Female Genital 3 Flashcards
T/F- pelvic masses are usually sympotomatic
False, no symptoms is most common. Mass must be large, cause ascites, or tossed to cause symptoms
What are the three major categories of ovarian tumors?
- epithelial tumors
- sex cord/stromal tumors
- germ cell tumors
Metastasis accounts for ___% of all ovarian neoplasms
10
T/F- The surface epithelium of the ovary and fallopian tube arises from the same coelomic epithelium that gives rise to the endometrium and endocervix as well, so epithelial tumors in the ovary can have a variety of morphologies (e.g., serous, endometrioid, mucinous)
True
What type of ovarian tumor is most common in the ovaries (over 20 yrs of age)?
epithelial neoplasms (benign or malignant)
What type of ovarian tumor is most common in those under 20?
Germ cell tumors
In contrast to women, most gonadal neoplasms are of what origin?
germ cell (germ cells constantly undergo division in men)
Review the 5 sub-types of ovarian EPITHELIAL tumors
serous mucinous endometrioid clear cell brenner
If a tumor is derived from the fallopian tube epithelium you should think of what type of tumor?
serous (can be benign or malignant)
If a tumor is derived from the endocervic or intestinal epithelium it will be what?
mucinous (can be benign or malignant)
If a tumor is derived from the endometrial epithelium it will begin with the word ____
endometrioid (begign or malignant)
If a tumor is derived from the urothelium it will contain the word _____
Brenner tumor (can be benign or malignant)
Rank serous, mucinous and endometrioid tumors from most common to least common
- serous (1/2 of ovarian neoplasms)
- Mucinous tumors (1/3)
- Endometrioid (10%)
Are serous tumors usually unilateral or bilateral?
Frequently bilateral (especially when malignant)
Are mucinous and endometrioid tumors usually unilateral or bilateral?
unilateral
many serous tumors will have a characteristic _____ epithelium and ____ bodies
- “hobnail”
- psammoma bodies (but not specific)
There is expanding literature that suggests high grade serous carcinoma of the ovary most likely originates in the ______rather than in the ovary itself.
distal fallopian tube (fimbriated end)
Benign mucinous tumors have a single layer of epthelium with apical mucin, nuclei are small and basally located. What features do borderline mucinous tumors have?
areas of papillary or velvety growth with piling up of nuclei
A ____mucinous tumor has areas of pseudo stratified nuclei whereas a _____tumor has basally oriented nuclei
- borderline
2. benign
A mucinous carcinoma will have what type of growth pattern histologically?
an “expansile” growth pattern, marked by confluency of mucinous glandular structures with little intervening stroma.
A surgeon accidentally removes a tumor mass without following the proper staging procedures. What should they do next before initiating therapy?
Proper staging is required before therapy is initiated. If the tumor mass is removed without these staging procedures, then a second surgery will likely be required.
What sample is used for cytology in ovarian carcinoma staging?
free peritoneal fluid and/or washing of pelvis, paracolic gutters, and diaphragm
What histological samples should be taken when staging ovarian carcinoma?
- TAH-BSO (except in specific instances where unilateral salpingo-oophorectomy is appropriate)
- Resect infracolic mesentery and all visible lesions
- If no visible lesions, biopsies of cul de sac, R and L pelvic sidewalls and paracolic gutters, diaphragm
- Sample pelvic and para-aortic nodes
Review requirements for stage I ovarian carcinoma
Stage I: Limited to ovaries
A Limited to one ovary
B Limited to both ovaries
C Surface growth, ruptured capsule or positive peritoneal fluid
Review stage II ovarian carcinoma
Stage II: Pelvic extension
A Uterus/tubes
B Other pelvic organs
C IIA or IIB with positive peritoneal fluid
Mucinous borderline tumors are often stage ___ at presentation
I
Review stage III guidelines
Stage III: Extrapelvic disease
A Microscopic peritoneal disease
B Macroscopic peritoneal disease < 2 cm
C Macroscopic peritoneal disease > 2 cm, or + nodal metastasis
Serous malignant tumors are usually stage ___ at presentation
III
Stage IV criteria involves____
Distant disease (e.g. lung metastases)
Name 3 gene mutations that have highest risk for ovarian carcinoma
- BRCA I
- BRCA 2
- Lynch (HNPCC)
T/F- p53, c-myc, H-ras, and K-ras are also implicated in some ovarian carcinoma
true
A woman has BRCA 1 and 2, what should she take to reduce her risk to that of the general population (1.6%)
oral contraceptives
Are there good screening tests for ovarian epithelial malignancy?
no, most women present at stage III (30-50% 5 yr survival)
Moving on to germ cell tumors, what is the most common germ cell tumor in women now?
teratomas (mature, immature, or malignant)
Name 5 types of germ cell tumors in women
- teratoma (resembles ecto, endo, or mesoderm)
- dysgerminoma (resembles germ cells)
- yolk sac tumor (resembles any endoderm structure)
- embryonal carcinoma (resembles embryonic disc)
- choriocarcinoma (resembles placenta)
A homogenous, tan tumor is discovered in a woman’s ovary. What is this analogous to in a male?
This is a dysgerminoma, homologous to a seminoma of the testis
Is lymphoid infiltrate common in a dysgerminoma?
no
T/F- the prognosis is good for germ cell tumors
true
Name 3 types of ovarian sex cord-stromal tumors
Thecoma-fibromas
granulosa cell tumors
Sertoli-leydig cell tumors
Ovarian sex cord stromal tumors often produce what?
HORMONES
Granolas cell tumors are often yellow because of what? What hormone do they produce?
- large amounts of lipid
- produce estrogens
T/F- if a patient has a granulosa cell tumor removed she doesn’t need long term follow up
False, They are known to recur many years after removal (e.g., ten or more years later), so patients must be followed up long-term.
Name the classic (but uncommon) feature of granulosa cell tumors (histologically)
- Call-exner bodies
- also will have nuclear grooves like coffee beans
Sertoli-leydig cell tumors are ______ (color) due to a large amount of ______ (tissue) and often produce _____ (hormone)
- yellow
- lipid
- androgens (virilization)
______ tumors are notorious for late recurrences
granulosa cell tumors!
T/F- prognosis is poor for thecoma-fibroma tumors
False, 10 year survival is 100%
A tumor from the stomach metastasizes to the ovary and has signet ring cells. What is it called?
krukenberg tumor
Name sites of common metastasis to the ovary
- endometrium
- colon
- stomach
- breast
- melanoma
- lymphoma
What helps distinguish if a tumor is metastatic to the ovaries?
- Bilaterality
- Mets sometimes grossly smaller in size than primary disease
- “Outside-In” infiltration of tumor (mostly involving ovarian surface and cortex)
- Known history of other tumors (colon, gastric, breast, etc.)
