mesothelial inclusion cyst ovary pathology outlines

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mesothelial inclusion cyst ovary pathology outlines - Ovary - nontumor
Nonneoplastic cysts / other
Epithelial inclusion cyst

Authors: Aurelia Busca, M.D., Ph.D., Carlos Parra-Herran, M.D.

Topic Completed: 1 September 2017

Minor changes: 5 May 2020

Copyright: 2002-2020, PathologyOutlines.com, Inc.

PubMed Search: Epithelial inclusion cysts [title]

Aurelia Busca, M.D., Ph.D.
Carlos Parra-Herran, M.D.

Page views in 2019: 11,115
Page views in 2020 to date: 5,586
Table of Contents
Definition / general | Essential features | Terminology | Epidemiology | Pathophysiology | Clinical features | Prognostic factors | Gross description | Microscopic (histologic) description | Microscopic (histologic) images | Immunohistochemistry | Differential diagnosis | Board review style question #1 | Board review answer #1
Cite this page: Busca A, Parra-Herran C. Epithelial inclusion cyst. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/ovarynontumorinclusioncyst.html. Accessed July 5th, 2020.
Definition / general
Invaginations of the ovarian surface epithelium into the ovarian cortex
Essential features
Two types based on morphology and pathophysiology:
Peritoneal inclusion cyst: lined by flat epithelium invaginated from ovarian surface epithelium; these express a peritoneal phenotype (calretinin, WT1 and D2-40 positive, PAX8 and BerEP4 negative)
Müllerian inclusion cyst: lined by ciliated tubal epithelium as a result of implantation of tubal epithelium in the ovarian parenchyma, presumably at the time of ovulation when the ovarian surface epithelium is disrupted; these express a tubal Müllerian phenotype (PAX8, BerEP4 and WT1 positive, calretinin and D2-40 negative)
Size is less than 1 cm; if more than 1 cm, by convention the lesion is designated as cystadenoma or cystadenofibroma
Terminology
Cortical inclusion cyst
Epidemiology
Can occur at any age but more common postmenopausal
Pathophysiology
Via invagination of the ovarian surface epithelium (peritoneal type cyst) or implantation of tubal epithelium when the ovarian surface epithelium is disrupted at ovulation (Müllerian type cyst, Int J Gynecol Pathol 2015;34:3, Mod Pathol 2011;24:1488)
Clinical features
Incidental findings, usually asymptomatic
Prognostic factors
Benign entities
Presence of inclusion cyst in postmenopausal women does not increase the risk of ovarian or other hormone driven cancers (breast and endometrial cancers, BJOG 2012;119:207)
Traditionally thought to represent a precursor lesion of ovarian carcinoma, but most ovarian serous carcinomas are now considered as tubal in origin with serous tubal intraepithelial carcinoma (STIC) as precursor lesion
For a subset of ovarian serous carcinomas in which STIC or tubal involvement is not identified, a potential origin in epithelial inclusion cyst of Müllerian (tubal) phenotype has been postulated (Gynecol Oncol 2013;130:246, Mod Pathol 2011;24:1488, Int J Gynecol Pathol 2015;34:3)
Use of oral contraceptives for more than 5 years was shown to reduce the number of Müllerian type inclusion cysts (PAX8 positive), supporting the hypothesis that this subtype constitutes a precursor lesion of ovarian serous carcinoma (Diagn Pathol 2016;11:30)
Gross description
Most are not apparent grossly unless very superficial in the cortex
When visible, they appear as small cysts bulging at the ovarian surface
Microscopic (histologic) description
Small cysts ( < 1 cm)
Peritoneal inclusion cyst: lined by simple flat epithelium devoid of cilia or mucinous cytoplasm
Müllerian inclusion cyst: lined by simple cuboidal to columnar epithelium with ciliated cells, sometimes admixed with nonciliated (secretory, peg) cells
Can have psammoma bodies in adjacent stroma

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