✓ 33- Benign and Malignant Ovarian Conditions Flashcards
What is the management/follow up plan for ovarian masses?
- < 5 cm → Doesn’t recquire follow up [likely physiological]
- 5-7 cm → Yearly US
- > 7 cm → further imaging and surgical intervention
What are the general types of ovarian masses?
- Functional
- Inflammatory
- Neoplastic
- Other
What are the functional ovarian masses?
- Follicular cyst
- Corpus Luteum cyst
- Theca Lutein cyst
What are the inflammatory ovarian masses?
- Tubo-ovarian masses
- Abscess
What are the neoplastic ovarian masses?
- Benign ovarian mass
- Borderline ovarian mass
- Malignant ovarian mass
What are the “other” type of ovarian masses?
Endometrima
Enlarged PCO
Parovarian cyst
Epidemiology of Ovarian Tumors
- 80% are benign
- cmost 20-45 yrs.
- High mortality in malignancies
- accounts for 27% of gynecologic cancer
- and accounts for 53% of deaths
- 75% are diagnosed with advanced stage
What are the risk factors for ovarian carcinoma?
- Nulliparity
- Family history
- Childhood gonadal dysgenesis
- Clomiphene
- Inheredited
What genes are responsible for Familial Ovarian Cancers?
BRCA1 [39%]
BRCA 2 [11%]
HNPCC- Mutations in mismatch repair genes
- MLH1
- MSH2
- MSH6
What cancers are associated with BRCA1 mutations?
- Breast
- Ovary
- Fallopian tube
- Colorectal
- Prostate
What cancers are associated with BRCA2 mutations?
- Breast
- Ovary
- Fallopian tube
- Pancreatic
- Gallbladder
- Bile Duct
- Gastric
- Melanoma
- Male Breast
- Prostate
What is the risk of Hereditary ovarian cancer in women? [General population, BRCA1, BRCA2, HNPCC]
- General Population: 1/70
- BRCA1: 20-40% [65%]
- BRCA2: 20-25%
- HNPCC: 9%
What are the different classification of Primary ovarian tumors?
- Surface/Mullerian Epithelial tumors
- Germ cell tumors
- Sex cord-stromall tumors
What is the frequency of each type of ovarian tumors?
- Surface/Mullerian Epithelial tumors
- 65-70%
- Germ cell tumors
- 15-20%
- Sex cord-stromall tumors
- 5-10%
- Metastasis
- 5%
What are the different types of Surface epithelial cell tumor?
- Serous [75-80%]
- Mucinous [8-10%]
- Endometrioid [10%]
- Clear cell [<1%]
- Brenner [<1%]
- Cystadenofibrma
What are the different types of Germ cell tumor?
- Teratoma
- Dysgerminoma
- Endodermal sinus
- Choriocarcinoma
What are the different types of Sex-cord stroma tumor?
- Fibroma
- Granulosa-theca cell tumor
- Sertoli-Leydig cell tumor
Describe the gross and microscopic features of borderline surface epithelial tumors?
Gross: cystic /solid foci
Microscopic:
- Papillary complexity
- Stratification
- Nuclear atypia
- No stromal invastion
Describe the gross and microscopic features of benign surface epithelial tumors?
Gross: mostly cystic
Microscopic:
- Cuboidal-Columnar epithelium
- Fine Papillae
- No stratification
- No nuclear atypia
- No stromal invastion
Describe the gross and microscopic features of malignant surface epithelial tumors?
Gross: mostly solid, and hemorrhage/necrosis
Microscopic:
- Papillary complexity
- Stratification
- Nuclear atypia/ Malignany cells in glandular pattern
- High mitotic activity
- Psammoma bodies
- Stromal invastion
What does the lining epithelium of serous tumors resemble?
Fallopian tube
What does the lining epithelium of mucinous tumors resemble?
- Intestinal → gastrointestinal mucosa
- Müllerian → endocervix
What does the lining epithelium of endometrioid tumors resemble?
Endometrial glands
What does the lining epithelium of brenner tumors resemble?
Bladder [transitional epithelium]
What does the lining epithelium of clear cell tumors resemble?
Mesonephric [renal cell]
General epidemiology of Serous tumors
- Most common in 4th/5th decades of life
- Most common cystic neoaplasm of ovary
- accounts for 75% of epithelial ovarian tumors
What are the different types of serous tumors and the incidence of each?
- Benign / Cystadenomas[60%]
- Borderline [15%]
- Malignant / Cystadenocarcinoma [25%]
How likely would both ovaries be affected in the different types of serous tumors
- Benign → 20%
- Borderline → 30%
- Malignanct → 65%
What factors would determine the prognosis of serous tumors?
- Stage of disease
- presence of peritoneal implants
Prognosis of Borderline Serous Cystadenoma
- Age: 20-50 yrs
- Bilaterally: 30%
- Prognosis: 100% 5yrs survival
Describe the histological appearance of ovarian cystadenofibroma
Well differentiated glands are embedded within a dense fibrous stroma
What type of ovarian tumors is the largest?
Mucinous tumors [mall fill entire abdominal cavity]
What is the condition may be associated with Endometrioid tumors?
Endometrial cancers [15-20%]
Describe the Gross and Morphological appearance of Endometrioid tumors
- May be cystic or solid
- Content tends to be hemorrhagic rather than serous or mucinous
T/F: Endometrioid tumors are benign.
False, almost all cases of Endometrioid tumors are malignant
What two other condition may be found in a patient with Endometrioid tumor?
- Concurrent endometrioisis [10-20%]
- Endometrial cancer [15-20%]
Describe clear cell tumors , in terms of its grade, malignancy and incidence
- Uncommon
- Agressive tumor
- Invariable high grade
- Mostly malignant
Describe the appearance of Clear cell tumors
clear, peg-like or hobnail-like cells
What is the precurosr of clear cell tumors?
in 1/4 of cases they arise from lining of benign endometrioid cyst
What other condition may a patient with clear cell tumor also complain of?
50-70% have endometriosis
What is the average age of incidence of Brenner tumor?
50 years
What signs maybe found in patients with Brenner Tumors?
- Sign of Hyperestronsim
- Post-menopausal bleeding from endometrial hyperplasia
- Ascites [rarely]
Describe the gross appearance of Brenner Tumor
- white to tan-yellow whorled cut surface
- Cystic spcaes and calcification [possible]
Describe the microscopic appearance of Brenner Tumors
- Epithelial cells: solid and cystic nests
- Resemble transitional epithelium
- Surrounded by abundant stroma.
T/F: Brenner tumor is described as a large and fast growing malignant tumor
False, its mostly benign and its slow growing with a variable size of 1-30 cm
What is the treatment of Borderline Brenner tumors?
Surgical removal
Define Malignant Brenner tumor
benign or borderline when coexisting with invasive transitional cell carcinoma
What are the prognostic factors in ovarian cancer?
- Stage of disease
- Volume of Residual disease post surgery
- Histological type and Grade of Tumor
- Age at presentation