- Published on
Pathology - Ovarian Cysts
Follicular (F) cyst linked to hyperestrinism and endometrial hyperplasia, commonly causing ovarian enlargement, typically detected during menstrual years.
Corpus luteum (CL) cysts are typically identified during the reproductive years.
Theca-lutein (TL) cyst is linked to choriocarcinoma, hydatidiform moles, and clomiphene treatment.
Follicle distention is frequently bilateral and involves an unruptured Graafian follicle bordered by granulosa cells.
CL: Typically one-sided; filled with transparent fluid; surrounded by yellow luteal cells containing lipid droplets in the cytoplasm; may experience bleeding into an existing mature corpus luteum.
TL: Frequently occurring on both sides and in several locations; surrounded by luteinized theca cells.
Symptoms may vary from being asymptomatic to experiencing pelvic pressure/pain or nonspecific gastrointestinal discomfort.
F: Non-menstrual pain.
CL: Menstrual cycle delay.
TL: Absence of menstruation.
Lab results show higher levels of hCG due to trophoblastic proliferation.
Frequently resolves after a 2-month course of oral contraceptives; monitor with repeated ultrasounds and consider surgical removal if it persists.
CL and TL: Cyst excision or unilateral oophorectomy.
Follicular (F) cyst linked to hyperestrinism and endometrial hyperplasia, commonly causing ovarian enlargement, typically detected during menstrual years.
Corpus luteum (CL) cysts are typically identified during the reproductive years.
Theca-lutein (TL) cyst is linked to choriocarcinoma, hydatidiform moles, and clomiphene treatment.
Follicle distention is frequently bilateral and involves an unruptured Graafian follicle bordered by granulosa cells.
CL: Typically one-sided; filled with transparent fluid; surrounded by yellow luteal cells containing lipid droplets in the cytoplasm; may experience bleeding into an existing mature corpus luteum.
TL: Frequently occurring on both sides and in several locations; surrounded by luteinized theca cells.
Symptoms may vary from being asymptomatic to experiencing pelvic pressure/pain or nonspecific gastrointestinal discomfort.
F: Non-menstrual pain.
CL: Menstrual cycle delay.
TL: Absence of menstruation.
Lab results show higher levels of hCG due to trophoblastic proliferation.
Frequently resolves after a 2-month course of oral contraceptives; monitor with repeated ultrasounds and consider surgical removal if it persists.
CL and TL: Cyst excision or unilateral oophorectomy.
- Published on
Pathology: Polycystic Ovarian Syndrome (Stein-Leventhal Syndrome)
The cause is uncertain, but it is thought that an imbalance of enzymes in androgen production may be triggered by elevated LH secretion, leading to an overproduction of androgens. This condition is linked to obesity, Cushing syndrome, congenital adrenal hyperplasia, genetic predisposition, and adrenal tumors that secrete androgens.
Prevalent endocrine condition that impacts 2%-5% of women in their reproductive years.
Pathophysiology: Elevated androgen levels lead to anovulation, the formation of numerous follicular cysts, and the proliferation of theca cells.
Ovaries are swollen with a thicker pearly white capsule and numerous cysts.
The cysts have a granulosa cell layer, luteinized theca cells, and cortical stromal fibrosis at a microscopic level.
Clinical Symptoms and Signs
Symptoms include amenorrhea or irregular menstruation, infertility, acne, obesity, hirsutism (in 70% of cases), insulin resistance leading to a higher risk of diabetes, virilism, and an increased risk of breast and endometrial cancer.
Laboratory results show elevated LH, reduced FSH, elevated testosterone levels, and signs of insulin resistance.
Treatment includes weight loss, oral contraceptives for cycle regulation in non-conceiving patients, metformin for insulin resistance, gonadotropin analogs, and ovulation induction with clomiphene.
The cause is uncertain, but it is thought that an imbalance of enzymes in androgen production may be triggered by elevated LH secretion, leading to an overproduction of androgens. This condition is linked to obesity, Cushing syndrome, congenital adrenal hyperplasia, genetic predisposition, and adrenal tumors that secrete androgens.
Prevalent endocrine condition that impacts 2%-5% of women in their reproductive years.
Pathophysiology: Elevated androgen levels lead to anovulation, the formation of numerous follicular cysts, and the proliferation of theca cells.
Ovaries are swollen with a thicker pearly white capsule and numerous cysts.
The cysts have a granulosa cell layer, luteinized theca cells, and cortical stromal fibrosis at a microscopic level.
Clinical Symptoms and Signs
Symptoms include amenorrhea or irregular menstruation, infertility, acne, obesity, hirsutism (in 70% of cases), insulin resistance leading to a higher risk of diabetes, virilism, and an increased risk of breast and endometrial cancer.
Laboratory results show elevated LH, reduced FSH, elevated testosterone levels, and signs of insulin resistance.
Treatment includes weight loss, oral contraceptives for cycle regulation in non-conceiving patients, metformin for insulin resistance, gonadotropin analogs, and ovulation induction with clomiphene.
- Published on
Pathology - Ovarian Surface Epithelium Origin Tumors
Risk factors consist of a family history of breast or ovarian cancer, mutations in BRCA1 or BRCA2, and nulliparity.
Typically manifests in females over 20 years old.
Serous cystadenoma: Benign cysts with fallopian tube-like epithelium present bilaterally.
Papillary serous cystadenocarcinoma is characterized by malignant cysts bordered with stratified atypical epithelium, papillary growth, and psammoma structures.
Mucinous cystadenoma is characterized by the presence of several benign cysts with columnar cells packed with mucin.
Mucinous cystadenocarcinoma is a malignant tumor characterized by mucus-secreting atypical columnar epithelium, loss of gland architecture, and necrosis.
Brenner tumor is a benign tumor characterized by clusters of cells that resemble bladder transitional epithelium, found inside a fibrous stroma.
Endometrioid tumor: Cancerous tumor that resembles the endometrium.
Clear cell tumor: Rare, malignant tumor composed of sheets of clear cells.
Clinical Symptoms
Subtle abdominal discomfort; severe cases may show weakness, weight loss, and loss of appetite; pseudomyxoma peritonei (buildup of mucinous material in the abdominal cavity) is linked to mucinous cystadenocarcinoma.
Laboratory results: Increased levels of CA-125 in ovarian cancer.
Treatment involves tumor excision through procedures such as oophorectomy or hysterectomy, followed by chemotherapy.
75% of ovarian cancers are ovarian epithelial tumors.
Risk factors consist of a family history of breast or ovarian cancer, mutations in BRCA1 or BRCA2, and nulliparity.
Typically manifests in females over 20 years old.
Serous cystadenoma: Benign cysts with fallopian tube-like epithelium present bilaterally.
Papillary serous cystadenocarcinoma is characterized by malignant cysts bordered with stratified atypical epithelium, papillary growth, and psammoma structures.
Mucinous cystadenoma is characterized by the presence of several benign cysts with columnar cells packed with mucin.
Mucinous cystadenocarcinoma is a malignant tumor characterized by mucus-secreting atypical columnar epithelium, loss of gland architecture, and necrosis.
Brenner tumor is a benign tumor characterized by clusters of cells that resemble bladder transitional epithelium, found inside a fibrous stroma.
Endometrioid tumor: Cancerous tumor that resembles the endometrium.
Clear cell tumor: Rare, malignant tumor composed of sheets of clear cells.
Clinical Symptoms
Subtle abdominal discomfort; severe cases may show weakness, weight loss, and loss of appetite; pseudomyxoma peritonei (buildup of mucinous material in the abdominal cavity) is linked to mucinous cystadenocarcinoma.
Laboratory results: Increased levels of CA-125 in ovarian cancer.
Treatment involves tumor excision through procedures such as oophorectomy or hysterectomy, followed by chemotherapy.
75% of ovarian cancers are ovarian epithelial tumors.
- Published on
Pathology - Ovarian Germ Cell Tumors
Risk factors comprise nulliparity, positive family history of ovarian cancer, mutations in BRCA I and BRCA2 genes, and high expression of the HER2/neu oncogene.
Most frequently happens in children and young adults, with the exception of teratomas, which can develop at any age.
Dysgerminoma is a malignant tumor seen unilaterally, consisting of large vesicular cells with transparent cytoplasm and central nuclei, similar to male testicular seminoma.
Yolk sac tumor is a malignant tumor characterized by Schiller-Duval bodies, which are glomerulus-like structures consisting of a central blood artery surrounded by germ cells.
Choriocarcinoma is a highly aggressive and malignant tumor characterized by regions of cell death and bleeding, consisting of cancerous syncytiotrophoblasts and cytotrophoblasts.
Teratomas account for 90% of germ cell tumors. Mature teratomas, also known as dermoid cysts, are benign, but immature teratomas are malignant.
Histology involves examining structures derived from all germ layers.
Struma ovarii is a type of ovarian teratoma that consists of thyroid tissue and often affects only one ovary.
Subtle, vague stomach discomfort; struma ovarii can cause hyperthyroidism.
Laboratory results: Elevated AFP indicates yolk sac tumor, while high hCG levels suggest choriocarcinoma.
Therapy
Excision of tumor; surgical removal of ovaries or uterus; chemotherapy.
25% of ovarian cancers are germ cell tumors.
Risk factors comprise nulliparity, positive family history of ovarian cancer, mutations in BRCA I and BRCA2 genes, and high expression of the HER2/neu oncogene.
Most frequently happens in children and young adults, with the exception of teratomas, which can develop at any age.
Dysgerminoma is a malignant tumor seen unilaterally, consisting of large vesicular cells with transparent cytoplasm and central nuclei, similar to male testicular seminoma.
Yolk sac tumor is a malignant tumor characterized by Schiller-Duval bodies, which are glomerulus-like structures consisting of a central blood artery surrounded by germ cells.
Choriocarcinoma is a highly aggressive and malignant tumor characterized by regions of cell death and bleeding, consisting of cancerous syncytiotrophoblasts and cytotrophoblasts.
Teratomas account for 90% of germ cell tumors. Mature teratomas, also known as dermoid cysts, are benign, but immature teratomas are malignant.
Histology involves examining structures derived from all germ layers.
Struma ovarii is a type of ovarian teratoma that consists of thyroid tissue and often affects only one ovary.
Subtle, vague stomach discomfort; struma ovarii can cause hyperthyroidism.
Laboratory results: Elevated AFP indicates yolk sac tumor, while high hCG levels suggest choriocarcinoma.
Therapy
Excision of tumor; surgical removal of ovaries or uterus; chemotherapy.
25% of ovarian cancers are germ cell tumors.
- Published on
Pathology - Ovarian Tumors of Sex Cord–Stromal Origin
Risk factors comprise nulliparity, positive family history of ovarian cancer, mutations in BRCA1 and BRCA2 genes, and high expression of the HER2/neu oncogene.
Impacts individuals of all age brackets.
Ovarian fibroma-thecoma (OFT) is a tumor that secretes estrogen and is made up of spherical lipid-containing cells along with well-differentiated fibroblasts.
Granulosa cell tumor (GCT) secretes estrogen, leading to endometrial hyperplasia or cancer in adults. It is identified by Call-Exner bodies, which are tiny follicles with eosinophilic secretions, and small cuboidal granulosa cells grouped in interconnected cords.
Sertoli-Leydig cell tumor (SLCT) secretes androgens and is made up of Sertoli or Leydig cells mixed with stroma.
Slight, vague stomach ache.
Ovarian tumor, ascites, and hydrothorax characterize Meig syndrome.
GCT: Vaginal bleeding due to endometrial hyperplasia; early puberty; individuals have a higher risk of developing breast cystic disease and endometrial malignancy.
SLCT: Virilism.
Laboratory results: Elevated estrogen levels (OFT and GCT).
Excision of tumor; surgical removal of ovaries or uterus; administration of chemotherapy.
Ovarian sex cord-stromal tumors are uncommon.
Risk factors comprise nulliparity, positive family history of ovarian cancer, mutations in BRCA1 and BRCA2 genes, and high expression of the HER2/neu oncogene.
Impacts individuals of all age brackets.
Ovarian fibroma-thecoma (OFT) is a tumor that secretes estrogen and is made up of spherical lipid-containing cells along with well-differentiated fibroblasts.
Granulosa cell tumor (GCT) secretes estrogen, leading to endometrial hyperplasia or cancer in adults. It is identified by Call-Exner bodies, which are tiny follicles with eosinophilic secretions, and small cuboidal granulosa cells grouped in interconnected cords.
Sertoli-Leydig cell tumor (SLCT) secretes androgens and is made up of Sertoli or Leydig cells mixed with stroma.
Slight, vague stomach ache.
Ovarian tumor, ascites, and hydrothorax characterize Meig syndrome.
GCT: Vaginal bleeding due to endometrial hyperplasia; early puberty; individuals have a higher risk of developing breast cystic disease and endometrial malignancy.
SLCT: Virilism.
Laboratory results: Elevated estrogen levels (OFT and GCT).
Excision of tumor; surgical removal of ovaries or uterus; administration of chemotherapy.
Ovarian sex cord-stromal tumors are uncommon.
- Published on
Pathology - Endometritis
Acute endometritis is typically caused by trauma, Staphylococcus aureus, and Streptococcus species, and commonly occurs following childbirth or miscarriage.
Chronic endometritis is caused by granulomatous disease, chronic pelvic inflammatory disease (PID), postpartum or post-abortal conditions, and tuberculosis (TB).
Endometrium: Plasma cells, macrophages, and lymphocytes observed in the glandular lumen.
Acute: Manifests with inflammation and discomfort following delivery or miscarriage.
Chronic cases are characterized by abnormal vaginal bleeding, discomfort, discharge, and infertility.
Antibiotic treatment can help prevent secondary complications, such as salpingitis.
Endometrial polyps are growths made up of endometrial tissue seen inside the uterine cavity.
Fibroids typically manifest in women over 40 years old and can lead to uterine hemorrhage, but they are commonly noncancerous.
Acute endometritis is typically caused by trauma, Staphylococcus aureus, and Streptococcus species, and commonly occurs following childbirth or miscarriage.
Chronic endometritis is caused by granulomatous disease, chronic pelvic inflammatory disease (PID), postpartum or post-abortal conditions, and tuberculosis (TB).
Endometrium: Plasma cells, macrophages, and lymphocytes observed in the glandular lumen.
Acute: Manifests with inflammation and discomfort following delivery or miscarriage.
Chronic cases are characterized by abnormal vaginal bleeding, discomfort, discharge, and infertility.
Antibiotic treatment can help prevent secondary complications, such as salpingitis.
Endometrial polyps are growths made up of endometrial tissue seen inside the uterine cavity.
Fibroids typically manifest in women over 40 years old and can lead to uterine hemorrhage, but they are commonly noncancerous.
- Published on
Pathology - Endometriosis
The etiology is uncertain, but believed to result from a blend of genetic, hormonal, and immunological elements.
Affects 10% of women, typically aged 20 to 30.
Non-neoplastic nodules are abnormal growths of endometrial tissue found outside the uterus, commonly in the ovary, uterine ligaments, rectovaginal septum, and pelvic peritoneum. These nodules can lead to the formation of chocolate cysts on the ovaries due to cyclic bleeding of ectopic endometrial tissue.
Microscopic features include endometrial glands, endometrial stroma, and the presence of hemosiderin pigment.
Manifests as firm, detectable, ovarian masses on both sides, overall pelvic discomfort, painful menstruation (dysmenorrhea), and discomfort during sexual intercourse (dyspareunia); irregular menstrual cycles can result in infertility, which is the main concern for 30%-40% of individuals.
Therapy
Options for treatment include oral contraceptives, medroxyprogesterone, danazol, GnRH analogues such as leuprolide, and surgical excision or coagulation of the lesion.
Adenomyosis is a condition where endometriosis occurs within the myometrium, often causing uterine enlargement and irregular bleeding.
The etiology is uncertain, but believed to result from a blend of genetic, hormonal, and immunological elements.
Affects 10% of women, typically aged 20 to 30.
Non-neoplastic nodules are abnormal growths of endometrial tissue found outside the uterus, commonly in the ovary, uterine ligaments, rectovaginal septum, and pelvic peritoneum. These nodules can lead to the formation of chocolate cysts on the ovaries due to cyclic bleeding of ectopic endometrial tissue.
Microscopic features include endometrial glands, endometrial stroma, and the presence of hemosiderin pigment.
Manifests as firm, detectable, ovarian masses on both sides, overall pelvic discomfort, painful menstruation (dysmenorrhea), and discomfort during sexual intercourse (dyspareunia); irregular menstrual cycles can result in infertility, which is the main concern for 30%-40% of individuals.
Therapy
Options for treatment include oral contraceptives, medroxyprogesterone, danazol, GnRH analogues such as leuprolide, and surgical excision or coagulation of the lesion.
Adenomyosis is a condition where endometriosis occurs within the myometrium, often causing uterine enlargement and irregular bleeding.
- Published on
Pathology - Leiomyoma
The cause is unidentified, however genetic abnormalities have been detected in the cancerous cells.
The most prevalent non-cancerous growth in the female reproductive system.
Most frequently observed in women over the age of 40, with a higher occurrence rate among African Americans.
The pathology indicates the presence of many enlarged, irregular, and heterogeneous tumors located in the myometrium (intramural), beneath the endometrium (submucosal), or beneath the serosa (subserosal). The tumor is estrogen-sensitive, with its size increasing during pregnancy and reducing with menopause.
Microscopic findings include a whorled pattern of smooth muscle bundles, with uncommon mitoses in muscle cells. Cellular atypia and large cells may also be observed.
May be asymptomatic or may result in excessive menstruation with frequent periods.
Additionally linked to pelvic pressure, frequent urination (due to bladder compression), and infertility.
Laboratory results indicate iron deficiency anemia caused by blood loss.
Treatment involves hormonal medication such as oral contraceptive tablets to induce regression of endometrial tissue. Myomectomy, hysterectomy, or uterine artery embolization may be performed for big tumors.
Uterine fibroids, also known as leiomyomas, do not develop into leiomyosarcomas.
Leiomyosarcomas are irregular tumors that develop spontaneously and may extend from the cervix, characterized by fleshy tissue, necrotic regions, and hemorrhaging. Leiomyosarcomas are more common among African Americans, are cancerous, and can be treated with a mix of chemotherapy drugs.
The cause is unidentified, however genetic abnormalities have been detected in the cancerous cells.
The most prevalent non-cancerous growth in the female reproductive system.
Most frequently observed in women over the age of 40, with a higher occurrence rate among African Americans.
The pathology indicates the presence of many enlarged, irregular, and heterogeneous tumors located in the myometrium (intramural), beneath the endometrium (submucosal), or beneath the serosa (subserosal). The tumor is estrogen-sensitive, with its size increasing during pregnancy and reducing with menopause.
Microscopic findings include a whorled pattern of smooth muscle bundles, with uncommon mitoses in muscle cells. Cellular atypia and large cells may also be observed.
May be asymptomatic or may result in excessive menstruation with frequent periods.
Additionally linked to pelvic pressure, frequent urination (due to bladder compression), and infertility.
Laboratory results indicate iron deficiency anemia caused by blood loss.
Treatment involves hormonal medication such as oral contraceptive tablets to induce regression of endometrial tissue. Myomectomy, hysterectomy, or uterine artery embolization may be performed for big tumors.
Uterine fibroids, also known as leiomyomas, do not develop into leiomyosarcomas.
Leiomyosarcomas are irregular tumors that develop spontaneously and may extend from the cervix, characterized by fleshy tissue, necrotic regions, and hemorrhaging. Leiomyosarcomas are more common among African Americans, are cancerous, and can be treated with a mix of chemotherapy drugs.
- Published on
Pathology - Primary Hyperparathyroidism
Resulting from PTH adenoma, PTH hyperplasia, PTH carcinoma, or the secretion of PTH-like hormone by malignancies, particularly squamous cell bronchogenic carcinoma.
Linked to Multiple Endocrine Neoplasia Type I and Type IIA.
Pathology
Parathyroid gland: Parathyroid adenoma is a well-defined nodule consisting of homogeneous polygonal chief cells and a small number of bigger oxyphil cells.
Osseous tissue: Osteitis fibrosa cystica is characterized by cystic areas filled with fibrous tissue, known as brown tumors, due to heightened osteoclast activity.
Clinical Symptoms and Signs
Symptoms include bone discomfort from osteitis fibrosa cystica, nephrocalcinosis, peptic ulcers, constipation, weakness, altered mental status, and polyuria.
Laboratory results: Hypercalcemia, elevated PTH levels, elevated blood alkaline phosphatase, reduced serum phosphate.
Surgical excision of aberrant glands is recommended for individuals with renal failure, osteoporosis, or substantial hypercalcemia.
Additional causes of hypercalcemia include bone cancer, multiple myeloma, sarcoidosis, milk alkali syndrome, Paget disease of the bone, hyperthyroidism, and vitamin D toxicity.
Resulting from PTH adenoma, PTH hyperplasia, PTH carcinoma, or the secretion of PTH-like hormone by malignancies, particularly squamous cell bronchogenic carcinoma.
Linked to Multiple Endocrine Neoplasia Type I and Type IIA.
Pathology
Parathyroid gland: Parathyroid adenoma is a well-defined nodule consisting of homogeneous polygonal chief cells and a small number of bigger oxyphil cells.
Osseous tissue: Osteitis fibrosa cystica is characterized by cystic areas filled with fibrous tissue, known as brown tumors, due to heightened osteoclast activity.
Clinical Symptoms and Signs
Symptoms include bone discomfort from osteitis fibrosa cystica, nephrocalcinosis, peptic ulcers, constipation, weakness, altered mental status, and polyuria.
Laboratory results: Hypercalcemia, elevated PTH levels, elevated blood alkaline phosphatase, reduced serum phosphate.
Surgical excision of aberrant glands is recommended for individuals with renal failure, osteoporosis, or substantial hypercalcemia.
Additional causes of hypercalcemia include bone cancer, multiple myeloma, sarcoidosis, milk alkali syndrome, Paget disease of the bone, hyperthyroidism, and vitamin D toxicity.
- Published on
Pathology - Secondary Hyperparathyroidism
Primarily due to chronic renal insufficiency.
Parathyroid gland shows diffuse expansion due to hyperplasia of principal cells.
Pathophysiology: Reduced l,25-(OH)2 D3 generation from deteriorating kidney function leads to diminished intestinal calcium absorption resulting in hypocalcemia. This condition is additionally exacerbated by elevated calcium excretion from the impaired kidney, leading to higher parathyroid hormone (PTH) levels.
Clinical Symptoms and Signs
Osteoclastic bone disease with widespread distribution; metastatic calcification in soft tissues.
Laboratory results: Low calcium levels, elevated parathyroid hormone (PTH), elevated serum alkaline phosphatase, elevated serum phosphate.
Therapy
If the disease is severe, the aberrant glands will be surgically removed.
Phosphate binders and vitamin D supplementation.
Primarily due to chronic renal insufficiency.
Parathyroid gland shows diffuse expansion due to hyperplasia of principal cells.
Pathophysiology: Reduced l,25-(OH)2 D3 generation from deteriorating kidney function leads to diminished intestinal calcium absorption resulting in hypocalcemia. This condition is additionally exacerbated by elevated calcium excretion from the impaired kidney, leading to higher parathyroid hormone (PTH) levels.
Clinical Symptoms and Signs
Osteoclastic bone disease with widespread distribution; metastatic calcification in soft tissues.
Laboratory results: Low calcium levels, elevated parathyroid hormone (PTH), elevated serum alkaline phosphatase, elevated serum phosphate.
Therapy
If the disease is severe, the aberrant glands will be surgically removed.
Phosphate binders and vitamin D supplementation.
