)
Dx: clinical suspicion (acute abdomen) Dx: clinical suspicion (acute abdomen) pelvic exam, pregnancy test, ultrasound, pelvic exam, pregnancy test, ultrasound,
laparoscopylaparoscopy D&C = D&C = deciduous stroma but no villideciduous stroma but no villi
Abdominal pregnancy may implant on psoas Abdominal pregnancy may implant on psoas muscle muscle to term to term Fetus may die and calcify Fetus may die and calcify lithopedion lithopedion
![Page 12: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/12.jpg)
Ectopic pregnancy within fallopian tube
![Page 13: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/13.jpg)
Ruptured ectopic pregnancy of fallopian tube
![Page 14: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/14.jpg)
Ectopic pregnancy near fimbriated end of tube. A corpus luteum is present within the ovary (arrow)
![Page 15: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/15.jpg)
Chorionic villi within lumen of fallopian tube Thin arrows point to chorionic villi
Ectopic pregnancy
![Page 16: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/16.jpg)
Placental insertion into liver
![Page 17: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/17.jpg)
Ectopic pregnancy associated with IUD use
![Page 18: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/18.jpg)
PREGNANCY-RELATED LESIONS (3)PREGNANCY-RELATED LESIONS (3)
Toxemia (pre-eclampsia, eclampsia):Toxemia (pre-eclampsia, eclampsia): Pre-eclampsia = hypertension, proteinuria and Pre-eclampsia = hypertension, proteinuria and
edema (~ 6% of pregnancies)edema (~ 6% of pregnancies) eclampsia = convulsions tooeclampsia = convulsions too
Usually last trimesterUsually last trimester Pathology: Pathology:
DICDIC fibrinoid vascular necrosis and thrombosis with fibrinoid vascular necrosis and thrombosis with
multiple small infarcts of liver, brain, kidney and multiple small infarcts of liver, brain, kidney and placentaplacenta
![Page 19: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/19.jpg)
![Page 20: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/20.jpg)
PREGNANCY-RELATED LESIONS (5)PREGNANCY-RELATED LESIONS (5)
Placenta accreta:Placenta accreta:
Absence of decidua of endometrium so placenta adheres Absence of decidua of endometrium so placenta adheres
directly to myometrium: failure of placental separation directly to myometrium: failure of placental separation
during pregnancyduring pregnancy
Often when placenta implants on scar (C-section)Often when placenta implants on scar (C-section)
60% associated with placenta previa60% associated with placenta previa
Bleeding may be life-threatening Bleeding may be life-threatening hysterectomy hysterectomy
Placenta previa: placenta implants over lower uterine segment Placenta previa: placenta implants over lower uterine segment
or cervix. During labor or cervix. During labor hemorrhage. hemorrhage.
![Page 21: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/21.jpg)
PREGNANCY-RELATED LESIONS (6)PREGNANCY-RELATED LESIONS (6)
Hydatidiform mole (partial and complete)Hydatidiform mole (partial and complete)
Most present with spontaneous abortion or are Dx’ed at U/SMost present with spontaneous abortion or are Dx’ed at U/S
Complete moleComplete mole
Placental villi massively edematous (hydropic) Placental villi massively edematous (hydropic)
center of villi = hyaline; no embryo; trophoblast center of villi = hyaline; no embryo; trophoblast
proliferative.proliferative.
Mechanism: Mechanism: ovum loses nuclear DNAovum loses nuclear DNA; sperm ; sperm
“fertilizes” with 23X, doubles to 46XX“fertilizes” with 23X, doubles to 46XX
Or two sperm fertilize empty ovum, 46XX or 46XYOr two sperm fertilize empty ovum, 46XX or 46XY
all chromosomes paternal.all chromosomes paternal.
![Page 22: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/22.jpg)
PREGNANCY-RELATED LESIONS (7)PREGNANCY-RELATED LESIONS (7)
Complete moleComplete mole Rapid uterine enlargement to excessive size; high Rapid uterine enlargement to excessive size; high
urinary gonadotropin; expelled @urinary gonadotropin; expelled @10-18 weeks 10-18 weeks
bleedingbleeding
2% 2% choriocarcinoma choriocarcinoma (mole histology doesn’t (mole histology doesn’t
predict) Malignant tumor of trophoblastic tissue predict) Malignant tumor of trophoblastic tissue
(cytotrophoblasts and synctiotrophoblasts)(cytotrophoblasts and synctiotrophoblasts)
May be Dx at ultrasound May be Dx at ultrasound Rx: suction curettage; Rx: suction curettage; follow urinary gonadotropinsfollow urinary gonadotropins
![Page 23: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/23.jpg)
PREGNANCY-RELATED LESIONS (8)PREGNANCY-RELATED LESIONS (8)
Partial molePartial mole
About 1/2 villi = normal (with fetal RBC), rest = hydropicAbout 1/2 villi = normal (with fetal RBC), rest = hydropic
Focal trophoblast proliferationFocal trophoblast proliferation
Mechanism:Mechanism: 2 sperm fertilize ovum that retains its 2 sperm fertilize ovum that retains its
nucleus nucleus triploidy (69, XXY or 69,XXX) or rarely triploidy (69, XXY or 69,XXX) or rarely
tetraploid (92, XXXY)tetraploid (92, XXXY)
Embryo formed, dies 4-8 weeks Embryo formed, dies 4-8 weeks fetal parts fetal parts
Less Less in serum HCG than complete mole in serum HCG than complete mole
These rarely lead to choriocarcinomaThese rarely lead to choriocarcinoma
![Page 24: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/24.jpg)
PREGNANCY-RELATED LESIONS (9)PREGNANCY-RELATED LESIONS (9)
Invasive mole: mole that penetrates & may perforate Invasive mole: mole that penetrates & may perforate
uterine walluterine wall
Gross: trophoblastic invasion of myometrium (shallow or Gross: trophoblastic invasion of myometrium (shallow or
perforating)perforating)
Micro: trophoblast invades myometrial veins and spreads Micro: trophoblast invades myometrial veins and spreads
to lungs or brain but does not thrive there, withersto lungs or brain but does not thrive there, withers
Threat: bleeding from ruptured uterus or at distant sitesThreat: bleeding from ruptured uterus or at distant sites
Has persistently elevated HCGHas persistently elevated HCG
Rx: chemotherapy and/or hysterectomyRx: chemotherapy and/or hysterectomy
![Page 25: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/25.jpg)
Hydatidiform mole fills and expands uterus: hydropic villi are evident
![Page 26: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/26.jpg)
Hydatidiform mole: uterus is filled with thin-walled, translucent, polypoid masses consisting of hydropic villi
![Page 27: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/27.jpg)
Hydropic villi of mole
![Page 28: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/28.jpg)
Markedly swollen (hydropic) villi of mole
![Page 29: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/29.jpg)
Central cavitation (cisterns) of complete mole
![Page 30: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/30.jpg)
PREGNANCY-RELATED LESIONS (10)PREGNANCY-RELATED LESIONS (10)
ChoriocarcinomaChoriocarcinoma
Malignant transformation of trophoblastic tissue from any form of Malignant transformation of trophoblastic tissue from any form of
pregnancy, 1 in 20-30,000 pregnancies in USpregnancy, 1 in 20-30,000 pregnancies in US
1 in 40 hydatidiform moles1 in 40 hydatidiform moles
Lacking its own vessels, necrosis and hemorrhage commonLacking its own vessels, necrosis and hemorrhage common
Early metastasis—widely hematogenouslyEarly metastasis—widely hematogenously
First symptom usually hemorrhage, but may be metastases First symptom usually hemorrhage, but may be metastases
Markedly elevated serum HCGMarkedly elevated serum HCG
![Page 31: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/31.jpg)
PREGNANCY-RELATED LESIONS (11)PREGNANCY-RELATED LESIONS (11)
Choriocarcinoma (cont.) Choriocarcinoma (cont.)
Dx: Dx: dimorphic histologydimorphic histology (cytotrophoblasts & (cytotrophoblasts &
syncytiotrophoblasts) without chorionic villisyncytiotrophoblasts) without chorionic villi
Rx: chemo Rx Rx: chemo Rx 70% survival 5 yr even if metastatic 70% survival 5 yr even if metastatic
Placental site trophoblastic tumor = intermediate Placental site trophoblastic tumor = intermediate
trophoblast, lower gonadotropin level trophoblast, lower gonadotropin level
Local invasionLocal invasion
10% metastasize10% metastasize
![Page 32: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/32.jpg)
Hemorrhagic tumor nodules of choriocarcinoma has distorted uterus
![Page 33: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/33.jpg)
Dimorphic histology of choriocarcinoma. Cytotrophoblasts have clear cytoplasm.
![Page 34: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/34.jpg)
Choriocarcinoma: syncytiotrophoblasts (arrows) flanked by cytotrophoblasts and necrotic tissue
![Page 35: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/35.jpg)
Multiple hemorrhagic nodules of metastatic choriocarcinoma in lungs
![Page 36: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/36.jpg)
![Page 37: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/37.jpg)
Germinal epithelium of fetal ovary
![Page 38: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/38.jpg)
Numerous follicles in various stages of development
![Page 39: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/39.jpg)
Maturing follicle with thecal cells (pink arrow) and granulosa cells (blue arrow)
![Page 40: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/40.jpg)
Mature Graafian follicle (arrow depicts oocyte)
![Page 41: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/41.jpg)
Site of rupture of ovum on surface of ovary
![Page 42: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/42.jpg)
Cut surface of corpus luteum
![Page 43: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/43.jpg)
Corpus luteum with luteinized granulosa cells & theca cells (arrow)
Granulosa cells
![Page 44: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/44.jpg)
Atretic follicle – scarring in center where ovum was and stuff around it
![Page 45: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/45.jpg)
OVARY: CYSTS, NON-NEOPLASTICOVARY: CYSTS, NON-NEOPLASTIC
Follicular:Follicular: cystic dilatation of unruptured graafian follicle cystic dilatation of unruptured graafian follicle Luteal cyst:Luteal cyst: cystic dilatation of corpus luteum cystic dilatation of corpus luteum Polycystic ovaryPolycystic ovary (Stein-Leventhal) syndrome: (Stein-Leventhal) syndrome:
Pathology: multiple follicular cysts and foci of hyperthecosis Pathology: multiple follicular cysts and foci of hyperthecosis with stromal fibrosis with stromal fibrosis
3-6% of reproductive-age women3-6% of reproductive-age women Clinical: persistent anovulation, hirsutism (50%), obesity Clinical: persistent anovulation, hirsutism (50%), obesity
(40%), infertility(40%), infertility Mechanism: Mechanism: excessive LHexcessive LH causes theca lutein causes theca lutein androgen androgen Rx: hormonal (used to be surgical – didn’t help)Rx: hormonal (used to be surgical – didn’t help)
![Page 46: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/46.jpg)
Follicular cyst
![Page 47: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/47.jpg)
Opened follicular cyst
![Page 48: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/48.jpg)
Wall of luteal cyst with luteinized granulosa cells
![Page 49: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/49.jpg)
Cut surfaces of polycystic ovary
![Page 50: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/50.jpg)
Polycystic ovary
![Page 51: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/51.jpg)
![Page 52: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/52.jpg)
Type % of Malignant Ovarian Tumors % Bilateral
____________________________________________________________________
Serous 40
Benign (60%) 25
Borderline (15%) 30
Malignant (25%) 65
Mucinous 10
Benign (80%) 5
Borderline (10%) 10
Malignant (10%) 20
Endometriod carcinoma 20 40
Undifferentiated carcinoma 10
Clear cell carcinoma 6 40
Granulosa cell tumor 5 5
Teratoma
Benign (96%)
Malignant (4%) 1 rare
Metastatic 5 >50
![Page 53: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/53.jpg)
OVARY: NEOPLASMS: OVERVIEWOVARY: NEOPLASMS: OVERVIEW
Surface (coelomic) epitheliumSurface (coelomic) epithelium benign cysts, both benign cysts, both
serous and mucinous, serous & mucinous tumors, serous and mucinous, serous & mucinous tumors,
endometrioid, clear-cell, Brenner tumorsendometrioid, clear-cell, Brenner tumors
Germ cellGerm cell dysgerminoma, teratoma, chorioca, dysgerminoma, teratoma, chorioca,
endodermal sinus tumorendodermal sinus tumor
Sex-cord-stromaSex-cord-stroma fibroma, granulosa-theca, Sertoli-fibroma, granulosa-theca, Sertoli-
Leydig cell tumorsLeydig cell tumors
![Page 54: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/54.jpg)
OVARY: CYSTIC TUMORS (1)OVARY: CYSTIC TUMORS (1)
Serous cystadenomasSerous cystadenomas (__ca): watery fluid, partly ciliated (__ca): watery fluid, partly ciliated
epithelium (salpinx-type)epithelium (salpinx-type)
Mucinous:Mucinous: slimy content; columnar mucinous (cervical) slimy content; columnar mucinous (cervical)
epitheliumepithelium
Malignancy odds related to: Malignancy odds related to:
gross: gross: solid/cystic ratio, fixation to neighboring solid/cystic ratio, fixation to neighboring
structures – structures – the more solid the more likely to be the more solid the more likely to be
malignantmalignant
micro: micro: amount and extent of lining papillation; amount and extent of lining papillation;
nuclear atypia, invasion of stromanuclear atypia, invasion of stroma
![Page 55: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/55.jpg)
OVARY: CYSTIC TUMORS (2)OVARY: CYSTIC TUMORS (2)
Above changes progress: benign Above changes progress: benign borderline borderline malignant. Prognosis inverse (malignant malignant. Prognosis inverse (malignant 70% 70% 5 yr survival, 25% if fixed)5 yr survival, 25% if fixed)
General: mucinous larger, less often malignant General: mucinous larger, less often malignant pseudomyxoma peritoneipseudomyxoma peritonei (tumor produces massive (tumor produces massive mucin with peritoneal implants) mucin with peritoneal implants) may cause fatal may cause fatal obstructionobstruction
Bilaterally Bilaterally toward malignancy toward malignancy
![Page 56: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/56.jpg)
Benign
Borderline
Malignant
![Page 57: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/57.jpg)
![Page 58: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/58.jpg)
Serous cystadenoma (3-10 cm is typical)– most common tumor of ovary, smooth cyst with no necrosis and typically no solid areas, smooth lining. Contains watery fluid and explode when cut into.
Typically asymptomatic so picked up incidentally on pelvic exam or vague minor discomfort
![Page 59: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/59.jpg)
Serous cystadenoma
![Page 60: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/60.jpg)
Opened serous cystadenoma with a smooth lining and very thin walled
![Page 61: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/61.jpg)
Serous epithelium of cystadenoma with some papillations (papillary serous cystadenoma)
![Page 62: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/62.jpg)
Ciliated epithelium of a serous cystadenoma
![Page 63: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/63.jpg)
Numerous psammona bodies in paillary serous tumor – not clinically significant, found in both benign and malignant papillary tumors
![Page 64: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/64.jpg)
Benign serous tumors may become large (20cm)
![Page 65: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/65.jpg)
52 lb benign serous cystadenoma
![Page 66: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/66.jpg)
Papillary excrescences from lining of serous tumor (papillary serous cystadenoma) – always section any one that looks papillary to check
![Page 67: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/67.jpg)
Borderline papillary serous cystadenocarcinoma with epithelial atypia
![Page 68: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/68.jpg)
Borderline tumor: no stromal invasion is present
![Page 69: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/69.jpg)
Multiloculated and solid papillary serous cystadenocarcinoma
![Page 70: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/70.jpg)
Solid areas in papillary serous cystadenocarcinoma
![Page 71: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/71.jpg)
Papillary serous cystadenocarcinoma: tumor has breached surface of ovary
![Page 72: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/72.jpg)
Mostly solid papillary serous cystadenocarcinoma
![Page 73: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/73.jpg)
Papillary serous cystadenocarcinoma
![Page 74: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/74.jpg)
Stratified, atypical nuclei in papillary serous cystadenocarcinoma: stromal invasion is present
![Page 75: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/75.jpg)
Mucin producing lining cells in benign mucinous cystadenoma
![Page 76: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/76.jpg)
Borderline mucinous tumor
![Page 77: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/77.jpg)
Mucin production and stromal implants in pseudomyxoma peritonei
![Page 78: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/78.jpg)
Nuclear atypia & mitotic figures in mucinous cystadenocarcinoma
![Page 79: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/79.jpg)
OVARY: ENDOMETRIOID CARCINOMAOVARY: ENDOMETRIOID CARCINOMA
Gross: mixed solid/cystic structureGross: mixed solid/cystic structure
Histo: endometrium-like malignant glandsHisto: endometrium-like malignant glands
25% = concurrent but independent endometrial 25% = concurrent but independent endometrial
ca in uterusca in uterus
Minority = benign cystadenofibromaMinority = benign cystadenofibroma
Variant: clear cell carcinomaVariant: clear cell carcinoma
![Page 80: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/80.jpg)
Endometrioid ovarian Ca
![Page 81: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/81.jpg)
Endometrioid cancer of ovary
![Page 82: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/82.jpg)
Benign cystadenofibroma of ovary
![Page 83: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/83.jpg)
Cystadenofibroma: benign dilated glands within fibrous stroma
![Page 84: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/84.jpg)
Clear cell adenocarcinoma of ovary
![Page 85: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/85.jpg)
OVARY: BRENNER TUMOROVARY: BRENNER TUMOR
Gross: Gross:
solid or cysticsolid or cystic
usually more solidusually more solid
Micro: Micro:
fibrous stroma; fibrous stroma; transitionaltransitional (urothelial) epithelium (urothelial) epithelium
microcystic to macrocytic (adenofibroma)microcystic to macrocytic (adenofibroma)
Majority = benignMajority = benign
![Page 86: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/86.jpg)
Mostly solid Brenner tumor
![Page 87: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/87.jpg)
Solid and cystic Brenner tumor
![Page 88: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/88.jpg)
Brenner tumor with transitional epithelium with microcysts & fibrous stroma
![Page 89: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/89.jpg)
Glandular spaces or microcysts in benign Brenner tumor
![Page 90: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/90.jpg)
![Page 91: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/91.jpg)
OVARY: GERM CELL TUMORS (1)OVARY: GERM CELL TUMORS (1)
TeratomaTeratoma:: Mature: Mature:
““Dermoid cystDermoid cyst”: predominantly skin, hair ”: predominantly skin, hair and teethand teeth
Most benignMost benign 10% bilateral10% bilateral Young adult. 46XXYoung adult. 46XX
Dominant subtypes: Dominant subtypes: thyroid (struma ovarii) thyroid (struma ovarii) hyperthyroidism hyperthyroidism
Carcinoid Carcinoid carcinoid syndrome carcinoid syndrome Malignancy rareMalignancy rare
![Page 92: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/92.jpg)
OVARY: GERM CELL TUMORS (2)OVARY: GERM CELL TUMORS (2)
Teratoma (cont.):Teratoma (cont.):
Immature (malignant teratoma): Immature (malignant teratoma): adolescent and young adultadolescent and young adult
solidsolid
Malignant histologyMalignant histology
early capsule penetration early capsule penetration seeding abdomen seeding abdomen
more more embryonic tissueembryonic tissue
prognosis stage + grade-dependentprognosis stage + grade-dependent
![Page 93: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/93.jpg)
Dermoid cyst filled with hair and keratin
![Page 94: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/94.jpg)
Opened dermoid cyst with keratin and hair
![Page 95: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/95.jpg)
Teeth (arrows), skin and hair in dermoid cyst
![Page 96: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/96.jpg)
Cartilage, glands and keratin cyst in benign teratoma
![Page 97: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/97.jpg)
Teratoma with squamous epithelium, mucin producing glands and cartilage (arrow)
![Page 98: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/98.jpg)
CNS tissue with neurons (arrow) in mature teratoma
![Page 99: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/99.jpg)
Mature thyroid tissue in monodermal teratoma: struma ovarii
![Page 100: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/100.jpg)
Thyroid follicles in struma ovarii
![Page 101: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/101.jpg)
Mostly solid malignant teratoma
![Page 102: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/102.jpg)
Malignant Transformation: Squamous cell carcinoma in malignant teratoma: arrows point to keratin pearls
![Page 103: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/103.jpg)
OVARY: DYSGERMINOMAOVARY: DYSGERMINOMA
Gross: solid, fleshyGross: solid, fleshy Histo: Histo:
identical to testicular seminomaidentical to testicular seminoma solid sheets similar cellssolid sheets similar cells stromal lymphocytesstromal lymphocytes
Behavior: Behavior: no endocrine functionno endocrine function unilateralunilateral radiosensitiveradiosensitive 80% 5 yr survival80% 5 yr survival
![Page 104: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/104.jpg)
Dysgerminoma – white, fleshy
![Page 105: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/105.jpg)
Sheets of polyhedral cells separated by scant fibrous septa (arrow) in dysgerminoma
![Page 106: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/106.jpg)
OVARY: ENDODERMAL SINUS (YOLK SAC) OVARY: ENDODERMAL SINUS (YOLK SAC) TUMORTUMOR
Gross: solid, unilateral; necrosis; children or young Gross: solid, unilateral; necrosis; children or young
adults, 2nd most common germ cell tumoradults, 2nd most common germ cell tumor
Histo: resembles glomeruloid structure of rat yolk Histo: resembles glomeruloid structure of rat yolk
sac (Schiller-Duval body)sac (Schiller-Duval body)
Behavior: Behavior:
Makes alpha fetoprotein and alpha antitrypsin Makes alpha fetoprotein and alpha antitrypsin
(hyaline droplets – can be indentified by stains)(hyaline droplets – can be indentified by stains)
Respond well to chemoRx (much better than Respond well to chemoRx (much better than
vaginal yolk sac tumors do)vaginal yolk sac tumors do)
![Page 107: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/107.jpg)
Prominent hemorrhage in endodermal sinus (yolk sac) tumor – necrosis and hemorrhage are very common b/c modeling itself after yolk sac which is very blood vessel rich
![Page 108: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/108.jpg)
Schiller-Duval body in endodermal sinus tumor
![Page 109: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/109.jpg)
OVARY: CHORIOCARCINOMAOVARY: CHORIOCARCINOMA
Gross: usually part of other germ cell tumors. Gross: usually part of other germ cell tumors.
Bloody, solid, unilateral.Bloody, solid, unilateral.
Histo: like placental tumors (cytotrophoblasts and Histo: like placental tumors (cytotrophoblasts and
syncytial trophoblasts)syncytial trophoblasts)
Behavior: aggressive 4+. Usually metastatic when Behavior: aggressive 4+. Usually metastatic when
found. Ovarian found. Ovarian choriocarcinoma does not choriocarcinoma does not
respond to chemoRx.respond to chemoRx.
Function Function chorionic gonadotropins. In children chorionic gonadotropins. In children
precocious pubertyprecocious puberty
![Page 110: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/110.jpg)
![Page 111: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/111.jpg)
OVARY: SEX-CORD-STROMAL TUMORS (1)OVARY: SEX-CORD-STROMAL TUMORS (1)
Granulosa-theca cell tumor: Granulosa-theca cell tumor: Derived from Derived from ovarian stromaovarian stroma Predominantly granulosa cells, minority Predominantly granulosa cells, minority
theca cellstheca cells Most postmenopausal, unilateral, solid to Most postmenopausal, unilateral, solid to
partly cystic partly cystic Histo: cords or sheets cells (occ. “follicle” = Histo: cords or sheets cells (occ. “follicle” =
Call-Exner body); by IHC + for inhibinCall-Exner body); by IHC + for inhibin
![Page 112: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/112.jpg)
Granulosa-Theca Cell TumorsGranulosa-Theca Cell Tumors
some clumps theca cells, some some clumps theca cells, some luteinizedluteinized
Behavior: subset Behavior: subset estrogen estrogen adults adults cystic endometrial hyperplasia or cystic endometrial hyperplasia or endometrial ca or cystic breast. Few endometrial ca or cystic breast. Few androgen androgen
Few Few malignant but histology can’t malignant but histology can’t predict which onespredict which ones
![Page 113: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/113.jpg)
Granulosa cell tumor
![Page 114: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/114.jpg)
Foci of hemorrhage in granulosa cell tumor
![Page 115: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/115.jpg)
Granulosa cell tumor with Call-Exner bodies (arrow)
![Page 116: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/116.jpg)
Oil red O fat stain of luteinized theca cells in granulosa cell tumor
![Page 117: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/117.jpg)
Granulosa cell tumor: coffee bean nuclei with grooves & Call-Exner bodies
![Page 118: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/118.jpg)
OVARY: SEX-CORD-STROMAL TUMOR (2)OVARY: SEX-CORD-STROMAL TUMOR (2)
Thecoma-fibroma:Thecoma-fibroma:
Gross: solid, fibrous (white), unilateral, more thecoma (yellow)Gross: solid, fibrous (white), unilateral, more thecoma (yellow)
Micro: fibrous; fat stains + for theca cellsMicro: fibrous; fat stains + for theca cells
Behavior: benign; some Behavior: benign; some fibromas fibromas estrogen; also estrogen; also effusion effusion
(Meig’s syndrome = hydrothorax, ascites & ovarian tumor)(Meig’s syndrome = hydrothorax, ascites & ovarian tumor)
May be part of basal cell nevus syndrome: multiple basal cell May be part of basal cell nevus syndrome: multiple basal cell
carcinomas with abnormalities of ovaries, eyes, bone and CNScarcinomas with abnormalities of ovaries, eyes, bone and CNS
![Page 119: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/119.jpg)
Fibroma-Thecoma
![Page 120: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/120.jpg)
Fibroma-Thecoma
![Page 121: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/121.jpg)
Yellow-white cut surface of fibroma-thecoma
![Page 122: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/122.jpg)
Fibroblasts intermixed with lipid laden thecal cells
![Page 123: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/123.jpg)
Oil red O stain demonstrates thecoma elements
![Page 124: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/124.jpg)
OVARY: SEX-CORD-STROMAL TUMORS (3)OVARY: SEX-CORD-STROMAL TUMORS (3)
Sertoli-Leydig cell tumors (androblastoma)Sertoli-Leydig cell tumors (androblastoma) Gross: young adult, unilateral, solidGross: young adult, unilateral, solid Micro: Micro:
Sertoli or Leydig cells in cords in fibrous stromaSertoli or Leydig cells in cords in fibrous stroma Some Some tubules (like testis) tubules (like testis) Some heterologous elementsSome heterologous elements Reinke crystalloidsReinke crystalloids
Behavior: most benign; few = aggressiveBehavior: most benign; few = aggressive Function: 1/2 Function: 1/2 androgens androgens masculinization masculinization
Hilus cell tumor (Leydig cells only):Hilus cell tumor (Leydig cells only): lipid-filled cells with Reinke lipid-filled cells with Reinke crystalloids (usually incidental finding), may cause hirsutism, crystalloids (usually incidental finding), may cause hirsutism, masculinizationmasculinization
![Page 125: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/125.jpg)
Well circumscibed Sertoli-Leydig cell tumor
![Page 126: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/126.jpg)
Tubules composed of Sertoli cells
![Page 127: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/127.jpg)
Prominent Leydig cells in Sertoli-Leydig Cell Tumor
![Page 128: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/128.jpg)
Sertoli-Leydig Cell tumor with Reinke crystalloids
![Page 129: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/129.jpg)
Solid, yellow Hilus Cell Tumor (pure Leydig Cell)
![Page 130: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/130.jpg)
OVARY: METASTATIC LESIONSOVARY: METASTATIC LESIONS
Uterus and tube Uterus and tube ovarian metastases (most common mets to ovarian metastases (most common mets to ovary)ovary)
Gastric mucinous ca Gastric mucinous ca both ovaries = Krukenberg tumor both ovaries = Krukenberg tumor (signet-ring ca) (simulates ovarian primary ca)(signet-ring ca) (simulates ovarian primary ca) Breast, pancreas and gallbladder and especially colon Breast, pancreas and gallbladder and especially colon Pseudomyxoma peritonei from appendix may present with Pseudomyxoma peritonei from appendix may present with
ovarian metsovarian mets
![Page 131: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/131.jpg)
Bilateral metastases to ovaries
![Page 132: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/132.jpg)
Metastaic adenocarcinoma to ovary with signet cells
![Page 133: SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l Complications: u abscess tubes, ovaries, tubo-ovarian,](https://reader038.vdocuments.net/reader038/viewer/2022103005/56649e185503460f94b048bc/html5/thumbnails/133.jpg)