Ch. 16 - Ovary Flashcards
What is the “triple test” of ovarian cyst analysis?
Ultrasound, cytology, and estradiol levels of cyst fluid.
What are the two major categories of benign ovarian cysts?
Functional cysts (eg. Follicular, corpus luteum) and nonfunctional (eg Endometriotic).
Recite the sequence of progression of a primordial follicle to becoming a corpus luteum.
Primordial follicle (oocyte & granulosa cells)»_space; Primary follicle»_space; Secondary follicle (stratified granulosa layer), Graafian follicle (fluid zone, theca cells)»_space; Rupture & corpus luteum.
From what does a follicular cyst arise?
A graafian follicle that fails to rupture
Describe the cytology of a follicular cyst.
Granulosa cells (granular chromatin, small nucleoli, yellow luteinization) and theca interna cells (spindle-shaped and indistinguishable from ovarian stroma cells).
Describe the cytology of a corpus luteum cyst.
Isolated very large cells with foamy lipid cytoplasm. Macrophages filled with hematoidin may be present. If associated with pregnancy, expect hyaline bodies and calcifications.
What features need to be present on cytology to diagnose an endometrial cyst?
Need 2 of 3: Endometrial glands (indistinct borders, scant cytoplasm), stroma (spindled, oval nuclei), and hemosiderin (incl. siderophages).
What are the possible origins of epithelial ovarian cysts?
May arise from ovarian surface or parovarian/paratubal tissue.
Describe the cytology of an ovarian simple cyst.
Depends on the epithelial lining; may see columnar, cuboidal, or flattened cells. If cilated cells are present, it is either a serous cyst or h ydrosalpinx.
Describe the cytology of a tuboovarian abscess.
Acute exudate and necrotic debris.
Describe the cytology of the benign serous tumors (eg serous cystadenoma, serous adenofibroma, serous cystadenofibroma)
Ciliated and cuboidal cells with detached ciliary tufts and rarely psammoma bodies
Describe the cytology of the benign mucinous tumors (eg mucinous cystadenoma, adenofibroma, cystadenofibroma)
Mucinous cells (columnar or foblet cells), muciphages.
Describe the cytology of benign brenner tumors.
Coffee-bean transitional cells, globular hyaline structures. Note that these are usually solid but may have cystic areas with mucinous differentiation.
What IHC markers identify ovarian surface epithelial/stromal tumors?
CK7, WT1 (in serous carcinomas), PAX8. CK20 and CDX2 should be negative.
Describe the cytology of a serous adenocarcinoma.
Twisted sheets and spheres or branching clusters of cells with nuclear atypia, some cytoplasmic vacuoles, and psammoma bodies.
Describe the cytology of a mucinous adenocarcinoma.
Columnar mucinous cells with cytoplasmic vacuolization and mucin. May present with pseudomyxoma peritonei.
Describe the cytology of an endometrioid carcinoma.
Numerous isolated cells and some short strips or crowded glands against a bloody background. Vague.
Describe the cytology of a mature teratoma.
Mixed crap…look especially for squamous cells, ciliated cells, and hair.
Describe the cytology of a dysgerminoma.
Highly cellular specimen with isolated polyhedral tumor cells with vacuolated PAS+ cytoplasm and central large nuclei. May have “tigroid” background.
What IHC markers help identify dysgerminoma?
PLAP, OCT-3/4, NANO-G, SALL4, membranous CD117.
Describe the cytology of non-dysgerminomatous germ cell tumors.
Aggressive with primitive appearance, marked nuclear anaplasia, necrosis, and hemorrhage.
What IHC markers can distinguish the non-dysgerminomatous germ cell tumors?
AFP stains Yolk sac tumors
b-hCG stains choriocarcinoma
What is the clinical presentation of a granulosa cell tumor?
A typically unilateral lesion that secretes estrogen (may result in endometrial hyperplasia or carcinoma) but can rarely secrete androgens.
Describe the cytology of a granulosa cell tumor.
Highly cellular specimen with call-exner bodies, coffee bean grooved nuclei, and ill-defined cytoplasm. There may be globular basement membrane-like material.
What IHC markers identify a granulosa cell tumor?
Inhibin, calretinin, ER/PR, CD56, CD99, WT1, keratins, S100, SMA
What are some rare subtypes of granulosa cell tumors?
Small cell carcinoma, hypercalcemic-type (seen in young women), pulmonary-type (post-menopausal women).
What is the “juvenile type” granulosa cell tumor?
Unilateral lesion that may rupture and does not exhibit Call-Exner bodies (otherwise pleomorphic looking). Associated with sexual pseudoprecocity.
Describe the cytology of a thecoma.
Hypocellular specimen; some isolated elongated cells with clear and vacuolated cytoplasm.
Describe the cytology of a fibroma.
Hypocellular, with rare spindled cells with clear cytoplasm similar to that of thecoma.
What is “Meigs syndrome”?
The combination of ovarian fibroma, ascites, and pleural effusion.
What is a “Krukenberg tumor”?
A mucinous signet ring metastasis to ovary usually from stomach or appendix.
What are the clinical features of dysgerminoma?
Affects young women, may be quite large and bilateral. Very radiosensitive.
What tumor marker can cyst fluid be analyzed for? How does estradiol level compare in these lesions?
CA125. Tends to inversely correlate with E2 (estradiol) levels.
