EXAM #1: OVARIAN DISEASE Flashcards
How do ovarian diseases present?
1) Abdominal pain and enlargement
2) Abnormal bleeding
3) Bowel or bladder symptoms
What is the most common: endometrial, ovarian, or cervical cancer in the US? Worldwide?
US= endometrial World= cervical is most common
What has the worst prognosis: endometrial, ovarian, or cervical cancer?
Ovarian
What is the most common ovarian mass in young women?
Follicular cyst
What is a follicular cyst?
Distention of unruptured graafian follicle
When are follicular cysts significant?
- If it lines granulosa cells and secretes estrogen
- Estrogen induces endometrial hyperplasia
What is a corpus luteum cyst?
Cystic enlargement of the corpus luteum with central hemorrhage
What condition may a corpus luteum cyst mimic?
Endometriosis
*If the cyst ruptures it may cause a peritoneal reaction with fibrosis and hemorrhage
What is a theca-lutein cyst?
A BILATEARL/ MULTIPLE cyst induced by Gonadotropin stimulation
What are theca-lutein cysts associated with?
Choriocarcinoma and moles
What is a hemorrhagic cyst?
- Ovarian cyst with a blood vessel that ruptures
- Cyst may grow due to bleeding
What is a dermoid cyst?
- Mature teratoma/ germ cell tumor
- Contains elements from all 3 germ layers i.e. teeth, hair, sebum, bone, cartilage…etc.
What is the most common ovarian tumor in women between 20-30 y/o?
Dermoid cyst or “Cystic teratoma”
When a dermoid cyst contains functional thyroid tissue, what is it called? How will this patient present?
Stuma ovarii
*This will cause HYPERTHYROIDISM
How do dermoid cysts present clincally?
1) Abdominal pain
2) Ovarian torsion
What is an endometrioid cyst?
Endometriosis in the ovary with cyst formation
What description is pathognomonic for an endometrioid cyst that is filled with blood?
Chocolate cyst
What age group is most affected by ovarian cancer?
Women older than 45-65
What are the risk factors for ovarian cancer?
1) Family history
2) BRCA1/2 mutations
3) Nulliparity
What is the most common ovarian tumor?
Serous cystadenoma
What age range is most common for a serous cystadenoma?
20-50 y/o
How are serous cystadenomas described? What are these tumors lined with? Are they unilateral or bilateral?
- Filled with serous fluid; not gel-like fluid
- Lined with fallopian-like epithelium
- Bilateral
What is the fallopian-like epithelium?
Tall, ciliated, secretory columnar epithelium
How are mucinous cystadenomas commonly described? What are these tumors lined with? Are they unilateral or bilateral?
- Unilateral
- Multilocuated
- Mucus-secreting epithelium (cervix-like)
What type of epithelium is seen in a mucinous cystadenoma?
Tall-mucus secreting columnar epithelium (similar to the cervix)
Which is more commonly malignant, serious or mucinous cystadenomas?
Serous
What is an endometrioma?
Typically malignant mass arising from the growth of ectopic endometrial tissue
How does an endometrioma present?
1) Pelvic pain
2) Dysmenorrhea
3) Dyspareunia
What is a Brenner Tumor?
This is a surface epithelial tumor composed by a transitional type epitheliumn (bladder-like)
How does a Brenner Tumor appear on gross evaluation?
Solid tumor that is
- Pale- yellow/tan
- Appears encapsulated
What type of nuclei are seen in a Brenner Tumor?
“Coffee Bean”
What other disease, aside from Brenner Tumors, has coffee bean nuclei?
Papillary Carcinoma of the Thyroid
What are Brenner Tumors commonly associated with?
Terataomas
What is a fibroma?
This is a benign tumor of fibroblasts that contains bundles of spindle-shaped fibroblasts
*Can cause a “pulling” sensation in the groin
What is Meigs Syndrome?
This is the triad of and ovarian fibroma, PLUS
1) Ascites
2) Hydrothorax/ pleural effusion
What is a thecoma?
Benign tumor like a granulosa tumor that may produce estrogen
How do Thecomas present?
Post-menopausal woman with abnormal uterine bleeding
What is the most common ovarian malignancy?
Serous cystadenocarcinoma
What histologic finding is seen in Serous cystadenocarcinomas? What other cancer has this feature?
Psammoma bodies (as seen in Papillary Carinoma of the Thyroid)
What is the gross appearance of a Serous Cystadenocarcinomas?
Complex cyst with thick shaggy lining
What is the histoliogc appearance of a Serous Cystadenocarcinomas?
- Papillary growth
- Hyperchromic cells
What do psammoma bodies represent?
Dystrophic calcification
How are mucunous cystadenocarcinomas described histologically?
1) Complex architecture
2) Nuclear atypia
3) Stromal invasion
What is pseudomyxoma peritonei?
Intraperitoneal accumulation of mucinous material from ovarian or appendiceal tumor
*Most commonly this represents a mucinous tumor of the appendix that metastesizes to the ovary
What is an immature teratoma?
Very rare , solid tumor, most commonly containing neuroectoderm
How do mature and immature teratomas differ in terms of the tissue that they most commonly contain?
Mature= thyroid tissue Immature= neuroectoderm
What is the most common sex-cord stromal tumor?
Granulosa cell tumor
When are Granulosa Cell Tumors most commonly seen?
Women in their 50s
What is unique about Granuloas Cell Tumors?
Produce estrogen/or progesterone that causes
- Abnormal uterine bleeding
- Sexual precocity (young women)
- Breast tenderness
What is pathognomonic for a Granulosa Cell Tumor?
Call-Exner body
What are Call-Exner bodies?
Small eosinophilic fluid-filled spaces between granulosa cells
What is a dysgerminoma?
This is a tumor of large cells with a clear cytoplasm and central nuclei (cells resemble oocytes)
*Most common tumor in adolescents (most common malignant germ cell tumor)
What is pathognomonic for a dysgerminoma?
Sheets of uniform “fried egg cells”
What are the tumor markers for dysgerminomas?
LDH*
HCG
What is a chroiocarcinoma?
Malignant trophoblastic tissue (placenta)
How do choriocarcinomas present?
1) Elevated B-HCG
2) Dyspnea
3) Hemoptysis
What should you remember about choriocarcinomas?
Respond well to chemotherapy
What is a Yolk sac tumor?
Malignant tumor that mimics the yolk sac; it is an aggressive tumor of the ovaries
What is associated with Yolk Sac Tumors?
Schiller Duval Bodies, which are “glomerulus-like structures”
What is the tumor marker for Yok Sac Tumors?
AFP
What is a Krukenberg Tumor?
- GI malignancy that mets to the ovaries
- Causes mucin-secreting signet cell adenocarcinoma
