Chapter 15 - Ovary Flashcards
Describe the normal morphology of:
Ovarian surface epithelium
Ovarian stroma
Surface epithelium: Mesothelial lining which is often denuded.
Stroma: Blue & spindled, mostly comprised of fibroblasts.
Describe the normal morphology of:
Follicles
Corpus luteum
Corpus albicans
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
Describe the normal morphology of:
Walthard’s rests
Rete ovarii
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
Describe the normal morphology of:
Follicle cyst
Inclusion cyst
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.
What are the normal sex cord cells in the ovary? What is their function?
Thecal cells, which secrete androgens under the influence of LH.
Granulosa cells, which convert androgens to estrogen under the influence of FSH.
What is the morphologic appearance of luteinization?
What are Call-exner bodies?
Like decidualization, luteinized cells are plump with abundant pink cytoplasm
Call-Exner bodies are rosettes of granulosa cells surrounding pink globules.
What are the four classes of malignancies seen in the ovary?
Surface epithelial tumors
Germ cell tumors
Sex cord stromal tumors
Metastases
What are the three “severities” of epithelial neoplasms?
Benign, borderline, and malignant.
What term is given to a benign epithelial proliferation in the ovary? What if it is cystic, has a fibrous stromal component, or both?
Adenoma
Cystic: Cystadenoma
Fibrous stromal component: Adenofibroma
Both: Cystadenofibroma
What is a borderline tumor? Can it metastasize?
An atypical tumor which is non-invasive and doesn’t induce desmoplasia. It can cause local implants which often do not invade.
How are carcinomas of the ovarian epithelium divided?
They can be divided into low and high-grade carcinomas (note: low-grade can still metastasize).
Describe the morphologic features of serous cystadenoma.
Simple cysts lined by a tubal epithelium. Watery contents/
Describe the morphologic features of serous borderline tumor.
Complex papillary fronds, with a single layer without atypia. May acquire micropapillae…
Describe the morphologic features of micropapillary serous carcinoma.
Low-grade carcinoma with medusa-head pattern. Can be invasive or non-invasive, with psammoma bodies. Nuclei should not be too pleomorphic…
Describe the morphologic features of high-grade serous carcinoma.
Very high-grade, mitotically active & apoptotic pleomorphic blue nuclei.
Architecture can be papillary, micropapillary, or solid.
Describe the morphologic features of mucinous cystadenoma.
Often multilocular. Cysts lined with flat mucinous epithelium.
Describe the morphologic features of mucinous borderline tumor.
Usually imitates intestinal epithelium with goblet cells and glandular architecture.
15% are of the endocervical type, with papillary architecture and endocervical mucinous cells.
Describe the morphologic features and clinical features of mucinous cystadenocarcinoma.
Very high-grade with intestinal morphology. In fact, these are usually actually metastases from the GI tract.
Describe the morphologic features and significance of endometrioid adenoma.
Resembles endometriosis but without any stroma. These are very rare; endometriosis is more common.
Describe the morphologic features and significance of endometrioid carcinoma.
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.
Describe the morphologic features of clear cell carcinoma.
What is a key association?
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.
Describe the morphologic features of transitional adenoma/adenofibroma.
What are these also known as?
Nests of transitional epithelium in a fibrous stroma, possibly with a mucinous central lumen.
Brenner tumor
Describe the morphologic features of malignant brenner tumor.
Very atypical cells, resembling urothelial cell carcinoma.
Challenge, if you see the following, think:
- Hobnailed cells lining spaces
- Mucinous cells with papillary fronds
- Papillary fronds otherwise
- Sheets of high-grade nuclei
- Clear cell neoplasms
- Mucinous cell neoplasms
- Serous, or any other type
- Serous or undifferentiated
Challenge, if you see the following, think:
- Solid growth with slit-like spaces
- Squamous-like nests of round cells
- Tall villi
- Tubular glands
- Serous neoplasm
- Transitional cell neoplasm
- Endometrioid or mucinous
- Endometrioid neoplasm
What are the two cancer pathways for serous ovarian neoplasms?
Cystadenoma >> atypical proliferative serous tumors >> micropapillary serous carcinoma >> invasive serous carcinoma
p53 mutation >> high-grade serous carcinoma (de novo)
Name the germ cell neoplasms of the ovary. Which is most common?
Teratoma (most common)
Dysgerminoma
Yolk sac tumor
Choriocarcinoma
Embryonal carcinoma
What are teratomas comprised of? What are some common elements?
At least two of three embryonic derivatives (endoderm/mesoderm/ectoderm).
Common elements include squamous epithelium, skin adnexae, fat, cartilage, thyroid, really any epithelium.
What defines a dermoid cyst?
What should they be evaluated for?
A teratoma that is cystic.
Evaluate for immature (embryonal-looking) elements, of which the most common is neural tissue.
What is the most common sex cord stromal tumor? What do they resemble?
Fibroma/thecomas. They grossly and histologically resemble leiomyomas.
How do the thecoma and fibroma components of a fibroma-thecoma differ?
Is this tumor malignant?
Thecoma is butter-colored and has tiny lipid vacuoles. Fibroma is white.
No, it is a benign lesion.
Describe the morphologic features of granulosa cell tumors.
Are these malignant?
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.
Ovarian stroma with follicle comprised of an oocyte (arrow) and ring of granulosa cells (arrowhead)
Left: Hemorrhagic corpus luteum, with granulosa cells (arrow)
Right: Corpus albicans
Rete ovarii
Left: Follicle cyst, lined by luteinized cells (arrow) and adjacent hemosiderin (circle)
Right: Inclusion cyst, lined by attenuated epithelium (arrow) with tubal metaplasia (arrowhead)
Serous borderline tumor
Arrow: Serous cells
Arrowhead: Invaginated folding (do not mistake for invasion)
Micropapillary serous carcinoma
Arrow: Invasive focus
Arrowhead: Desmoplasia
Circle: Psammoma body
Inset: Medusa-head
High-grade serous carcinoma
Arrow: Solid nests with slit-like spaces
Mucinous borderline tumor
Arrow: Invaginations, not invasion
Arrowhead: Mucinous cyst lining, endocervical type
Endometrioid carcinoma
Arrows: Glandular spaces with central necrosis
Clear cell carcinoma
Left: Nests of cells with fibrovascular septa
Right: Vessel-like spaces with hobnailed atypical cells
Brenner tumor
Arrow: Transitional epithelium in a fibrotic stroma
Arrowhead: Pink secretions in a gland-like space
Immature neural tissue in a teratoma.
Arrow: Rosettes
Fibrothecoma
Granulosa cell tumor
