4/28 Ovarian Neoplasm Flashcards
what is a functional cyst?
cysts that form as a normal part of the menstrual cycle; usually transient in nature and does not progress to cancer
examples of functional cysts?
Follicle cyst
Corpus luteum cyst
Hemorrhagic cyst
What is a follicle cyst?
functional cyst
distension of an unruptured graafian follicle; may be associated with hyperestrogenism and endometrial hyperplasia
What is a Corpus luteum cyst?
functional cyst
Appear after ovulation; hemorrhage into the persistent corpus luteum, commonly regresses spontaneously within 5–9 days
What is a Hemorrhagic cyst?
functional cyst
Ovulates -> bleeds into itself; Blood vessel rupture in the cyst wall; cyst grows with increased blood retention; usually self-resolves
What is a non-functional cyst?
aka non-functional neoplasms; does NOT occur as a normal part of the menstrual cycle
examples of non-functional cyst?
Theca-lutein cyst Dermoid cyst (teratomas) Endometrioid cyst
What is a theca-lutein cyst?
Often bilateral/multiple
Due to gonadotropin stimulation
Associated with choriocarcinoma and moles
what is a dermoid cyst?
Dermoid cyst (teratomas) filled with various types of tissue, such as fat, hair, teeth, bits of bone, and cartilage
what is an Endometrioid cyst?
cyst formation secondary to endometriosis within the ovary; varies with menstrual cycle. When filled with dark, reddish-brown blood, AKA “chocolate cyst”
RA: chocolate cyst
Endometrioid cyst
What are various types of tumors of the ovary? (general)
Surface epithelial cells
Germ cell tumors
Sex-cord stromal cell tumor
Metastasis to ovaries (krukenberg)
How does BRCA1/BRCA2 affect risk of ovarian cancer?
which one is associated with a greater risk of ovarian cancer?
- recognize and repair dsDNA breaks
- mutation in BRCA genes results in ø DNA repair, leading to p53 activation, leading to cell cycle arrest, apoptosis, or both. If p53 is also inactivated, cells with DNA damage continue to proliferate and accumulate; increased malignancy potential
• greater risk of ovarian cancer with BRCA1
What is the “Inclusion-related Carcinogenesis model” for development of surface epithelial ovarian tumors?
surface epithelium invaginates and loses connection to the ovarian surface; lined by mesothelial or tubal-type epithelium (though studies suggest that tubal origin, specifically in high grade serous carcinomas).
the mesothelium is of an uncommitted phenotype and has the potential to differentiate in response to signals associated with ovulation or those associated with the stromal microenvironment (commonly undergoes Müllerian metaplasia usually to a serous phenotype)
What is the “tubal carcinogenesis model” for development of surface epithelial ovarian tumors?
epithelial cells experience genotoxic damage, including p53 and BRCA tumor suppressor genes, leading to the clonal expansion of ciliated cells/ “dysplastic” epithelium; progresses from STIL -> STIC in the fallopian tube, and then releases mutated cells or ROS into the ovaries
wtf are STIL and STICs? WHY DO WE HAVE TO KNOW THIS USELESS STUFF
STIL – serous tubal intraepithelial lesions – contain “p53 signatures” (mutations) have some cytologic abnormalities but fall short of STICs
STIC – serous tubal intraepithelial carcinomas – precursor of ovarian high-grade serous carcinoma; contains p53 mutations and high levels of chromosomal instability in both lesions; frequently detected in fallopian tubes of women with hereditary BRCA mutations.
Dx based on nuclear enlargement, hyperchromasia, irregularly distributed chromatin, nucleolar prominence, mitotic activity, apotosis, loss of polarity, and epithelial tufting
risk factors for surface epithelial ovarian tumors?
- age
- early menarche/late menopause
- nulliparity, infertility
- endometriosis
- PCOS
- post-menopausal hormone therapy
- BRCA1/BRCA2
- HPNCC
when do ovarian tumors commonly present?
Teens: Germ cell tumors 20's: Functional and benign adenomas 30's: Endometriomas 40's: Benign and Borderline tumors 50-60's: Epithelial carcinomas 70+: Granulosa cell tumors
Serous Cystadenoma when does it occur? bilateral? unilateral? features? subtypes?
surface epithelial ovarian tumors
Most common ovarian neoplasm; 20s
Often bilateral
Thin walled
Serous benign or serous borderline
difference btwn serous cystadenoma - benign or serous borderline?
Serous benign - Lined with fallopian-like epithelium (single layer of tall, columnar ciliated cells); no atypia, no architectural complexity, no invasion of the stroma
Serous borderline – more complex papillary structures, absence of stromal invasion
Mucinous cysatdenoma when does it occur? bilateral? unilateral? features? subtypes?
surface epithelial ovarian tumors
20s
Often unilateral
Multi-loculated, large
Mucinous benign or mucinous borderline
difference btwn mucinous benign or mucinous borderline?
Mucinous benign - lined by mucus-secreting epithelium; lining is a single layer (indicates benign)
Mucinous borderline – lining w/ proliferative nuclei
Endometrioma
features?
common presentation?
surface epithelial ovarian tumors
Endometrioid cyst “chocolate cyst”; mass arises from ectopic endometrial tissue; when it bleeds, the blood accumulates and turns brown
Presents with pelvic pain, dysmenorrhea, dyspareunia
Clear cell histology?
surface epithelial ovarian tumors
Neoplastic cells with cleared cytoplasm (contains glycogen)
Brenner tumor
Gross appearance?
Histologic feature?
surface epithelial ovarian tumors
Looks like bladder; solid tumor that is pale yellow-tan in color; circumscribed
encapsulated “coffee bean” nuclei lying in abundant fibrous stroma
when does Mature teratoma (dermoid cyst) occur?
What is unique about this tumor?
sx?
20s
can contain elements from all 3 germ layers (teeth, bone, cartilage, hair, sebum; thyroid tissue is less common)
Presents
- pain secondary to ovarian enlargement or torsion
- hyperthyroidism (struma ovarii) if it contains functional thyroid tissue!!!
What is a Fibroma?
clinical presentation?
characteristic hx features?
Sex-cord; stromal cell tumor
Meigs syndrome – triad of ovarian fibroma, ascites, and hydrothorax
Pulling sensation in groin
Bundles of spindle-shaped fibroblasts
Thecoma - what is it and common presentation?
Like granulosa cell tumors; may produce estrogen
Usually presents as abnormal uterine bleeding in a post-menopausal woman
What are some malignant ovarian neoplasms?
Serous cystadenocarcinoma Mucinous cystadenocarcinoma Immature teratoma Sertoli-Leydig Cell tumor Granulosa-theca cell tumor Dysgerminoma Choriocarcinoma Yolk sac (endodermal sinus) tumor Krukenberg tumor
Serous cystadenocarcinoma?
unilateral? bilatera?
hx features?
Surface epithelial tumor
Most common ovarian neoplasm
frequently bilateral
Psammoma bodies, solid, cystic, papillary, necrotic, hemorrhagic
Immature teratoma
what is it?
features?
likelihood of containing thyroid tissue?
Germ cell tumor Aggressive, contains fetal tissue, neuroectoderm
Most typically represented by immature/embryonic-like neural tissue
Less likely to contain thyroid tissue
Sertoli-Leydig Cell tumor
typical onset?
presentation?
markers? 3
Sex-cord stromal tumor that produces excess testosterone
onset: young adults
F = present with history of progressive masculinization preceded by anovulation, oligomenorrhea, amenorrhea, defeminization (acne, hirsutism, voice deepening, clitormeagly, temporal hair recession)
Marker: CA-125, AFP, incr testosterone
Granulosa-theca cell tumor
typical onset?
presentation?
markers? 2
Sex-cord stromal tumor that produce estrogen and/or progesterone
Predominately F, 50s
Presents with abnormal uterine bleeding, precocious puberty, breast tenderness
Marker: inhibin, CA-125
Dysgerminoma
typical onset?markers? 2
histological features?
Germ cell tumor
adolescents
Tumor markers: hCG, LDH
Sheets of uniform “fried-egg” cells with lymphocytes
Choriocarcinoma typical onset? presentation? marker? treatment?
Trophoblast malignancy (cytotrophoblasts, syncytiotrophoblast)
Rare, can develop during or after pregnancy in mother or baby
presentation: shortness of breath, hemoptysis due to hematogenous spread to LUNGS
marker: ß-hCG
presentation: shortness of breath, hemoptysis due to hematogenous spread to lungs
very responsive to chemotherapy
Yolk sac (endodermal sinus) tumor typical onset? prognosis? marker? gross-apperance? Hx features?
Male infants
bad = aggressive tumor!
tumor marker: AFP
Gross appearance: Yellow, friable (hemorrhagic) solid mass
Hx presentation: Schiller-Duval bodies (resembles glomeruli)
what is a Krukenberg tumor?
Metastasis tumor: GI malignancy that metz to the ovaries, causing a mucin-secreting signet cell adenocarcinoma
