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13 Female Genital and Gestational > 13.5 Ovary, ovarian tumors > Flashcards

13.5 Ovary, ovarian tumors Flashcards

1
Q

Surface epithelial tumors, ovary

  • serous and mucinous tumors: divided into what types (3)
  • gross appearance
  • population
A
  1. cystadenoma–single cyst with simple, flat lining. Premenopausal women 30-40 yo
  2. cystadenocarcinoma–complex cysts with thick, shaggy lining. postmenopausal 60-70 yo
  3. borderline–in btwn features. possible malignant
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1
Q

20 yo female pt presents with hyperthyroidism and ovarian mass. Think what?

A

Struma ovarii

(teratoma of thyroid tissue)

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1
Q

granulosa-theca cell tumor

-malignant?

A

-malignant, but minimal risk for metastasis

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2
Q

Tumors that metastasize to ovary

name 2 characteristic types:

A
  1. Krukenberg tumor–metastatic mucinous tumor that involves both ovaries. Usu diffuse gastric carcinoma.
  2. pseudomyxoma peritonei–massive amounts of mucus in peritoneum
    - caused by mucinous tumor of appendix, usu with mets to the ovary

‘Jelly Belly’

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3
Q

PCOD

  • population
  • classic presentation (3)
  • important late complication
A

obese young woman with:

  1. infertility (follicular degeneration, no ovulation)
  2. oligomenorrhea (cycles disrupted)
  3. hirsutism (excess androgens)
    - T2DM 10-15 years later.
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3
Q

Struma ovarii

A

teratoma that is composed of thryoid tissue

-can create hyperthyroidism

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4
Q

60 yo female pt has endometrial hyperplasia and uterine bleeding. think what tumor?

A

granulosa-theca cell tumor

(secrete estrogen)

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5
Q

5 yo female presents with ovarian mass

think what?

A

Yolk sac tumor (most common in children)

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6
Q

Ovarian tumor differential by age:

age 15-30

30-40

60-70

A

age 15-30–germ cell

30-40–benign surface epithelial (eg cystadenoma)

60-70–malignant surface epithelial (eg cystadenocarcinoma)

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7
Q

Cystic teratoma, ovary

  • cell type
  • malignant?
  • what specific teratoma has its own name
A
  • cystic tumor, composed of fetal tissue from 2-3 embryologic layers
  • benign, but malignant potential from:
    1. immature tissue (usu neural)
    2. somatic malignancy (usu SCC of skin)

Struma ovarii: tertoma of thyroid tissue

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8
Q

Meig’s syndrome

  • what is it
  • tx
A
  1. ovarian tumor (usu fibroma)
  2. pleural effusion
  3. ascites

resolves with tumor removal

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9
Q

dysgerminoma

  • cell type
  • histiology appearance
A

oocytes. -counterpart to seminoma in males
- tumor resembles oocytes. composed of:
1. large cells
2. clear cytoplasm
3. central nuclei

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11
Q

What is most common germ cell tumor in children

A

yolk sac tumor

‘glomeruloid’

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12
Q

Embryonal carcinoma, female

  • cell type
  • prognosis
A
  • malignant, aggresive, poor prognosis
  • large primitive cells
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12
Q

sex-cord stromal tumors, female

-divided into what

A
  1. granulosa-theca cell tumor
  2. sertoli-leydig cell tumor
  3. Fibroma (fibroblasts, assoc with Meigs syndrome)
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13
Q

Follicular cyst

A

-degeneration of follicles can lead to follicular cysts. small numbers are common in women, no significance

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14
Q

Ovarian tumors, primary

-divided into what 3 main types. list them by prevalence

A
  1. Surface epithelium (70%)
    - serous, mucinous, endometrioid, Brenner
  2. Germ cell (15%)
    - cystic teratoma, embryonal carcinoma, yolk sac, choriocarcinoma, dysgerminoma
  3. Sex cord-stroma
    - granulosa-theca cell tumor, sertoli-leydig tumor, fibroma
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15
Q

Pt is dx with PCOD.

-What to worry about 10-15 years later?

A

-Development of T2DM

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16
Q

Fibroma

  • cell type
  • assoc with what
A
  • benign tumor of fibroblasts
  • assoc with Meig’s syndrome:
    1. ovarian tumor
    2. pleural effusion
    3. ascites

(resolves with tumor removal)

17
Q

choriocarcinoma, female

  • cell types (2)
  • what elevated in blood
  • what to know about spread
A
  1. syncytiotrophoblasts (hCG)
  2. cytotrophoblasts

(mimic placenta, but villi absent)

  • hCG elevated
  • spread through blood
17
Q

Seroli-leydig cell tumor, female

  • clinical presentation
  • histology appearance
A
  • may produce androgens
    1. hirsutism
    2. virilization

Reinke crystals (pink cells with crystals–appear in Leydig cells)

18
Q

surface epithelial tumors

-derived from what common types of cells (2)

A

derived from coelomic epithelium that lines ovary. This produces:

  1. serous cells–epithelial lining of fallopian tube
  2. mucinous cells–endocervix epithelium
19
Q

dysgerminoma

-prognosis

A

good prognosis

responds well to radiotherapy

20
Q

Pseudomyxoma peritonei

A

“jelly belly”

massive amounts of mucus in peritoneum

-caused by mucinous tumor of appendix, usu with mets to ovary

21
Q

Corpus luteum

What does corpus luteum primarily secrete?

-what is a complication during early pregnancy of it?

A
  • progesterone
  • hemorrhagic corpus luteum cyst (caused by hemorrhage into corpus luteum)
21
Q

yolk sac tumor, female

-histology appearance

A

Schiller-Duval bodies (glomerulus like structures) classic.

‘glomeruloid’

23
Q

Granulosa-theca cell tumor

-clinical presentation, by ages (3)

A

Often produces excess estrogen, so effects based on estrogen:

before puberty: precocious puberty

reproductive age: menorrhagia (heavy bleeding), metrorrhagia (ireegular bleeding)

postmenopause: endometrial hyperplasia, uterine bleeding.

23
Q

Glomeruloid appearance on histology

-what is this

A

Schiller Duval bodies.

Yolk sac tumor, females. usu children.

24
Q

Surface epithelial tumors of ovary

  • clinical presentation inculde (2)
  • prognosis
  • spread pattern
A
  • present late.
    1. vague abdominal symptoms (eg pain)
    2. signs of compression–urinary frequency
  • prognosis generally poor
  • spread locally, esp to peritoneum (‘omental caking of peritoneum’, ‘seeding of body cavities’))
25
Q

Germ cell tumors, ovary

-what types (5)

A

think what germ cell needs to make:

Fetal tissue:

  1. cystic teratoma
  2. embryonal carcinoma
  3. dysgerminoma (oocytes)
  4. yolk sac
  5. choriocarcinoma
27
Q

Brenner tumor of ovary

  • cell type
  • malignant?
A
  • bladder-like epithelium (urothelium)–this is a less common surface epithelim tumor of ovary
  • usu benign
29
Q

what’s the most common somatic malignancy in teratoma (female)?

A

SCC of skin

30
Q

BRCA1 mutation carriers have increased risk for what? in female genital system

A

serous carcinoma (surface epithelium tumor) of:

  1. ovaries
  2. fallopian tubes
    - This is why BRCA1 carriers often choose to get a prophylactic salpingo-oophorectomy along with prophylactic mastectomy
32
Q

PCOD

-mech

A

polycystic ovarian disease

-High LH:FSH ratio. (>2:1)

LH stimulates thecal cells to make androgen, which is converted to estrone in fat tissue. Estrone reduces FSH secretion, which causes cystic degeneration of follicles.

Excess androgen also causes hirsutism.

33
Q

Endometrioid tumor of ovary

  • malignant?
  • assoc with what
  • if your pt has one, what else to look for
A

–tumor of endometrial-like glands, usu malignant

  • assoc with endometriosis
  • 15% are assoc with another endometrioid tumor elsewhere (eg of endometrium). So always look for more
33
Q

Krukenberg tumor

  • what is it
  • what else present similarly, and how to distinguish?
A

mucinous tumor that metastasized to ovaries, bilaterally

  • usu gastric carcinoma, diffuse
  • similar to primary mucinous carcinoma of ovary (surface epithelial). Distinguish b/c Krukenberg is bilateral.
34
Q

Yolk sac tumor, female

  • cell type
  • what is elevated in blood
  • population
A

aka endodermal sinus tumor

  • malignant tumor, mimics yolk sac
  • AFP elevated in blood
  • most common germ cell tumor in children
35
Q

General patterns of tumor spread:

  1. carcinomas
  2. sarcomas
  3. ovarian
A
  1. carcinomas–lymph
  2. sarcomas-blood
  3. ovarian–‘omental caking of peritoneum–seeding of body cavities’
36
Q

BRCA1:

think what cancers

A
  1. breast cancer
  2. serous carcinoma (surface epithelium) of ovaries, fallopian tubes
38
Q

What is the tumor that is benign in one gender and malignant in the other?

A

Teratoma.

malignant in males, not females

40
Q

what is the most common tissue that’s immature in an immature teratoma? (female)

A

neuroectoderm. this is malignant potential

42
Q

choriocarcinoma, female

-classic presentation

A

tiny primary tumor in ovary, massive metastasis.

(early blood spread)

43
Q

choriocarcinoma, female

-prognosis

A

poor response to chemo

44
Q

Surface epithelial tumors, ovary

-divided into what types (4)

A
  1. serous–filled with watery fluid
  2. mucinous–mucus fluid
    - these are divided into:
    1) benign (adenoma)
    2) malignant (cystadenocarcinomas)
    3) borderline
  3. endometrioid–assoc with endometriosis
  4. Brenner–bladder epithelium
45
Q

choriocarcinoma, female

-what can high hCG lead to in the ovary?

A

thecal cysts

46
Q

surface epithelial tumors of ovary

  • serum tumor marker
  • its uses
A

CA-125

  1. monitor treatment response
  2. screen for recurrence

(measure CA-125 in pt after cancer tx if symptoms reappear)

not for preventive screening.

47
Q

What is the defining feature of cystadenocarcinomas in ovary, histology

A

Cells invade through connective tissue of cyst wall.

-complex cysts with thick, shaggy lining

13 Female Genital and Gestational (6 decks)

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