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Book - Molavi > Chapter 15 - Ovary > Flashcards

Chapter 15 - Ovary Flashcards

1
Q

Describe the normal morphology of:

Ovarian surface epithelium

Ovarian stroma

A

Surface epithelium: Mesothelial lining which is often denuded.

Stroma: Blue & spindled, mostly comprised of fibroblasts.

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2
Q

Describe the normal morphology of:

Follicles

Corpus luteum

Corpus albicans

A

Follicles: Halo of thecal cells outside a ring of granulosa cells, surrounding an oocyte.

Corpus luteum: Collapsed follicle; undulating granulosa cells with associated hemorrhage.

Corpus albicans: Hyalinized cloud-shaped pink islands

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3
Q

Describe the normal morphology of:

Walthard’s rests

Rete ovarii

A

Walthard’s rests: Nests of transitional type epithelium in the ovary and fallopian tube

Rete ovarii: Rudimentary gland spaces; angulated slit-like spaces with a low-cuboidal epithelium

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4
Q

Describe the normal morphology of:

Follicle cyst

Inclusion cyst

A

Follicle cyst: Lined with the normal components of the follicle (granulosa and thecal layers).

Inclusion cyst: Simple cyst lined with a cuboidal, columnar, or ciliated epithelium. Consider cystadenoma if large.

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5
Q

What are the normal sex cord cells in the ovary? What is their function?

A

Thecal cells, which secrete androgens under the influence of LH.

Granulosa cells, which convert androgens to estrogen under the influence of FSH.

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6
Q

What is the morphologic appearance of luteinization?

What are Call-exner bodies?

A

Like decidualization, luteinized cells are plump with abundant pink cytoplasm

Call-Exner bodies are rosettes of granulosa cells surrounding pink globules.

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7
Q

What are the four classes of malignancies seen in the ovary?

A

Surface epithelial tumors

Germ cell tumors

Sex cord stromal tumors

Metastases

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8
Q

What are the three “severities” of epithelial neoplasms?

A

Benign, borderline, and malignant.

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9
Q

What term is given to a benign epithelial proliferation in the ovary? What if it is cystic, has a fibrous stromal component, or both?

A

Adenoma

Cystic: Cystadenoma

Fibrous stromal component: Adenofibroma

Both: Cystadenofibroma

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10
Q

What is a borderline tumor? Can it metastasize?

A

An atypical tumor which is non-invasive and doesn’t induce desmoplasia. It can cause local implants which often do not invade.

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11
Q

How are carcinomas of the ovarian epithelium divided?

A

They can be divided into low and high-grade carcinomas (note: low-grade can still metastasize).

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12
Q

Describe the morphologic features of serous cystadenoma.

A

Simple cysts lined by a tubal epithelium. Watery contents/

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13
Q

Describe the morphologic features of serous borderline tumor.

A

Complex papillary fronds, with a single layer without atypia. May acquire micropapillae…

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14
Q

Describe the morphologic features of micropapillary serous carcinoma.

A

Low-grade carcinoma with medusa-head pattern. Can be invasive or non-invasive, with psammoma bodies. Nuclei should not be too pleomorphic…

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15
Q

Describe the morphologic features of high-grade serous carcinoma.

A

Very high-grade, mitotically active & apoptotic pleomorphic blue nuclei.

Architecture can be papillary, micropapillary, or solid.

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16
Q

Describe the morphologic features of mucinous cystadenoma.

A

Often multilocular. Cysts lined with flat mucinous epithelium.

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17
Q

Describe the morphologic features of mucinous borderline tumor.

A

Usually imitates intestinal epithelium with goblet cells and glandular architecture.

15% are of the endocervical type, with papillary architecture and endocervical mucinous cells.

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18
Q

Describe the morphologic features and clinical features of mucinous cystadenocarcinoma.

A

Very high-grade with intestinal morphology. In fact, these are usually actually metastases from the GI tract.

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19
Q

Describe the morphologic features and significance of endometrioid adenoma.

A

Resembles endometriosis but without any stroma. These are very rare; endometriosis is more common.

20
Q

Describe the morphologic features and significance of endometrioid carcinoma.

A

Has same architecture and nuclear features as primary endometrioid carcinoma, with tubular to cribriform and villous glands. These often arise within endometriosis and/or with concurrent endometrial carcinoma.

21
Q

Describe the morphologic features of clear cell carcinoma.

What is a key association?

A

Clear cells occurring in papillary, glandular, nested, or trabecular patterns. Cells fall out of the center, leaving a hobnailed layer outlining the nest.

These are also associated with endometriosis.

22
Q

Describe the morphologic features of transitional adenoma/adenofibroma.

What are these also known as?

A

Nests of transitional epithelium in a fibrous stroma, possibly with a mucinous central lumen.

Brenner tumor

23
Q

Describe the morphologic features of malignant brenner tumor.

A

Very atypical cells, resembling urothelial cell carcinoma.

24
Q

Challenge, if you see the following, think:

  1. Hobnailed cells lining spaces
  2. Mucinous cells with papillary fronds
  3. Papillary fronds otherwise
  4. Sheets of high-grade nuclei
A
  1. Clear cell neoplasms
  2. Mucinous cell neoplasms
  3. Serous, or any other type
  4. Serous or undifferentiated
25
Q

Challenge, if you see the following, think:

  1. Solid growth with slit-like spaces
  2. Squamous-like nests of round cells
  3. Tall villi
  4. Tubular glands
A
  1. Serous neoplasm
  2. Transitional cell neoplasm
  3. Endometrioid or mucinous
  4. Endometrioid neoplasm
26
Q

What are the two cancer pathways for serous ovarian neoplasms?

A

Cystadenoma >> atypical proliferative serous tumors >> micropapillary serous carcinoma >> invasive serous carcinoma

p53 mutation >> high-grade serous carcinoma (de novo)

27
Q

Name the germ cell neoplasms of the ovary. Which is most common?

A

Teratoma (most common)

Dysgerminoma

Yolk sac tumor

Choriocarcinoma

Embryonal carcinoma

28
Q

What are teratomas comprised of? What are some common elements?

A

At least two of three embryonic derivatives (endoderm/mesoderm/ectoderm).

Common elements include squamous epithelium, skin adnexae, fat, cartilage, thyroid, really any epithelium.

29
Q

What defines a dermoid cyst?

What should they be evaluated for?

A

A teratoma that is cystic.

Evaluate for immature (embryonal-looking) elements, of which the most common is neural tissue.

30
Q

What is the most common sex cord stromal tumor? What do they resemble?

A

Fibroma/thecomas. They grossly and histologically resemble leiomyomas.

31
Q

How do the thecoma and fibroma components of a fibroma-thecoma differ?

Is this tumor malignant?

A

Thecoma is butter-colored and has tiny lipid vacuoles. Fibroma is white.

No, it is a benign lesion.

32
Q

Describe the morphologic features of granulosa cell tumors.

Are these malignant?

A

Oval, folded “coffee-bean” nuclei that are closely packed and arranged in sheets iwth a “zigzag” pattern. Call-exner bodies, but not always.

They are technically of low malignant potential.

33
Q
A

Ovarian stroma with follicle comprised of an oocyte (arrow) and ring of granulosa cells (arrowhead)

34
Q
A

Left: Hemorrhagic corpus luteum, with granulosa cells (arrow)

Right: Corpus albicans

35
Q
A

Rete ovarii

36
Q
A

Left: Follicle cyst, lined by luteinized cells (arrow) and adjacent hemosiderin (circle)

Right: Inclusion cyst, lined by attenuated epithelium (arrow) with tubal metaplasia (arrowhead)

37
Q
A

Serous borderline tumor

Arrow: Serous cells

Arrowhead: Invaginated folding (do not mistake for invasion)

38
Q
A

Micropapillary serous carcinoma

Arrow: Invasive focus

Arrowhead: Desmoplasia

Circle: Psammoma body

Inset: Medusa-head

39
Q
A

High-grade serous carcinoma

Arrow: Solid nests with slit-like spaces

40
Q
A

Mucinous borderline tumor

Arrow: Invaginations, not invasion

Arrowhead: Mucinous cyst lining, endocervical type

41
Q
A

Endometrioid carcinoma

Arrows: Glandular spaces with central necrosis

42
Q
A

Clear cell carcinoma

Left: Nests of cells with fibrovascular septa

Right: Vessel-like spaces with hobnailed atypical cells

43
Q
A

Brenner tumor

Arrow: Transitional epithelium in a fibrotic stroma

Arrowhead: Pink secretions in a gland-like space

44
Q
A

Immature neural tissue in a teratoma.

Arrow: Rosettes

45
Q
A

Fibrothecoma

46
Q
A

Granulosa cell tumor

Book - Molavi (29 decks)

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