Ch. 16 - Ovary

Question 1

What is the “triple test” of ovarian cyst analysis?

Answer 1

Ultrasound, cytology, and estradiol levels of cyst fluid.

Question 2

What are the two major categories of benign ovarian cysts?

Answer 2

Functional cysts (eg. Follicular, corpus luteum) and nonfunctional (eg Endometriotic).

Question 3

Recite the sequence of progression of a primordial follicle to becoming a corpus luteum.

Answer 3

Primordial follicle (oocyte & granulosa cells)&raquo_space; Primary follicle&raquo_space; Secondary follicle (stratified granulosa layer), Graafian follicle (fluid zone, theca cells)&raquo_space; Rupture & corpus luteum.

Question 4

From what does a follicular cyst arise?

Answer 4

A graafian follicle that fails to rupture

Question 5

Describe the cytology of a follicular cyst.

Answer 5

Granulosa cells (granular chromatin, small nucleoli, yellow luteinization) and theca interna cells (spindle-shaped and indistinguishable from ovarian stroma cells).

Question 6

Describe the cytology of a corpus luteum cyst.

Answer 6

Isolated very large cells with foamy lipid cytoplasm. Macrophages filled with hematoidin may be present. If associated with pregnancy, expect hyaline bodies and calcifications.

Question 7

What features need to be present on cytology to diagnose an endometrial cyst?

Answer 7

Need 2 of 3: Endometrial glands (indistinct borders, scant cytoplasm), stroma (spindled, oval nuclei), and hemosiderin (incl. siderophages).

Question 8

What are the possible origins of epithelial ovarian cysts?

Answer 8

May arise from ovarian surface or parovarian/paratubal tissue.

Question 9

Describe the cytology of an ovarian simple cyst.

Answer 9

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.

Question 10

Describe the cytology of a tuboovarian abscess.

Answer 10

Acute exudate and necrotic debris.

Question 11

Describe the cytology of the benign serous tumors (eg serous cystadenoma, serous adenofibroma, serous cystadenofibroma)

Answer 11

Ciliated and cuboidal cells with detached ciliary tufts and rarely psammoma bodies

Question 12

Describe the cytology of the benign mucinous tumors (eg mucinous cystadenoma, adenofibroma, cystadenofibroma)

Answer 12

Mucinous cells (columnar or foblet cells), muciphages.

Question 13

Describe the cytology of benign brenner tumors.

Answer 13

Coffee-bean transitional cells, globular hyaline structures. Note that these are usually solid but may have cystic areas with mucinous differentiation.

Question 14

What IHC markers identify ovarian surface epithelial/stromal tumors?

Answer 14

CK7, WT1 (in serous carcinomas), PAX8. CK20 and CDX2 should be negative.

Question 15

Describe the cytology of a serous adenocarcinoma.

Answer 15

Twisted sheets and spheres or branching clusters of cells with nuclear atypia, some cytoplasmic vacuoles, and psammoma bodies.

Question 16

Describe the cytology of a mucinous adenocarcinoma.

Answer 16

Columnar mucinous cells with cytoplasmic vacuolization and mucin. May present with pseudomyxoma peritonei.

Question 17

Describe the cytology of an endometrioid carcinoma.

Answer 17

Numerous isolated cells and some short strips or crowded glands against a bloody background. Vague.

Question 18

Describe the cytology of a mature teratoma.

Answer 18

Mixed crap…look especially for squamous cells, ciliated cells, and hair.

Question 19

Describe the cytology of a dysgerminoma.

Answer 19

Highly cellular specimen with isolated polyhedral tumor cells with vacuolated PAS+ cytoplasm and central large nuclei. May have “tigroid” background.

Question 20

What IHC markers help identify dysgerminoma?

Answer 20

PLAP, OCT-3/4, NANO-G, SALL4, membranous CD117.

Question 21

Describe the cytology of non-dysgerminomatous germ cell tumors.

Answer 21

Aggressive with primitive appearance, marked nuclear anaplasia, necrosis, and hemorrhage.

Question 22

What IHC markers can distinguish the non-dysgerminomatous germ cell tumors?

Answer 22

AFP stains Yolk sac tumors

b-hCG stains choriocarcinoma

Question 23

What is the clinical presentation of a granulosa cell tumor?

Answer 23

A typically unilateral lesion that secretes estrogen (may result in endometrial hyperplasia or carcinoma) but can rarely secrete androgens.

Question 24

Describe the cytology of a granulosa cell tumor.

Answer 24

Highly cellular specimen with call-exner bodies, coffee bean grooved nuclei, and ill-defined cytoplasm. There may be globular basement membrane-like material.

Question 25

What IHC markers identify a granulosa cell tumor?

Answer 25

Inhibin, calretinin, ER/PR, CD56, CD99, WT1, keratins, S100, SMA

Question 26

What are some rare subtypes of granulosa cell tumors?

Answer 26

Small cell carcinoma, hypercalcemic-type (seen in young women), pulmonary-type (post-menopausal women).

Question 27

What is the “juvenile type” granulosa cell tumor?

Answer 27

Unilateral lesion that may rupture and does not exhibit Call-Exner bodies (otherwise pleomorphic looking). Associated with sexual pseudoprecocity.

Question 28

Describe the cytology of a thecoma.

Answer 28

Hypocellular specimen; some isolated elongated cells with clear and vacuolated cytoplasm.

Question 29

Describe the cytology of a fibroma.

Answer 29

Hypocellular, with rare spindled cells with clear cytoplasm similar to that of thecoma.

Question 30

What is “Meigs syndrome”?

Answer 30

The combination of ovarian fibroma, ascites, and pleural effusion.

Question 31

What is a “Krukenberg tumor”?

Answer 31

A mucinous signet ring metastasis to ovary usually from stomach or appendix.

Question 32

What are the clinical features of dysgerminoma?

Answer 32

Affects young women, may be quite large and bilateral. Very radiosensitive.

Question 33

What tumor marker can cyst fluid be analyzed for? How does estradiol level compare in these lesions?

Answer 33

CA125. Tends to inversely correlate with E2 (estradiol) levels.