SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l...
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Transcript of SALPINX: SALPINGITIS l Cause: chlamydia and gonococcus = most l Route: cervix lymphatics adnexae l...
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
Supprative salpingitis with massively swollen fallopian tube
Purulent exudate flowing from transected fallopian tube
Wall and lumen of fallopian tube is filled with PMNs
Bilateral hydrosalpinx dwarfs uterus: hydrosalpinx may be end result of resolution of infection
Hydrosalpinx
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
Adenomatoid tumor as seen at surgery in wall of fallopian tube
Adenomatoid tumor of fallopian tube
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
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
Ectopic pregnancy within fallopian tube
Ruptured ectopic pregnancy of fallopian tube
Ectopic pregnancy near fimbriated end of tube. A corpus luteum is present within the ovary (arrow)
Chorionic villi within lumen of fallopian tube Thin arrows point to chorionic villi
Ectopic pregnancy
Placental insertion into liver
Ectopic pregnancy associated with IUD use
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
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.
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.
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
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
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
Hydatidiform mole fills and expands uterus: hydropic villi are evident
Hydatidiform mole: uterus is filled with thin-walled, translucent, polypoid masses consisting of hydropic villi
Hydropic villi of mole
Markedly swollen (hydropic) villi of mole
Central cavitation (cisterns) of complete mole
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
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
Hemorrhagic tumor nodules of choriocarcinoma has distorted uterus
Dimorphic histology of choriocarcinoma. Cytotrophoblasts have clear cytoplasm.
Choriocarcinoma: syncytiotrophoblasts (arrows) flanked by cytotrophoblasts and necrotic tissue
Multiple hemorrhagic nodules of metastatic choriocarcinoma in lungs
Germinal epithelium of fetal ovary
Numerous follicles in various stages of development
Maturing follicle with thecal cells (pink arrow) and granulosa cells (blue arrow)
Mature Graafian follicle (arrow depicts oocyte)
Site of rupture of ovum on surface of ovary
Cut surface of corpus luteum
Corpus luteum with luteinized granulosa cells & theca cells (arrow)
Granulosa cells
Atretic follicle – scarring in center where ovum was and stuff around it
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)
Follicular cyst
Opened follicular cyst
Wall of luteal cyst with luteinized granulosa cells
Cut surfaces of polycystic ovary
Polycystic ovary
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
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
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
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
Benign
Borderline
Malignant
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
Serous cystadenoma
Opened serous cystadenoma with a smooth lining and very thin walled
Serous epithelium of cystadenoma with some papillations (papillary serous cystadenoma)
Ciliated epithelium of a serous cystadenoma
Numerous psammona bodies in paillary serous tumor – not clinically significant, found in both benign and malignant papillary tumors
Benign serous tumors may become large (20cm)
52 lb benign serous cystadenoma
Papillary excrescences from lining of serous tumor (papillary serous cystadenoma) – always section any one that looks papillary to check
Borderline papillary serous cystadenocarcinoma with epithelial atypia
Borderline tumor: no stromal invasion is present
Multiloculated and solid papillary serous cystadenocarcinoma
Solid areas in papillary serous cystadenocarcinoma
Papillary serous cystadenocarcinoma: tumor has breached surface of ovary
Mostly solid papillary serous cystadenocarcinoma
Papillary serous cystadenocarcinoma
Stratified, atypical nuclei in papillary serous cystadenocarcinoma: stromal invasion is present
Mucin producing lining cells in benign mucinous cystadenoma
Borderline mucinous tumor
Mucin production and stromal implants in pseudomyxoma peritonei
Nuclear atypia & mitotic figures in mucinous cystadenocarcinoma
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
Endometrioid ovarian Ca
Endometrioid cancer of ovary
Benign cystadenofibroma of ovary
Cystadenofibroma: benign dilated glands within fibrous stroma
Clear cell adenocarcinoma of ovary
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
Mostly solid Brenner tumor
Solid and cystic Brenner tumor
Brenner tumor with transitional epithelium with microcysts & fibrous stroma
Glandular spaces or microcysts in benign Brenner tumor
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
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
Dermoid cyst filled with hair and keratin
Opened dermoid cyst with keratin and hair
Teeth (arrows), skin and hair in dermoid cyst
Cartilage, glands and keratin cyst in benign teratoma
Teratoma with squamous epithelium, mucin producing glands and cartilage (arrow)
CNS tissue with neurons (arrow) in mature teratoma
Mature thyroid tissue in monodermal teratoma: struma ovarii
Thyroid follicles in struma ovarii
Mostly solid malignant teratoma
Malignant Transformation: Squamous cell carcinoma in malignant teratoma: arrows point to keratin pearls
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
Dysgerminoma – white, fleshy
Sheets of polyhedral cells separated by scant fibrous septa (arrow) in dysgerminoma
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)
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
Schiller-Duval body in endodermal sinus tumor
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
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
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
Granulosa cell tumor
Foci of hemorrhage in granulosa cell tumor
Granulosa cell tumor with Call-Exner bodies (arrow)
Oil red O fat stain of luteinized theca cells in granulosa cell tumor
Granulosa cell tumor: coffee bean nuclei with grooves & Call-Exner bodies
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
Fibroma-Thecoma
Fibroma-Thecoma
Yellow-white cut surface of fibroma-thecoma
Fibroblasts intermixed with lipid laden thecal cells
Oil red O stain demonstrates thecoma elements
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
Well circumscibed Sertoli-Leydig cell tumor
Tubules composed of Sertoli cells
Prominent Leydig cells in Sertoli-Leydig Cell Tumor
Sertoli-Leydig Cell tumor with Reinke crystalloids
Solid, yellow Hilus Cell Tumor (pure Leydig Cell)
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
Bilateral metastases to ovaries
Metastaic adenocarcinoma to ovary with signet cells