Pathophysiology
Summary
In the ovary, cysts can manifest in various forms, the most common of which are follicular cysts and corpus luteum cysts. Follicular cysts develop from mature follicles that fail to rupture, leading to complications such as sterile peritonitis and ovarian torsion. Corpus luteum cysts often occur during pregnancy, and form when fluid accumulates in the corpus luteum after egg rupture. Both types of cysts, as well as ovarian tumors, may present as a palpable adnexal mass.
Ovarian tumors are categorized into epithelial tumors, germ cell tumors, and sex-cord stromal tumors, with epithelial tumors being the most prevalent.
Epithelial ovarian tumors originate from the cuboidal cells that make up the ovarian surface epithelium and are associated with various risk factors, including mutations in BRCA1 & BRCA2 and Lynch syndrome. Repeated damage to the ovarian surface epithelium, known as torn basket rim, and conditions like endometriosis also increase risk of epithelial tumors. Hormonal factors like increased ovulation, nulliparity, early menarche, and late menopause also elevate the risk due to increased lifetime ovulatory cycles. Interestingly, OCPs decrease risk by reducing the number of lifetime ovulatory cycles.
Clinically, epithelial ovarian cancer can manifests with symptoms like ascites, bowel obstruction, or malignant pleural effusions. The tumor marker CA-125 is used to track response to therapy. Histologically, epithelial ovarian tumors display a variety of features. Serous epithelial tumors are the most common, and are composed of fallopian tube-like ciliated columnar cells. Serous tumors can occur as serous cystadenomas (benign) or serous cystadenocarcinomas (malignant), which forms characteristic calcified psammoma bodies on histology.
Mucinous tumors can be also occur as either cystadenomas (benign), or cystadenocarcinomas (malignant) and are distinguished by their light-pink, mucin-secreting epithelial cells. Mucinous tumors can cause pseudomyxoma peritonei, a condition where the peritoneal cavity fills with jelly-like mucin. Brenner tumors are typically benign and feature nests of transitional-type epithelium similar to that found in the urinary tract. Brenner tumors have characteristic ‘coffee bean’ nuclei.
Endometrioid ovarian cancer is a malignant subtype of epithelial ovarian cancer frequently accompanied by endometrial carcinoma. Histologically, it closely resembles endometrial carcinoma, characterized by glands containing numerous purple nuclei. Krukenberg tumors refers to metastases from gastric cancer that affect the ovaries. These tumors are unique in their composition of signet ring cells, where mucin displaces the nucleus to the edge of the cell membrane, and typically affect both ovaries.
Lesson Outline
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FAQs
Follicular and corpus luteum cysts are types of functional cysts that develop in the ovaries. A follicular cyst forms when a mature follicle, which is supposed to release an egg fails to rupture and continues to grow. Conversely, a corpus luteum cyst occurs when the corpus luteum, the structure left behind after the egg is released, fills with fluid. While these cysts are often benign and may resolve on their own, they can sometimes rupture or lead to ovarian torsion, causing severe abdominal pain.
Ovarian tumors can be categorized into three primary types: epithelial, germ cell, and sex-cord stromal tumors. Epithelial tumors are the most common and originate from the cuboidal cells on the ovarian surface. Germ cell tumors start in the egg-producing cells, while sex-cord stromal tumors arise from the connective tissue cells that support the ovaries. These tumors and benign cysts often present as a palpable adnexal mass. Identification typically involves a combination of patient symptoms, imaging studies, and histological examination during surgery.
Various factors can increase the risk of developing epithelial ovarian cancer. Genetic mutations in the BRCA1 and BRCA2 genes, as well as Lynch syndrome, are significant risk factors. Lifestyle and reproductive factors, such as early menarche, late menopause, and nulliparity, which increase the number of lifetime ovulatory cycles, also elevate the risk. Conditions like endometriosis contribute to the risk due to oxidative stress and inflammation. Conversely, taking oral contraceptive pills can reduce the risk by decreasing the number of ovulatory cycles.
Epithelial ovarian cancer can manifest with symptoms like ascites, bowel obstruction, or malignant pleural effusions due to metastasis to these areas. Diagnosis is often challenging due to the lack of noticeable symptoms in early stages. A combination of physical examination, imaging tests such as ultrasound or CT scans, and blood tests for tumor markers like CA-125 are typically used for diagnosis. However, elevated CA-125 levels can occur in other conditions, so a biopsy may be necessary for confirmation.
Epithelial ovarian tumors include various subtypes such as serous, mucinous, Brenner, endometrioid, and Krukenberg tumors. Serous tumors are the most common and are characterized by fallopian tube-like ciliated columnar cells and calcified psammoma bodies on histology. Mucinous tumors have light-pink, mucin-secreting epithelial cells and can lead to pseudomyxoma peritonei. Brenner tumors feature nests of transitional-type epithelium and coffee bean nuclei. Endometrioid ovarian cancer resembles endometrial carcinoma histologically and may coexist with it. Krukenberg tumors are metastatic gastric cancers that affect the ovaries and display signet ring cells on histology.
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