Fallopian tube/broad lig/ovary tumors Flashcards
hadatids of morgani: what is its histology?
hadatids of morganin- paratubal cysts, most common primary lesion of the fallopian tube. lined by serous (tubal) epithelium (ciliated columnar)
translucent cysts filled with serous fluid on the broad ligament
hadatids of morganin- paratubal cysts, most common primary lesion of the fallopian tube. lined by serous (tubal) epithelium (ciliated columnar)
mesothelioma tumor of the fallopian tube
adenomatoid tumor- occur subserosally on the tube or in the meosalpinx. BENIGN
usually 1/2 of the cells are stage 1 @ diagnosis
primary adenocarcinoma
presents as a dominant tubal mass that may be detected by pelvic examination. Others come to attention because of abnormal discharge, bleeding, or (occasionally) abnormal cells in a Pap smear. nearly 40% are dead within 5 years, with higher stage tumors pursuing an even more aggressive course.
primary adenocarcinoma
most common lesions encountered in the ovary are….and what kinds are there?
functional/benign cysts and tumors. three types: mullerian epithelium, germ cell, sex cord stromal cell
One of the rarest gynecologic cancers
primary adenocarcinoma of the fallopian tube
serous cancer that may arise from the fallopian tube initially: in what group are they more common?
this is a primary adenocarcinoma of the ovary: most common in
Postmenopausal Caucasians
very common in the ovary, and originate from unruptured graafian collicles
cystic follicle
usually multiple, filled with serous fluid and lined by a gray glistening membrane, can be diagnosed by both palpation and US, may cause pain
cystic follicle in the ovary
lined by rim of bright yellow tissue containing luteinized granulosa cells, can rupture and cause a reaction. what age group would these appear in?
Luteal cysts women of reproductive age , present in normal ovaries
central morphological abnormality: numerous cystic follicles or folliciular cysts that enlarge the ovaries
Polycystic ovarian syndrome (PCOS)
PCOS associations
DM 1, obesity, premature atherosclerosis
PCOS etiology
not fully understood but they think it involves enzymatic dysregulation
seen mostly in post-menopausal women, may overlap with PCOS in younger women
stromal hyperthecosis
characterized by uniform enlargement of the ovary, usually bilateral. what complications does it pose?
stromal hyperthecosis: virilization, acanthosis nigricans
diagnosed with type I DM. Patient is obese, XX, and returns to your office a year later presenting with masculine features and complaining of missing multiple menstrual cycles.
PCOS: hyper-androgenism, menstrual abnormalities, polycystic ovarie, chronic anovulation, decreased fertility
a 58 yo female presents with a mustache. US reveals bilateral ovarian enlargement
stromal hyperthecosis
perafolliicular zone expands, follicles regress and appear nodular
theca lutein hyperplasia of pregnancy
ovarian tumors by age: 20-45 vs 45-65
20-45 most likely benign, 45-65 mostly benign but malignancy will more likely occur in older groups
carcinoma associated with borderline tumors or endometrosis
type 1 low grade carcinoma
arises from serous intraepithelial carcinoma
type 2 high grade serous carcinoma
“tube like epithelium” in these tumors, and account for 40% of all ovarian cancers
serous tumors (cystic neoplasms)
Serous tumors: benign, borderline, and malignant together =
30% of ovarian tumors, 50% of ovarian epithelial tumors
most common serous tumors in 20-45 yos and 45+
benign/borderline = 20/45, 45+ = malig
BRCA1 and BRCA2
increased susceptibility to ovarian cancer, almost always high grade serous carcinomas with TP53 mutations
genetic mutations ass w/ low grade serous tumors
KRAS, BRAF, ERB2, wild type TP53
ovarian tumors account for ___ of all cancers and ____ most common cause of cancer caused mortality
3% of all cancers, 5th most common
if ovarian tumors are only 3% of all cancers, why are they the 5th leading cause of mortality caused by cancer?
Because most ovarian cancers have spread beyond the ovary by the time of diagnosis, they account for a disproportionate number of deaths from cancer of the female genital tract.
High grade tumors
high frequency TP53 muts, all BRCA1/2 mut ass w/TP53 mutations
serous ovarian tumors total% and bilaterality by %:
benign 60%; 25% bl
borderline 15%; 30% bl
malignant 25%; 65% bl
mucinous ovarian tumors by total % and bl %
benign 80%; %5 bl
borderline 10%; 10% bl
malignant 10%; < 5 % bl
Frequency of malignancy (> < = etc)
Serous borderline tumors> endometrioid tumor > undifferentiated > clear cell > [granulosa ~ = metastatic teratoma] > [mucinous borderline ~= other tumors unnamed] > benign teratoma (1%)
bilaterality by frequency
malignant serous tumor > metastatic teratoma > [clear cell ~= endometrioid] > borderline serous > benign serous> teratomas all together > borderline mucinous > benign mucinous > malignant mucinous > benign teratoma (rare for bilaterality to occur at all)
risk factors for malignant serous cystadenocarcinoma and reduced-risk factors
Risk factors:
- Nulliparity (low parity)
- Family/hereditary history. Heritable mutations: BRCA1 and BRCA2 (serous cystadenocarcinoma)
Reduced-risk Factors
- birth control pills
- tubal ligation
cystic lesion projecting from ovarian surface– no epithelial thickening, and no papillary projection
benign serous tumor: KRAS, ERB,2, BRAF, TP52 mutations
cystic lesion with papillary epithelium in a fibrous wall, contains an increased number of papillary projections
borderline serous cystadenoma
Serious cystcadenocarcinoma: the cyst has been dissected open to expose solid masses with nodular capsules, the masses are papillary
complex stromal papillae, stratification of the epithelium, nuclear atypia, but no invasion of the stroma see
epithelial proliferation often grows in a delicate, papillary pattern referred to as “micropapillary carcinoma,”
what is this tumor, and what is it thought to be the precursor of?
serous borderline tumor, thought to be a precursor to serous cystadenomcarcinoma
- CA-125
- HE4
- CA-125 (used to monitor recurrence/progression)
- HE4 (new, same purpose as above)
what kind of tumor is shown here
chocolate cyst found in endometriosis
what would we see increased in the individual from whom this biopsy was taken?
what are two names for it?
how common is it?
” glomeruloid” structures (Schiller-Duvall bodies): Yolk sac tumor AKA endodermal sinus tumor
Most common germ cell tumor in children
Increased serum AFP (hyaline droplets)
papillary serous cystadenocarcinoma.
psammoma bodies often found in serous carcinomas but are not pathognomonic
granulosa cell tumor attempts to form structures that resemble primitive follicles, as seen at the left. Most of these tumors are histologically benign, but some are malignant.
