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Question 1

What is the most common disorder of the fallopian tubes?

Answer 1

inflammation (salpingitis), almost invariably occurring as a component of pelvic inflammatory disease. Less common abnormalities are ectopic pregnancy, endometriosis, and rarely primary tumors

Question 2

Inflammation of the fallopian tubes mostly occurs due to what?

Answer 2

bacterial, now more due to nongonoccal organisms such as Chlamydia, Mycoplasma hominis, and streptococci in postpartum settingsNOTE: Nongonnocal infections can pentrate the tube walls and spread via blood and seed to the meninges, heart, and joints

Question 3

How does salpingitis present?

Answer 3

fever, lower abdominal or pelvic pain, all of which are the result of distention of the tubes with debris or exudate

Question 4

Describe tumors of the fallopain tubes

Answer 4

Primary adenocarcinomas are rare but are associated with BRCA mutations (usually occur in the fimbria)NOTE:It is generally well accepted that serous carcinomas generally arise here and metastasize to the ovary and not the other way around

Question 5

What are follicular ovarian cysts?

Answer 5

These are so commonplace that they are considered part of normal physiology and begin from unruptured graafian follicles. These cysts are often multiple, small, and filled with clear fluid. When small they are lined by grnaulosa or luteal cells (but when they grow larger, fluid accumulation may produce pressure that causes cellular atrophy). These usually spontanoeusly rupture and dissappear.

Question 6

What is this?

Answer 6

This is a corpus leuteal cyst- again mostly harmless but can causeovarian torsion (20% in pregnancy). In these cases, pts. present withacute unilateral lower abdominal pain caused by venous congestion.Histologically, these cysts are lined by a rim of bright yellow tissue containing luteinized granulosa cells.They occasionally rupture and cause a peritoneal reaction.

Question 7

What is Polycystic Ovarian Disease?

Answer 7

aka Stein-Leventhal disease, this is a disorder in which multiple cystic follicles in the ovaries produce excess androgens and estrgoens and typically comes to attention after menarche in teenage girls who present with oligomenorrhea, hirsutism, infertility, and obesity.

Question 8

Tumors of the ovaries arise from what three structures?

Answer 8

-surface epithelium-germ cells-sex cord-stroma

Question 9

Where do most ovarian tumors arise from?

Answer 9

The vast mjaorty originate in the surface epithelium

Question 10

How do epithelial tumors typically form?

Answer 10

Repeated cycles of ovulation and scarring causes the surface epithelium to become entrapped in the cortex of the ovary, forming small cysts that can become metaplastic or give rise to a number of tumors

Question 11

What are the risk factors for ovarian cancer?

Answer 11

nulliparity and unmarried womenfam Hxgermline mutations in certain tumor suppressor genes like BRCA

Question 12

T or F. Prolonged use of oral contraceptives lowers the risk of ovarian cancer

Answer 12

T.

Question 13

Describe serous ovarian epithelial tumors

Answer 13

These are the most common ovarian epithelial tumors, with the majority being benign (60%) and malignant versions typically being found in older pts. These typically present at an advanced age and cause a significant number of deaths

Question 14

What are the variants of serious epithelial ovarian tumors?

Answer 14

There are Type I (low grade) types that arise in the ovaries and produce borderline tumors that can progress to invasive carcinomasand then Type II (high grade) that probably arise in the fimbriae as STIC lesions fallopian tubes and are more strongly associated with BRCA and T53 mutations

Question 15

Are serous epithelial ovarian tumors bilateral?

Answer 15

Bilaterality is common, occurring in 20% of benign serous cystadenomas, 30% of serous borderline tumors, and approximately 66% of serous carcinomas.

Question 16

What is this?

Answer 16

Borderline serous epithelial ovarian tumorshowing increased architectural complexity and epithelial cell stratification.

Question 17

How can you distinguish low grade and high grade ovarian epithelial tumors histologically?

Answer 17

High-grade serous carcinomas are distinguished from low-grade tumors by having more complex growth patterns and widespread infiltration of the underlying stroma

Question 18

What is this?

Answer 18

A mucinous tumor of the ovarian epithelium. The vast majority of these are benign, very large and commonly multicystic

Question 19

What parts of a mucinous epithelial tumor of the ovary suggests malignancy?

Answer 19

•Serosal penetration and solid areas of growth are suggestive of malignancy•Malignant tumors are characterized by the presence of architectural complexity, including solid areas of growth, cellular stratification, cytologic atypia, and stromal invasion.

Question 20

T or F. Mucinous tumors of the ovary are more likely to be bilateral than serous tumors

Answer 20

F.

Question 21

Mutation of the _________is a consistent genetic alteration in mucinous tumors of the ovary

Answer 21

KRAS proto-oncogene

Question 22

What is pseudomyxoma peritonei?

Answer 22

This is aclinical condition marked by extensive mucinous ascites, cystic epithelial implants on the peritoneal surfaces, adhesions, and frequent involvement of the ovaries•Recent evidence points to the source being, in almost all cases, extraovarian (usually appendiceal)

Question 23

What is this?

Answer 23

Anendometrioid adenocarcinoma, a tumor of the epithelium of the ovaries that often co-exist with endometriosis (15% to 20% of cases with endometrioid carcinoma coexist with endometriosis) and are marked bythe formation of tubular glands similar to those of the endometrium within the lining of cystic spaces

Question 24

T or F. Endmedtrioid tumors are mostly benign

Answer 24

F. They are mostly malignant

Question 25

What mutation is common in endometrioid carcinomas of the ovary?

Answer 25

PTEN

Question 26

Describe transitional cell (Brenner)tumors

Answer 26

These are uncommon, usually unilaterla ovarian tumors characterized by nests of transitional-type epithelium. Most of these are benign

Question 27

What are the main sources of secondary (met) tumors in the ovaries?

Answer 27

Metastatic tumors to the ovaries account for about 5% of all ovariantumors•The most common are derived from tumors of müllerian origin: the uterus, fallopian tube, contralateral ovary, or pelvic peritoneum.•The most common extra-müllerian tumors are breast and gastrointestinal tract.•Also included in this group are the rare cases of pseudomyxoma peritonei, derived from appendiceal tumors.

Question 28

What is this?

Answer 28

A Krukenberg tumor, aclassic metastatic GI carcinoma that goes tothe ovaries and ischaracterized by bilateral metastases composed of mucin-producing, signet-ring cancer cells, most often of gastric origin.

Question 29

What are the ovarian tumors of sex cord stroma origin?

Answer 29

•Granulosa tumors•Fibromas,Fibrothecomas, andThecomas•Sertoli-Leydig cell tumors

Question 30

Describe granulosa tumors

Answer 30

Low grade sex cord tumors that can produce a large amountofestrogen (which can in turn cause endometrial hyperplasia and even carcinoma)These primarily occur in postmenopausal women andare unilateral

Question 31

How do granulosa tumors of the ovary appear histologically?

Answer 31

The tumor cells are arranged in sheets punctuated by small follicle-like structures (Call-Exner bodies).

Question 32

Grnaulosa tumors of the ovary stain strongly with an Ab to _____

Answer 32

inhibin

Question 33

What is this?

Answer 33

This can either be a fibroma, a fibrothecoma, or a thecoma.These can present at any age and are usually unilateral

Question 34

What are some ommon associations with fibromas and thecomas?

Answer 34

•Combination of findings (ovarian tumor, hydrothorax, and ascites) is designated Meigs syndrome. Its genesis is unknown.•The second association is with the basal cell nevus syndrome

Question 35

What is this?

Answer 35

A Sertoli-Leydig cell tumor- these tumors are often functional and commonly produce masculinization or defeminization, but a few have estrogenic effects.• less than5% metastasize, and these can present at any age (unilateral)

Question 36

What are some germ cell neoplasms of the ovary?

Answer 36

-teratoma-Dysgerminoma-Yolk sac tumor

Question 37

How common are teratomas of the ovary?

Answer 37

they account for 15-20% of all ovarian tumors and commonly present within the first 20 yrs of life (and the younger the presentation, the greater the likelihood of malignancy. More than 90% of these are benign mature cystic teratomas however)

Question 38

What are the types of ovarian teratomas?

Answer 38

-benign (mature) cystic teratoma-immature malignant-specialized

Question 39

Describe mature benign teratomas of the ovary

Answer 39

These are marked by the presence of tissue derived from all three germ layers (ecto, meso, and endo). Most are found in young women incidentally because they contain calcifications. The vast majority are unilateral

Question 40

What else can be a very good tip of a mature cystic teratoma when excised?

Answer 40

it may contain hair, pieces of bone, cartilage, or even teeth

Question 41

T or F. Benign teratomas are likely to undergo torsion

Answer 41

T. AND they are very commonly associated with infertility

Question 42

What is this?

Answer 42

An immature malignant teratoma. These resemble embryonal and immature fetal tissue and are commonly found in prepubertal adolescents and young women•An important risk for subsequent extraovarian spread is the histologic grade of tumor (I through III), which is based on the proportion of tissue containing immature neuroepithelium .

Question 43

What is this?

Answer 43

This isstruma ovarii, a monodermal teratoma composed of normal ovarian tissue on the left and thyroid tissue on the right

Question 44

What are dysgerminomas?

Answer 44

The ovarian counterpart of testicular seminoma (Also present in mediastinum, pineal gland (germinoma), and retroperitoneum)All are malignant but only about 1/3 are aggressive so there is an 8)% cure rateBelow: Fried egg appearance with lymphocytes

Question 45

Dysgerminomas commonly overexpress what gene? How can it be ID’d?

Answer 45

receptor tyrosine kinase KIT which can be ID’d using a CD117 stain (below) or a PLAP marker

Question 46

_____is elevated in the sera of 75% to 90% of women with epithelial ovarian cancer.

Answer 46

CA-125.However, CA-125 is undetectable in up to 50% of women with cancer limited to the ovary. it is primarily used to monitor therapy