Pathology of the

Adnexa
Dr. Soekimin, SpPA ; dr. Jessy Chrestella, SpPA
Dept. Patologi Anatomi Fakultas Kedokteran
Universitas Sumatera Utara
Medan 2010
Congenital Anomalies
Parametritis/Salphingitis
Ectopic pregnancy
Hydrosalpinx
Endometriosis
Para ovarian cyst
Carcinoma





Tubal common.
implantation allows early
placental development,
secretion of hCG, and
maintainance of the corpus
luteum.
Clinically features of a normal
pregnancy and the embryo
may also complete the early
embryonic stages of
development.
6
Inflam/Infections - rare
Ovarian cysts - common.
Non-Neoplastic
Follicular, epithelial, Luteal, etc.
Polycystic ovary syndrome
Ovarian Hyperstimulation synd.
Stromal Hyperplasia*
Endometriosis
Neoplasms
Benign (Cysts)
Malignant (Solid)
7
Serous cystadenoma
Cystoma
Papillary cystadenoma serosum
Surface papilloma
Serous adenofibroma
Serous cystadenofibroma
Pseudomucinous cystadenoma
Teratoma
- dermoid cyst
- Solid teratoma.
Granulosa cell tumor
Theca cell tumor
Arrhenoblastoma
Adrenal rest tumor
Dysgerminoma
Brenner tumor
Fibroma
Meigs syndrome
Sarcoma
Carcinoma (ad.Carcinoma)
Metastase carcinoma.
Cysts Common benign very large.
Solid rare malignant high mortality.
5
th
common cause of female cancer.
But carcinomas of the ovaries account for more
deaths than do cancers of all other female
malignancies together. (US stat).
Nulliparity & family history (BRCA) - Risk factor.

10
Amenorrhoea, hyperoestrogenism and
multiple follicular cysts.
Stromal hyperplasia & anovovulation
Important cause of infertility,
Endometrial hyperplasia/Carcinoma.
Clinical features:
Acne, alopecia, hirsutism,
Hypertension,
Insulin resistance, Type 2 DM.
Obesity Syndrome X.
11
12
Note: capsule thickening, cystic follicles without ova, thecal hyperplasia.
Metastases of hyperplastic
endometrium into ovary.
Retrograde menstruation
/Metaplasia.
Estrogen related.
Pouch of Douglas, the pelvic
peritoneum and the ovary -
'chocolate cysts'.
Periodic Pain, pelvic
inflammation, infertility.
13
14
Chocolate
Cysts
15
Chocolate
Cysts
Common, produce estrogen.
80% are benign, cystic, young (20-45)
20% are Malignant, solid - older (>40)
6% of all cancers in women.
50% deaths due to late detection.
The rule:
Cystic tumors are commonly benign
Solid tumors are commonly malignant.
16
Less clear than other
Null parity
Gonadal Dysgenesis
Family History
Ovarian cancer genes
BRCA1 (17q12) & BRCA2(13q12)
17
18
Classification of
Ovarian Tumours
Coelomic mesothelium
Serous (tubal)
Mucinous (Cx)
Endometrioid (End)
Transitional (UT)
90% of malignant tumors of ovary
Morphologically
Cystic Cystadenomas - Benign
Solid/cystic Cystadenoma - Borderline.
Solid Cystadenocarcinoma Malignant.
19
Frequently bilateral (30-66%).
75% benign/bord., 25% malignant.
One or few cysts, papillary/solid.
Tall columnar ciliated epithelium.
Papillary, solid, hemorrhage, necrosis or adhesions
malignancy.
Extension to peritoneum bad prog.
20
Less common 25%, very large.
Rarely malignant - 15%.
Multiloculated, many small cysts.
Rarely bilateral 5-20%.
Tall columnar, apical mucin.
Pseudomyxoma peritonei.
21
22
23
24
Borderline / Intermediate grade: note larger papillary growth.
25
multiloculated, 24cm cystic
ovary with attached fallopian
tube and uterus. benign
serous cystadenoma.
26
Note: papillary growths on inner surface
27
Note: Multi-loculated cystic tumor with some cysts showing hemorrhage.
28
Cuboidal simple Columnar Mucous
29
High grade: note large papillary growth extending and covering the cyst.
30
High grade: note large papillary growth extending and covering the cyst.
31
32
33
High grade: note large papillary growth extending and covering the cyst.
34
Infiltration
Papillary projections
35
36
Solid tumor with atypical cells forming sheets and gland like structures
without stroma. (back to back arrangement of glands)
Teratoma
Benign cystic (dermoid cyst)
Solid immature
Monodermal struma ovarii, carcinoid
Dysgerminoma
Yolksac tumor
Mixed germ cell tumor
37
38
39
40
41
42
Cartilage
Resp. Epith
Sweat Gl.
43
Sebaceous Gl.
Thyroid
M.A.L.T.
Cyst Lumen
44
Black arrow: Stratified squamous Keratinizing epithelium.
Blue arrow: Abundant sebaceous glands.
45
46
Any type of carcinoma, sarcoma or germ cell malignancy.
47
Torsion - infarction, perforation,
hemoperitoneum, and autoamputation
Bacterial infection of the cyst
Perforation - sudden acute abdomen, Slow
granulomatous peritonitis
Hemolytic anemia clears after removal.
<5% malignancy Sq. carcinoma.


48
49
50
51
52
53
Teenage / young, 2% of ovarian neoplasms.
1/2 of malignant germ cell neoplasms
Gonadal dysgenesis risk factor.
54
Note the pale brown appearance of the parenchyma, along with some central
collagenous scar. The gross and microscopic appearance of an ovarian dysgerminoma is
essentially same as a seminoma of the testis in a male.
55
56
Steroid cell tumour of the ovary. A well-circumscribed benign ovarian stromal
tumour that caused virilisation in the patient
57
Summary
Thank you