Difference between revisions of "Ovary"

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


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


Micrograph
===Images===
www:
*[http://media.photobucket.com/image/ovary%20histology/lovesthesunset/anatomy%20and%20physiology/ovarycorpusluteum.jpg Ovarian stroma (photobucket.com)].
*[http://media.photobucket.com/image/ovary%20histology/lovesthesunset/anatomy%20and%20physiology/ovarycorpusluteum.jpg Ovarian stroma (photobucket.com)].
<gallery>
Image:Corpus_albicans.JPG| Corpus albicans. (WC)
</gallery>


==Cysts==
=Cysts - overview=
General:
==General==
*Very common.
*Very common.


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*Endometrioma (see [[endometriosis]]).
*Endometrioma (see [[endometriosis]]).
*Simple cyst.
*Simple cyst.
*[[Corpus luteum cyst]].
*Cancerous cyst (see [[ovarian cancer]]).
*Cancerous cyst (see [[ovarian cancer]]).


Notes
Notes:
*Epithelium is often lost in processing - may make interpretation challenging
*Epithelium is often lost in processing - may make interpretation challenging
*Ovarian surface epithelium (previously call ''germinal epithelium'') - covers the ovary
*Ovarian surface epithelium (previously call ''germinal epithelium'') - covers the ovary
**Cuboidal/flat epithelium.<ref>{{cite journal |author=Auersperg N, Wong AS, Choi KC, Kang SK, Leung PC |title=Ovarian surface epithelium: biology, endocrinology, and pathology |journal=Endocr. Rev. |volume=22 |issue=2 |pages=255–88 |year=2001 |month=April |pmid=11294827 |doi= |url=http://edrv.endojournals.org/cgi/pmidlookup?view=long&pmid=11294827}}</ref>
**Cuboidal/flat epithelium.<ref>{{cite journal |author=Auersperg N, Wong AS, Choi KC, Kang SK, Leung PC |title=Ovarian surface epithelium: biology, endocrinology, and pathology |journal=Endocr. Rev. |volume=22 |issue=2 |pages=255–88 |year=2001 |month=April |pmid=11294827 |doi= |url=http://edrv.endojournals.org/cgi/pmidlookup?view=long&pmid=11294827}}</ref>
**Has ovarian stroma underneath.
**Has ovarian stroma underneath.
**Nobnail morphology (free surface larger than basement membrane surface).<ref>ALS. 5 February 2009.</ref>  
**Hobnail morphology (free surface larger than basement membrane surface).<ref>ALS. 5 February 2009.</ref>  


Ovarian surface vs. mesothelium:
Ovarian surface vs. mesothelium:
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*Image: [http://internetattitude.com/bioimage/OldSlides/bio231histo800x600/Mesothelium%20Simple%20Squamous%20x440.JPG mesothelium] - internetattitude.com.
*Image: [http://internetattitude.com/bioimage/OldSlides/bio231histo800x600/Mesothelium%20Simple%20Squamous%20x440.JPG mesothelium] - internetattitude.com.


=Specific benign diagnoses=
==Endometriosis==
==Endometriosis==
{{main|Endometriosis}}
{{main|Endometriosis}}


==Ovarian tumours==
==Corpus luteum cyst==
{{main|Ovarian tumours}}
===General===
*Normal in childbearing age women.
 
===Gross===
*Classically yellow.
 
===Microscopic===
Features:
*Pseudocyst lined by stratified, pale staining (luteinized) cells.
*+/-Hemorrhagic centre.


For a ''very'' brief overview of gynecologic tumours see: ''[[Gynecologic pathology]]''.
Images:
*[http://commons.wikimedia.org/wiki/File:Luteinized_follicular_cyst.jpg Luteinized cells in a follicular cyst (WC)].
*[http://php.med.unsw.edu.au/embryology/index.php?title=File:Ovary_corpus_luteum.jpg Corpus luteum (unsw.edu.au)].


==Benign mesothelial inclusion cyst==
==Benign mesothelial inclusion cyst==
===Epidemiology===  
*[[AKA]] ''mesothelial inclusion cyst''.
*Assoc. with previous surgery.
*[[AKA]] ''[[peritoneal inclusion cyst]]''.{{fact}}
*[[AKA]] ''cortical inclusion cyst''.<ref name=pmid11207821>{{Cite journal  | last1 = Feeley | first1 = KM. | last2 = Wells | first2 = M. | title = Precursor lesions of ovarian epithelial malignancy. | journal = Histopathology | volume = 38 | issue = 2 | pages = 87-95 | month = Feb | year = 2001 | doi =  | PMID = 11207821 }}</ref>{{fact}}
*[[AKA]] ''surface epithelial inclusion cyst''.
 
===General===
*May be found incidentally, e.g. during C-section.
*May be found incidentally, e.g. during C-section.
Epidemiology:
*Associated with previous surgery.


===Gross===
===Gross===
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*Benign mesothelium.
*Benign mesothelium.
**Single layer of squamoid or cuboid mesothelial cells.<ref name=pmid16092670/>  
**Single layer of squamoid or cuboid mesothelial cells.<ref name=pmid16092670/>  
DDx:
*[[Serous cystadenoma of the ovary]] - must be >=1 cm.<ref name=Ref_GP384>{{Ref GP|384}}</ref>
Image:
*[http://www.jultrasoundmed.org/content/27/3/327/F3.expansion.html Cortical inclusion cyst (jultrasounmed.org)].<ref name=pmid18314510>{{Cite journal  | last1 = Asch | first1 = E. | last2 = Levine | first2 = D. | last3 = Kim | first3 = Y. | last4 = Hecht | first4 = JL. | title = Histologic, surgical, and imaging correlations of adnexal masses. | journal = J Ultrasound Med | volume = 27 | issue = 3 | pages = 327-42 | month = Mar | year = 2008 | doi =  | PMID = 18314510 }}</ref>


===[[IHC]]===
===[[IHC]]===
*[[CK]] +ve, [[calretinin]] +ve.<ref name=pmid16092670/>
*[[CK]] +ve, [[calretinin]] +ve.<ref name=pmid16092670/>


==Pregnancy luteoma==
===Sign out===
===General===
<pre>
*Tumour of pregnancy.
OVARY, LEFT, BIOPSY:
*Benign.
- BENIGN CORTICAL INCLUSION CYST.
*Regress after pregnancy; thus, conservative management.<ref name=pmid21144088>{{Cite journal  | last1 = Masarie | first1 = K. | last2 = Katz | first2 = V. | last3 = Balderston | first3 = K. | title = Pregnancy luteomas: clinical presentations and management strategies. | journal = Obstet Gynecol Surv | volume = 65 | issue = 9 | pages = 575-82 | month = Sep | year = 2010 | doi = 10.1097/OGX.0b013e3181f8c41d | PMID = 21144088 }}</ref>
</pre>


Clinical:
==Ovarian infarct==
*Increased serum testosterone.<ref name=pmid15782020>{{Cite journal  | last1 = Kao | first1 = HW. | last2 = Wu | first2 = CJ. | last3 = Chung | first3 = KT. | last4 = Wang | first4 = SR. | last5 = Chen | first5 = CY. | title = MR imaging of pregnancy luteoma: a case report and correlation with the clinical features. | journal = Korean J Radiol | volume = 6 | issue = 1 | pages = 44-6 | month =  | year =  | doi =  | PMID = 15782020 }}</ref>
{{Main|Ovarian infarct}}


===Gross===
==Pregnancy luteoma==
*Solid.
*[[AKA]] ''luteoma of [[pregnancy]]''.
*Yellow.
{{Main|Pregnancy luteoma}}


===Microscopic===
=Ovarian tumours=
Features:
{{main|Ovarian tumours}}
*Sheets of cells.
*Cells with eosinophilic cytoplasm, round nuclei and prominent [[nucleoli]].


DDx:
For a ''very'' brief overview of gynecologic tumours see: ''[[Gynecologic pathology]]''.
*[[Leydig cell tumour]].
 
Images:
*[http://www.webpathology.com/image.asp?case=522&n=1 Pregnancy luteoma - low mag. (webpathology.com)].
*[http://www.webpathology.com/image.asp?n=2&Case=522 Pregnancy luteoma - high mag. (webpathology.com)].


==See also==
=See also=
*[[Gynecologic pathology]].
*[[Gynecologic pathology]].
*[[Testis]].
*[[Testis]].


==References==
=References=
{{reflist|2}}
{{reflist|2}}


[[Category:Gynecologic pathology]]
[[Category:Gynecologic pathology]]

Latest revision as of 10:08, 5 August 2017

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.
    • Hobnail 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

Sign out

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

Ovarian infarct

Main article: Ovarian infarct

Pregnancy luteoma

Main article: Pregnancy luteoma

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. ↑ Nucci, Marisa R.; Oliva, Esther (2009). Gynecologic Pathology: A Volume in Foundations in Diagnostic Pathology Series (1st ed.). Churchill Livingstone. pp. 384. ISBN 978-0443069208.
  8. ↑ 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.
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