04-28 PATH: Ovarian Neoplasms

Question 1

1. Describe the most common ovarian neoplasms according to age

Answer 1

ADNEXAL MASSES

• In ♀ < 20y/o or > 50/yo, 90% of palpable ovarian masses are benign

TUMORS

Teens - Germ cell tumors

20s - Functional and benign adenomas

30s - Endometriomas

40s - Benign and borderline

50s-60s - Epithelial carcinomas

70+ - granulosa cells

Surface Epithelial Tumors

• 90% of malig
• >20 y/o

GSTs

• >25 y/o
• ~10% of malig ovarian tumors

Sex Cord/Stromal Tumors

• All ages
• 2-3% of malig ov tumors

Mets to Ovaries

• adults
• 5% of malig ov tumors

Question 2

2. Recite the pathogenesis of epithelial ovarian cancer

Answer 2

Multiple Theories of Pathogenesis

1. Multi-hit theory
   
   • May start w/ predisposing mutation:
     
     • BRCA1/BRCA2
     • K-rsa, B-RAF
     • PTEN
     • β-catenin
     • ARID1A
2. Inclusion-related carcinogenesis model
   
   • Invaginations of the surface epithelium lose connection to the ovarian surface
   • Lined by either mesothelial or tubal-­‐type epithelium
   • Studies: ovarian inclusion cysts: tubal origin
3. “Tubal Carcinogenesis Model”
   
   • ​Those cells come from fimbrae
   • p53 signature: ​​loss of cilia
4. ​Integrated Carcinogenesis Model
   
   • combination of the two??​​

Question 3

3. Discuss familial ovarian cancer syndromes BRCA1 & BRCA2

Answer 3

BRCA1 and BRCA2 are tumor suppressor genes (DNA repair) than when absent increase the risk of ovarian cancer (only needs ?1 hit now, mutated oncogene)

• BRCA 1: 45% liftetime risk of ovarian cancer
  
  • Chromosome 17
  • 1/800 gen population
  • 1/100 Ashkenazi Jews
• BRCA 2: 35% lifetime risk
  
  • Chromosome 13

Question 4

3. Discuss the familial ovarian cancer syndrome HNPCC

Answer 4

• 10% lifetime risk of ovarian cancer
• Modified Amsterdam criteria (??) : 3-2-1

Question 5

4. Be able to evaluate an adnexal mass

Answer 5

.

Question 6

Simple Cysts

• Natural Hx
• Malig?
• Name a few

Answer 6

Natural history: common, transitory, usu last only 6 wks

Usually not malig

A few examples:

• Follice cyst: unruptured Graafian follicle
  
  • or ruptured follicle that sealed immediately
• Corpus luteum/Corpus luteal cyst:
• Endometriotic cyst: all over the abd cavity; chocolate cyst

Question 7

Review First Aid

Answer 7

Pg 531-532

Question 8

Review cases starting on Slide 38

Answer 8

okay?