Non-neoplastic diseases of the ovary and fallopian tube

1. Non-Neoplastic Diseases of the Ovary

A) Follicle + Luteal Cysts

• Very common, harmless lesions.
• Origin: unruptured follicles or follicles that ruptured and immediately sealed.
• Often multiple; below serosal covering.
• Usually small, lined by granulosa + luteal cells, filled with clear serous fluid.
• Fluid accumulation → pressure atrophy of lining cells.
• Occasionally > 10 cm → palpable mass + pelvic pain.
• Rupture → intraperitoneal bleeding + acute abdomen.

B) Polycystic Ovary Disease (PCOS / Stein-Leventhal syndrome)

• One of the most common endocrine disorders in women.
• Multiple cystic ovaries covered by a dense fibrous capsule.

Clinical features

• Hyperandrogenism
• Chronic anovulation
• Oligomenorrhea
• Hirsutism
• Infertility
• Obesity (insulin resistance, metabolic syndrome)

Pathogenesis

• Excessive production of estrogens + androgens.
• → ↑ LH, ↓ FSH (↑ LH/FSH ratio).
• ↑ unopposed estrogen → ↑ risk of endometrial hyperplasia + carcinoma.

Morphology

• Ovaries double the normal size, gray-white, smooth outer cortex.
• Many subcortical cysts.
• Histology: thickened fibrotic outer tunica overlying cysts.

2. Non-Neoplastic Diseases of the Fallopian Tubes

A) Salpingitis

• Inflammation of fallopian tubes.
• Usually part of pelvic inflammatory disease (PID).
• Almost always microbial, ascending from vagina:
  • N. gonorrhoeae
  • Chlamydia trachomatis
  • Mycoplasma hominis
  • Polymicrobial in puerperal cases.

Clinical features

• Fever + lower abdominal/pelvic pain + pelvic mass (distention from exudate).
• Tubo-ovarian abscess — from adherence of tube to ovary.
• Tubo-ovarian complex — residual mass after infection subsides.
• Plica adhesions → ↑ risk of ectopic pregnancy.
• Other complications: infertility, hydrosalpinx, chronic pelvic pain.

B) Ectopic Pregnancy (Tubal Pregnancy)

• Fertilized ovum implants outside the uterine cavity.
• > 90 % in fallopian tubes; other sites: ovary, abdominal cavity, cervix.
• Mechanism: impaired embryo-tubal transport + alterations in tubal environment allowing early implantation.
• ~50 % have prior chronic salpingitis in history.
• Other risk factors: endometriosis, intrauterine tumors, prior tubal surgery, IUD use.

Clinical course

• Until rupture, indistinguishable from normal pregnancy (↑ hCG, decidual reaction).
• Rupture → abdominal bleeding → hypovolemic shock → surgical emergency.
• Beta-hCG lower than expected for gestational age (relative).

C) Other Non-Neoplastic Tubal Conditions

• Hydrosalpinx: dilated tube filled with clear fluid after chronic obstruction.
• Pyosalpinx: pus-filled tube after acute salpingitis.
• Hematosalpinx: blood-filled tube (post-rupture ectopic).

3. Comparison — Ovarian Cysts vs PCOS

Feature	Follicle/luteal cyst	PCOS (Stein-Leventhal)
Number	Few, often single	Multiple
Capsule	Thin	Thick fibrous
Hormones	Normal	↑ androgens + estrogen, ↑ LH/FSH ratio
Sx	Usually none; rupture → pain	Hirsutism + oligomenorrhea + infertility + obesity
Endometrial risk	None	↑ hyperplasia + carcinoma

💡 High-yield: Follicle/luteal cysts = harmless, may rupture → acute abdomen. PCOS (Stein-Leventhal) = #1 endocrinopathy in women; hyperandrogenism + anovulation + oligomenorrhea + hirsutism + obesity + infertility; ↑ LH/FSH ratio; ovary double size with thick fibrous tunica + multiple subcortical cysts; ↑ endometrial hyperplasia + carcinoma. Salpingitis = ascending gonorrhea/chlamydia/mycoplasma; complications = tubo-ovarian abscess, ectopic pregnancy, infertility. Ectopic pregnancy = >90 % tubal, 50 % have prior salpingitis; rupture = surgical emergency.