Surface epithelial tumors, ovary - serous and mucinous tumors: divided into what types (3) - gross appearance - population

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

PCOD - population - classic presentation (3) - important late complication

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

Cystic teratoma, ovary - cell type - malignant? - what specific teratoma has its own name

- 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

Meig's syndrome - what is it - tx

1. ovarian tumor (usu fibroma) 2. pleural effusion 3. ascites resolves with tumor removal

Embryonal carcinoma, female - cell type - prognosis

- malignant, aggresive, poor prognosis - large primitive cells

Fibroma - cell type - assoc with what

- benign tumor of fibroblasts - assoc with Meig's syndrome: 1. ovarian tumor 2. pleural effusion 3. ascites (resolves with tumor removal)

13.5 Ovary, ovarian tumors Flashcards by Marcus Wong

Surface epithelial tumors, ovary

serous and mucinous tumors: divided into what types (3)
gross appearance
population

cystadenoma–single cyst with simple, flat lining. Premenopausal women 30-40 yo
cystadenocarcinoma–complex cysts with thick, shaggy lining. postmenopausal 60-70 yo
borderline–in btwn features. possible malignant

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

Struma ovarii

(teratoma of thyroid tissue)

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granulosa-theca cell tumor

-malignant?

-malignant, but minimal risk for metastasis

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Tumors that metastasize to ovary

name 2 characteristic types:

Krukenberg tumor–metastatic mucinous tumor that involves both ovaries. Usu diffuse gastric carcinoma.
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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PCOD

population
classic presentation (3)
important late complication

obese young woman with:

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

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Struma ovarii

teratoma that is composed of thryoid tissue

-can create hyperthyroidism

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

granulosa-theca cell tumor

(secrete estrogen)

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5 yo female presents with ovarian mass

think what?

Yolk sac tumor (most common in children)

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Ovarian tumor differential by age:

age 15-30

30-40

60-70

age 15-30–germ cell

30-40–benign surface epithelial (eg cystadenoma)

60-70–malignant surface epithelial (eg cystadenocarcinoma)

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Cystic teratoma, ovary

cell type
malignant?
what specific teratoma has its own name

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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Meig’s syndrome

what is it
tx

ovarian tumor (usu fibroma)
pleural effusion
ascites

resolves with tumor removal

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dysgerminoma

cell type
histiology appearance

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

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What is most common germ cell tumor in children

yolk sac tumor

‘glomeruloid’

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Embryonal carcinoma, female

cell type
prognosis

malignant, aggresive, poor prognosis
large primitive cells

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sex-cord stromal tumors, female

-divided into what

granulosa-theca cell tumor
sertoli-leydig cell tumor
Fibroma (fibroblasts, assoc with Meigs syndrome)

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Follicular cyst

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

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Ovarian tumors, primary

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

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

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Pt is dx with PCOD.

-What to worry about 10-15 years later?

-Development of T2DM

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Fibroma

cell type
assoc with what

benign tumor of fibroblasts
assoc with Meig’s syndrome:
1. ovarian tumor
2. pleural effusion
3. ascites

(resolves with tumor removal)

choriocarcinoma, female

cell types (2)
what elevated in blood
what to know about spread

syncytiotrophoblasts (hCG)
cytotrophoblasts

(mimic placenta, but villi absent)

hCG elevated
spread through blood

Seroli-leydig cell tumor, female

clinical presentation
histology appearance

may produce androgens
1. hirsutism
2. virilization

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

surface epithelial tumors

-derived from what common types of cells (2)

derived from coelomic epithelium that lines ovary. This produces:

serous cells–epithelial lining of fallopian tube
mucinous cells–endocervix epithelium

dysgerminoma

-prognosis

good prognosis

responds well to radiotherapy

Pseudomyxoma peritonei

“jelly belly”

massive amounts of mucus in peritoneum

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

Corpus luteum What does corpus luteum primarily secrete? -what is a complication during early pregnancy of it?

- progesterone - hemorrhagic corpus luteum cyst (caused by hemorrhage into corpus luteum)

yolk sac tumor, female -histology appearance

Schiller-Duval bodies (glomerulus like structures) classic. 'glomeruloid'

Granulosa-theca cell tumor -clinical presentation, by ages (3)

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.

Glomeruloid appearance on histology -what is this

Schiller Duval bodies. Yolk sac tumor, females. usu children.

Surface epithelial tumors of ovary - clinical presentation inculde (2) - prognosis - spread pattern

- 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'))

Germ cell tumors, ovary -what types (5)

think what germ cell needs to make: Fetal tissue: 1. cystic teratoma 2. embryonal carcinoma 3. dysgerminoma (oocytes) 4. yolk sac 5. choriocarcinoma

Brenner tumor of ovary - cell type - malignant?

- bladder-like epithelium (urothelium)--this is a less common surface epithelim tumor of ovary - usu benign

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

SCC of skin

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

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

PCOD -mech

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.

Endometrioid tumor of ovary - malignant? - assoc with what - if your pt has one, what else to look for

--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

Krukenberg tumor - what is it - what else present similarly, and how to distinguish?

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.

Yolk sac tumor, female - cell type - what is elevated in blood - population

aka endodermal sinus tumor - malignant tumor, mimics yolk sac - AFP elevated in blood - most common germ cell tumor in children

General patterns of tumor spread: 1. carcinomas 2. sarcomas 3. ovarian

1. carcinomas--lymph 2. sarcomas-blood 3. ovarian--'omental caking of peritoneum--seeding of body cavities'

BRCA1: think what cancers

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

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

Teratoma. malignant in males, not females

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

neuroectoderm. this is malignant potential

choriocarcinoma, female -classic presentation

tiny primary tumor in ovary, massive metastasis. (early blood spread)

choriocarcinoma, female -prognosis

poor response to chemo

Surface epithelial tumors, ovary -divided into what types (4)

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

choriocarcinoma, female -what can high hCG lead to in the ovary?

thecal cysts

surface epithelial tumors of ovary - serum tumor marker - its uses

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.

What is the defining feature of cystadenocarcinomas in ovary, histology

Cells invade through connective tissue of cyst wall. -complex cysts with thick, shaggy lining