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Ovary-nontumor

Infectious disorders

Granulomatous inflammation


Reviewer: Mohiedean Ghofrani, M.D. (see Reviewers page)
Revised: 28 March 2012, last major update August 2011
Copyright: (c) 2002-2011, PathologyOutlines.com, Inc.

Definition
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● Necrotizing or non-necrotizing granulomatous inflammation of the ovary

Laboratory
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● May be associated with elevated CA-125, raising concern for cancer (Rom J Intern Med 2009;47:297)

Epidemiology
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● Cortical granulomas are common incidental findings with uncertain clinical significance
● Primary ovarian tuberculosis and other primary ovarian granulomas are uncommon
● Frequency of secondary ovarian granulomas depends on primary cause

Etiology
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● Tuberculosis: hematogenous spread to ovary or secondary to tuberculous salpingitis (Arch Gynecol Obstet 2008;278:359); may clinically resemble malignancy (Arch Gynecol Obstet 2010;282:643)
● Actinomyces: associated with IUD (Am J Clin Pathol 1977;68:622)
● Ascaris lumbricoides: J Coll Physicians Surg Pak 2009;19:663
● Bowel contents via coloovarian fistula: Obstet Gynecol 1987;69:533
● Crohn's disease: usually extension from bowel (Am J Obstet Gynecol 1975;122:527)
● Dysgerminoma: granulomatous reaction
● Enterobius vermicularis: Eur J Gynaecol Oncol 2007;28:513
● Foreign material: often post-surgical, including suture, talc, starch, lubricant and carbon (Obstet Gynecol 1985;66:701, Hum Pathol 1996;27:1008)
● Keratin from cystic teratomas and squamous elements of endometrial and ovarian endometrioid adenocarcinomas
● Malakoplakia: Obstet Gynecol 1987;69:537
● Necrobiotic (palisading) granuloma: often with history of surgery or cauterization months to years previous
● Sarcoidosis: rare (Am J Obstet Gynecol 1990;162:1284)
● Schistosomiasis

Clinical features
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● Often an incidental finding or part of a systemic granulomatous disorder

Case reports
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● Due to microfibrillar collagen hemostat (avitene) used to control bleeding (Arch Pathol Lab Med 1995;119:1161)

Treatment
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● In secondary cases, treat primary cause

Gross description
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● May present as a mass and simulate a tumor

Micro description
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● Tuberculosis is typically confined to the cortex

Micro images
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Central suppuration and surrounding giant cells in Crohn’s disease

Tuberculosis

AFIP images:

Actinomycosis: the ovary is replaced by tissue that was soft and yellow; a characteristic sulfur granule surrounded by polymorphonuclear leukocytes is on the right

   
Actinomycosis: left-histiocytes have abundant bubbly gray-pink cytoplasm and resemble signet-ring cells; right-histiocytes are mucicarmine+

   
Actinomycosis: tubo-ovarian

Positive stains
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● AFB is typically positive in tuberculous oophoritis

Additional references
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J Clin Pathol 1997;50:324

End of Ovary-nontumor > Infectious disorders > Granulomatous inflammation


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