219/222 - Ovary/Fallopian Tubes and Adenexal Mass + Pathology Flashcards
What are the findings indicated by the arrows called?
What ovarian tumor are they associated with?
Cal-Exner bodies
Associated with granulosa cell tumor
Low malignant potential, but produce estrogen -> can cause endometrial hyperplasia
Which type of tumor is derived from pluripotent stem cells?
Germ cell tumors
- Teratoma
- Yolk sac tumor
- Dysgerminoma
Elevated inhibin A or B may be indicative of which ovarian tumors?
Stromal tumors
(Theca or granulosa cell)
Is the following true of Type I or Type II ovarian epithelial tumors?
Histologic types include endeometroid, low-grade serous, mucinous, and clear cell carcinomas
Type I
What is the appropriate management for “borderline” epithelial tumors?
Conservative treatment
- These tumors are usually have atypical proliferation and low malignant potential*
- Unusual features = we can’t definitively say its benign onr malignant*
- If tumor is invasive, considered carcinoma*
How does the pathogenesis of ovarian Type I and Type II tumors differ?
- Type 1 (ex: clear cell)
- Originates in stepwise fashion (hyperplasia -> dysplasia -> carcinoma)
- Associated with MAPK pathway
- Usually more indolent
- Type 2 (ex: high-grade serous)
- Arise de novo, likely from fallopian tube
- Associated with p53 mutation
- Aggressive, presents at advanced stage
Is the following true of Type I or Type II ovarian epithelial tumors?
Stepwise development: benign -> borderline -> malignant
Type I
Which germ cell tumor is most likley to produce AFP?
What is the histopathologic hallmark of this tumor?
Yolk sact tumor
Schiller duval body
What type of ovarian tumor arises from endometriosis?
What is the histologic hallmark?
Clear cell carcinoma
(Type I)
What is the precursor legion for high-grade serous ovarian cancer?
Serous tubal intra-epithelial carcinoma (STIC)
Often contains p53 mutation
High-grade serous = type II
List 2 sex-cord stromal ovarian tumors
Granulosa cell tumor
Fibrothecoma
What is the imaging modality of choice for adenexal masses?
Ultrasound
Transvaginal give a better picture than abdominal
Adenexal mass = ovarian and/or fallopian tube mass?
Is the following true of Type I or Type II ovarian epithelial tumors?
Associated with p53 and/or BRCA1 and/or BRCA2 mutations
Type II
List 2 epithelial ovarian tumors
Serous carcnioma
Clear cell carcinoma
In what age groups do germ cell tumors (teratoma, yolk sac, dysgerminoma) usually occur?
Children through early reproductive age
A patient with a uterus is recently found to have a BRCA1 mutation. They ask you what prophylactic treatment will offer the MOST protection from developing ovarian cancer.
What do you tell them?
Bilateral salpingooophorectomy
Need to take ovaries AND tubes - Serous tubal intraepithelial carcinoma (of the tube) is a precursor for ovarian cancer; if no ovaries, can get to other places instead
How do theca cells and granulosa cells differ in appearance?
- Granulosa
- Multi-layered
- Don’t stick together
- Small blue nuclei
- Theca
- Spindled
- Eventually blend into backgorund stroma
When is a theca-lutein cyst normal?
Pregnancy
What are the indications for surgery on an ovarian mass? (5)
- Any adnexal mass >10cm
- Complex adnexal cyst >5cm
- Any cyst >5cm w/o resolution after 6-8 weeks
- To avoid torsion or rupture
- To confirm not malignant
- Solid ovarian lesions
- Symptomatic for pain
- Worry for ovarian torsion - this is an emergency! Intervene surgically!
What findings on ultrasound are concerining for adenexal malignancy?
What is the next step in management?
- Internal echos
- Intramural nodules
- Solid components
Order serum tumor markers if you see any of these!
CA-125 (ovarian cancer)
bHCG, AFP, LDH (germ cell tumors)
Inhibitn A/B (stromal tumors)
In general:
Sex cord stromal tumors are more likely in [younger/older] patients
Germ cell tumors are more likely in [younger/older] patients
Sex cord stromal tumors are more likely in older patients
Germ cell tumors are more likely in younger patients
What is the most common ovarian carcinoma?
What is the proposed pathogenesis?
High-grade serous carcinoma (aka type II)
Originates from in situ lesions in the fimbriated end of the fallopian tube -> implants on the ovarian surface. Associated with p53 mutation
Which ovarian tumor will have elvated LDH?
Dysgerminoma (type of germ cell tumor)
- Note: LDH not specific to dysgerminoma*
- CA-125 (ovarian cancer)*
- bHCG, AFP, LDH (germ cell tumors)*
- Inhibitn A/B (stromal tumors)*
Is the following true of Type I or Type II ovarian epithelial tumors?
Histologic types include high-grade serous carcinoma, carcinosarcoma, and undifferentiated carcinoma
Type II
In which patient population is a fibrothecoma most common?
Describe the appearance
Post-menopausal patients
- Fibroblasts w/collagenous stroma, spindled
- Theca cells: plump, round, abundant cytoplasm
All epithelial tumors are more common in post-menopausal patients
List 2 hereditary mutations associated with ovarian caner
BRCA 1 or 2 mutation
Lynch syndrome
Is the following true of Type I or Type II ovarian epithelial tumors?
Aggressive; usually high stage at diagnosis
Type II
What is the most likely diagnosis of this cyst?
Mucinous cystadenoma
What is the name for this histoligical finding?
(Bulbous protusion of nucleus into lumen)
What type of ovarian cancer is it associated with?
Hob-nailing (aka hobnail cell)
Associated with ovarian clear cell carcinoma
Arises from teh endometrium
List 3 risk factors for ectopic pregnancy
- Prior ectopic pregnancy
- History of tubal sterilization
- History of PID/salpingitis
Is the following true of Type I or Type II ovarian epithelial tumors?
Arises de novo from tubal epithelium
Type II
Arises from serous tubal intraepithelial carcinoma (STIC)
What is Mieg’s syndrome?
Which type of ovarian tumor is associated with this syndrome?
Fibroma + ascites + pleural effusion
Usually a fibroma or fibrothecoma
List 2 germ cell ovarian tumors
Teratoma
Yolk sac tumor
Which tumor marker will be elevated in ovarian cancer?
CA-125
In general, what is the treatment strategy for ovarian cancer?
Start with surgery if possible
Then:
- Observe if stage 1A/1B
- If more severe -> chemotherapy
If not a candidate for primary surgical de-bulking, do neoadjuvant chemo then interval debulking
What is this finding called?
Which ovarian tumor is it associated with?
Schiller-Duvall body
Yolk sac tumor
Will also see high AFP
What is the difference between a mature teratoma and an immature teratoma?
- Mature
- Contains mature (adult-type) tissues
- Benign
- Immature
- Contains varying amounts and type sof immature or embryonal tissue
- Malignant
