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Repro/GU by Minnie (she/her) > 219/222 - Ovary/Fallopian Tubes and Adenexal Mass + Pathology > Flashcards

219/222 - Ovary/Fallopian Tubes and Adenexal Mass + Pathology Flashcards

1
Q

What are the findings indicated by the arrows called?

What ovarian tumor are they associated with?

A

Cal-Exner bodies

Associated with granulosa cell tumor

Low malignant potential, but produce estrogen -> can cause endometrial hyperplasia

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2
Q

Which type of tumor is derived from pluripotent stem cells?

A

Germ cell tumors

  • Teratoma
  • Yolk sac tumor
  • Dysgerminoma
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3
Q

Elevated inhibin A or B may be indicative of which ovarian tumors?

A

Stromal tumors

(Theca or granulosa cell)

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4
Q

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

A

Type I

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5
Q

What is the appropriate management for “borderline” epithelial tumors?

A

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*
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6
Q

How does the pathogenesis of ovarian Type I and Type II tumors differ?

A
  • 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
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7
Q

Is the following true of Type I or Type II ovarian epithelial tumors?

Stepwise development: benign -> borderline -> malignant

A

Type I

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8
Q

Which germ cell tumor is most likley to produce AFP?

What is the histopathologic hallmark of this tumor?

A

Yolk sact tumor

Schiller duval body

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9
Q

What type of ovarian tumor arises from endometriosis?

What is the histologic hallmark?

A

Clear cell carcinoma

(Type I)

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10
Q

What is the precursor legion for high-grade serous ovarian cancer?

A

Serous tubal intra-epithelial carcinoma (STIC)

Often contains p53 mutation

High-grade serous = type II

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11
Q

List 2 sex-cord stromal ovarian tumors

A

Granulosa cell tumor

Fibrothecoma

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12
Q

What is the imaging modality of choice for adenexal masses?

A

Ultrasound

Transvaginal give a better picture than abdominal

Adenexal mass = ovarian and/or fallopian tube mass?

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13
Q

Is the following true of Type I or Type II ovarian epithelial tumors?

Associated with p53 and/or BRCA1 and/or BRCA2 mutations

A

Type II

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14
Q

List 2 epithelial ovarian tumors

A

Serous carcnioma

Clear cell carcinoma

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15
Q

In what age groups do germ cell tumors (teratoma, yolk sac, dysgerminoma) usually occur?

A

Children through early reproductive age

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16
Q

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?

A

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

17
Q

How do theca cells and granulosa cells differ in appearance?

A
  • Granulosa
    • Multi-layered
    • Don’t stick together
    • Small blue nuclei
  • Theca
    • Spindled
    • Eventually blend into backgorund stroma
18
Q

When is a theca-lutein cyst normal?

A

Pregnancy

19
Q

What are the indications for surgery on an ovarian mass? (5)

A
  • 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!
20
Q

What findings on ultrasound are concerining for adenexal malignancy?

What is the next step in management?

A
  • 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)

21
Q

In general:

Sex cord stromal tumors are more likely in [younger/older] patients

Germ cell tumors are more likely in [younger/older] patients

A

Sex cord stromal tumors are more likely in older patients

Germ cell tumors are more likely in younger patients

22
Q

What is the most common ovarian carcinoma?

What is the proposed pathogenesis?

A

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

23
Q

Which ovarian tumor will have elvated LDH?

A

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)*
24
Q

Is the following true of Type I or Type II ovarian epithelial tumors?

Histologic types include high-grade serous carcinoma, carcinosarcoma, and undifferentiated carcinoma

A

Type II

25
Q

In which patient population is a fibrothecoma most common?

Describe the appearance

A

Post-menopausal patients

  • Fibroblasts w/collagenous stroma, spindled
  • Theca cells: plump, round, abundant cytoplasm

All epithelial tumors are more common in post-menopausal patients

26
Q

List 2 hereditary mutations associated with ovarian caner

A

BRCA 1 or 2 mutation

Lynch syndrome

27
Q

Is the following true of Type I or Type II ovarian epithelial tumors?

Aggressive; usually high stage at diagnosis

A

Type II

28
Q

What is the most likely diagnosis of this cyst?

A

Mucinous cystadenoma

29
Q

What is the name for this histoligical finding?

(Bulbous protusion of nucleus into lumen)

What type of ovarian cancer is it associated with?

A

Hob-nailing (aka hobnail cell)

Associated with ovarian clear cell carcinoma

Arises from teh endometrium

30
Q

List 3 risk factors for ectopic pregnancy

A
  • Prior ectopic pregnancy
  • History of tubal sterilization
  • History of PID/salpingitis
31
Q

Is the following true of Type I or Type II ovarian epithelial tumors?

Arises de novo from tubal epithelium

A

Type II

Arises from serous tubal intraepithelial carcinoma (STIC)

32
Q

What is Mieg’s syndrome?

Which type of ovarian tumor is associated with this syndrome?

A

Fibroma + ascites + pleural effusion

Usually a fibroma or fibrothecoma

33
Q

List 2 germ cell ovarian tumors

A

Teratoma

Yolk sac tumor

34
Q

Which tumor marker will be elevated in ovarian cancer?

A

CA-125

35
Q

In general, what is the treatment strategy for ovarian cancer?

A

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

36
Q

What is this finding called?

Which ovarian tumor is it associated with?

A

Schiller-Duvall body

Yolk sac tumor

Will also see high AFP

37
Q

What is the difference between a mature teratoma and an immature teratoma?

A
  • Mature
    • Contains mature (adult-type) tissues
    • Benign
  • Immature
    • Contains varying amounts and type sof immature or embryonal tissue
    • Malignant

Repro/GU by Minnie (she/her) (31 decks)

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