Ovarian Cyst Tumors Disord Endo N Myometrium

The most likely primary tumor in this case is a mucinous ovarian tumor of borderline malignancy. This is suggested by the presence of mucin-secreting neoplastic cells in the peritoneal implants, as well as the significantly enlarged left ovary. Mucinous ovarian tumors of borderline malignancy have the potential to spread to the peritoneum and cause peritoneal implants. The other options, such as mucinous ovarian cystadenoma, Krukenberg metastases, adenoma of the appendix, and well-differentiated adenocarcinoma of the appendix, are less likely based on the given information.

The histologic examination of the ovaries revealed tissue consistent with a granulosa cell tumor. Granulosa cell tumors are a type of ovarian cancer that arise from the granulosa cells, which are responsible for producing estrogen. These tumors are more common in women in their 40s and 50s and often present with symptoms related to hormonal imbalances, such as abnormal vaginal bleeding. Histologically, granulosa cell tumors are characterized by the presence of small, uniform cells arranged in a characteristic pattern known as Call-Exner bodies. These tumors are typically low-grade malignancies and have a good prognosis with early detection and treatment.

Sertoli-Leydig cell tumour is a group of tumours composed of variable proportions of Sertoli cells, Leydig cells, and in the case of intermediate and poorly differentiated neoplasms, primitive gonadal stroma and sometimes heterologous elements.
Sertoli-Leydig cell tumour is a member of the sex cord-stromal tumour group of ovarian and testicular cancers. The tumour is rare, comprising less than 1% of testicular tumours. While the tumour can occur at any age, it occurs most often in young adults. Recent studies have shown that many cases of Sertoli Leydig cell tumor of the ovary are caused by germline mutations in the DICER1 gene. These hereditary cases tend to be younger, often have a multinodular thyroid goiter and there may be a personal or family history of other rare tumors such as pleuropulmonary blastoma, Wilms tumor and cervical rhabdomyosarcoma
ClassificationThe tumour is subdivided into many different subtypes. The most typical is composed of tubules lined by Sertoli cells and interstitial clusters of Leydig cells.
PresentationDue to excess testosterone secreted by the tumour, one-third of female patients present with a recent history of progressive masculinization. Masculinization is preceded by anovulation, oligomenorrhoea, amenorrhoea and defeminization. Additional signs include acne and hirsutism, voice deepening, clitoromegaly, temporal hair recession, and an increase in musculature. Serum testosterone level is high.
DiagnosisPresence of an ovarian tumour plus hormonal disturbances suggests a Sertoli-Leydig cell tumour. However, hormonal disturbance is present in only 2/3 of cases. A conclusive diagnosis is made via histology, as part of a pathology report made during or after surgery. See also Sex cord-stromal tumour.

If left untreated, the possible complication for a 22-year-old woman with purulent vaginal discharge, fever, lower abdominal pain, and extreme tenderness of the cervix is an ectopic pregnancy. Ectopic pregnancy occurs when a fertilized egg implants outside of the uterus, typically in the fallopian tube. This can lead to severe abdominal pain, bleeding, and potentially life-threatening complications if the pregnancy continues to develop in the fallopian tube. Prompt medical intervention is necessary to prevent further complications and preserve the woman's health.

A tuboovarian abscess is an inflammatory mass involving the fallopian tube, ovary, and, occasionally, other adjacent pelvic organs (eg, bowel, bladder) . This may manifest as a tuboovarian complex (an agglutination of those structures) or a collection of pus (tuboovarian abscess). These abscesses are found most commonly in reproductive age women and typically result from upper genital tract infection. Tuboovarian abscess is usually a complication of ****PELVIC INFLAMMATORY DISEASE.******
Tuboovarian abscess is a serious and potentially life-threatening condition. Aggressive medical and/or surgical therapy is required and rupture of an abscess may result in sepsis. The mortality rate associated with tuboovarian abscess was approximately 50 percent or higher prior to the advent of broad-spectrum antibiotics and modern surgical practice.
In current practice, the mortality rate approaches zero for abscesses that have not ruptured. Current mortality rates for patients with ruptured abscesses are not reported in the literature; data from the 1960s suggested a mortality rate ranging from 1.7 to 3.7 percent.
Treatment modalities include broad spectrum antibiotic therapy, minimally-invasive drainage procedures, invasive surgery, or combinations of these interventions. For the large majority of small to medium sized tuboovarian abscesses, antibiotic therapy alone can affect cure.

The most likely explanation for the woman's infertility is chronic salpingitis. Chronic salpingitis is inflammation of the fallopian tubes, which can lead to scarring and blockage of the tubes. This can prevent the sperm from reaching the egg and can also interfere with the fertilized egg's ability to travel to the uterus for implantation. The patient's history of lower abdominal pain and recurrent fevers following her divorce suggest a possible infection that could have led to chronic salpingitis. The normal physical examination findings do not rule out this possibility, as the inflammation may be internal and not visible externally.

The best criterion to determine benignancy versus malignancy in this case is the mitotic rate. Mitotic rate refers to the number of cells undergoing mitosis, which is an indicator of cell division and proliferation. In general, malignant tumors have a higher mitotic rate compared to benign tumors. Therefore, the pathologist can assess the mitotic rate of the tumor cells to determine if they are rapidly dividing, suggesting malignancy, or if they are not dividing as rapidly, suggesting benignancy. Other criteria such as degree of cellular pleomorphism, presence/absence of geographic necrosis, and tumor size can also provide additional information, but the mitotic rate is the most reliable indicator in this context.

The presence of plasma cells in the endometrial biopsy suggests chronic endometritis. Chronic endometritis is characterized by inflammation of the endometrium, which is the lining of the uterus. Plasma cells are a type of white blood cell that are typically found in chronic inflammatory conditions. Their presence indicates a chronic immune response, supporting the diagnosis of chronic endometritis. Neutrophils are typically seen in acute inflammation, while lymphocytes and eosinophils are not typically associated with endometritis.

METRORRHAGIA refers to light bleeding from the uterus at irregular intervals. MENOMETRORRHAGIA refers to heavy bleeding from the uterus at irregular intervals.
MENORRHAGIA: refers to excessive or prolonged menstrual bleeding. It is technically defined as blood loss greater than 80 mL per cycle and/or menstrual periods lasting longer than seven days. However, both patients and clinicians are unreliable in their ability to predict the amount of blood loss and measurement of actual blood loss is not practical in a clinical setting. In ovulatory women, menorrhagia is typically due to an anatomic lesion (eg, fibroid) or systemic disease (eg, hemostatic defect) in ovulatory women. Anovulation is also a common cause of menorrhagia. (See "Chronic menorrhagia or anovulatory uterine bleeding".)
AMENORRHEA: refers to absence of bleeding for at least three usual cycle lengths . (See "Etiology, diagnosis, and treatment of primary amenorrhea" and "Etiology, diagnosis, and treatment of secondary amenorrhea".)
OLIGOMENORRHEA: refers to bleeding that occurs at an interval greater than 35 days.
POLYMENORRHEA: refers to regular bleeding that occurs at an interval less than 24 days.
INTERMENSTRUAL BLEEDING BLEEDING refers to bleeding that occurs between menses or between expected hormone withdrawal bleeds in women using some forms of hormonal contraception or postmenopausal hormone therapy.
PREMENSTRUAL SPOTTING SPOTTING refers to light bleeding preceding regular menses.
POSTCOITAL BLEEDING refers to vaginal bleeding that is noted within 24 hours of vaginal intercourse

COWDEN SYNDROME is rare autosomal dominant syndrome that derives from a mutation in the PTEN tumor suppressor gene. Women with Cowden syndrome have lifetime risk of endometrial cancer of 13 to 28 percent. There are no established guidelines for endometrial screening or prevention for Cowden syndrome. Potential strategies include endometrial sampling and risk-reducing hysterectomy, similar to Lynch syndrome.

The most likely cause of the woman's menorrhagia is uterine leiomyoma. Uterine leiomyomas, also known as fibroids, are benign smooth muscle tumors that commonly occur in women of reproductive age. They can cause heavy or prolonged menstrual bleeding, leading to iron deficiency anemia. The physical exam findings of an enlarged and nodular uterus are consistent with uterine leiomyoma. Uterine carcinoma and uterine leiomyosarcoma are less likely as they are associated with postmenopausal bleeding, and functional gonadal tumors are not typically associated with menorrhagia.

The presence of "chocolate cysts" outside of the uterus suggests the most likely diagnosis of endometriosis. Endometriosis is a condition where the tissue that lines the uterus (endometrium) grows outside of the uterus, causing the formation of cysts. These cysts are often filled with old blood, giving them a "chocolate" appearance. This condition can cause fertility problems in women. Adenomyosis is a condition where the endometrium grows into the muscular wall of the uterus, but it does not typically result in the formation of cysts. Endometriosarcoma is a rare form of cancer that arises from endometrial tissue and is not typically associated with the formation of cysts. Ectopic pregnancy refers to the implantation of a fertilized egg outside of the uterus and would not be associated with the presence of "chocolate cysts."

The presence of hyperplastic and dysplastic glands in the endometrial curettage indicates an abnormal growth of cells in the lining of the uterus. This condition is known as endometrial hyperplasia, which is considered a precancerous condition. Precancerous conditions have the potential to develop into cancer if left untreated. Therefore, it is important for the patient to undergo further evaluation and treatment to prevent the progression to endometrial cancer.