Female genital tract 2 Flashcards
Covers PCOS, non- neoplastic ovarian cysts and ovarian neoplasms
- See attached image and name the tumor marker
- What category of ovarian tumors does it belong to?
- Inhibin
- Sex cord stromal tumors
Bilateral ovarian masses
Microscopy of the ovarian masses show findings seen in the attached image.
Diagnosis?
Most likely primary?
Krukenberg tumor- bilateral metastases
Gastric origin
second most common malignant tumor of germ cell origin
See attached image
What tumor is this?
Marker?
Yolk Sac
Alpha-feto protein
Ovarian neoplasm associated with the syndrome described below:
Widely spaced nipples, webbed neck, lack of secondary sex charcateristics
Dysgerminoma assoc with Turner Syndrome
1. Gestational(Placental) /Non gestational(Ovarian) choriocarcinoma?
- Øunresponsive to chemotherapy
- Øoften fatal
- Øexists in combination with other germ cell tumors
2. Marker for choriocarcinomas?
- Non gestational choriocarcinoma
- human chorionic gonadotropin (hCG)
Microscopy findings in ovarian dysgerminoma
- large vesicular cells, clear cytoplasm, well-defined cell boundaries, central regular nuclei.
- grow in sheets or cords
- scant fibrous stroma , infiltrated by mature lymphocytes
- Presenting symptoms of an ovarian mass
- mc site for seeding of malignant surface derived ovarian tumors
- Lower Abdominal pain and distention
- Omentum
1. What is this condition termed as?
Bilateral ovarian masses
Extensive mucinous ascites
cystic epithelial implants on the peritoneal surface
2. Most likely primary tumor of origin?
1. Pseudomyxoma peritonei
2. Appendix
Unilateral ovarian mass
No palpable thyroid
Thyroid function tests suggestive of hyperthyroidism
Struma Ovarii
1. Diagnosis?
20 year old female
unilocular cyst
cyst wall lined by stratified squamous epithelium
Microscopy : Image attached
2. Type of carcinoma that may rarely develop from this benign tumor?
- Mature teratoma
- Squamous cell carcinoma
52 year old female
abdominal distension
unilateral ovarian mass
Gross: Larger cystic masses, multiloculated,sticky, gelatinous fluid
What would you see on microscopy?
Tall columnar cells with apical mucin
(Mucinous tumor)
1. Diagnosis?
52 year old female , distended abdomen and low back ache
elevated CA-125
gross and microscopic images attached
2. Which type of calcification would you expect to see?
- Malignant surface epithelial tumor- papillary serous cystadenocarcinoma
- Dystrophic calcification in psammoma bodies
1. Diagnosis?
- ovarian counterpart of testicular seminoma
- MC malignant germ cell tumor
- soft and fleshy
- see attached microscopic image
2. Markers?
- Dysgerminoma
2.
- serum LDH
- hcG
- OCT-3, OCT4, and NANOG
Functional ovarian tumors
- Estrogen secreting
- Androgen secreting
- Granulosa cell, thecomas
- Sertoli Leydig cell tumor
20 year old female
Bulky, solid; Hair, sebaceous material, cartilage, bone, and calcification may be present, along with areas of necrosis and hemorrhage
Microscopy image attached
Diagnosis?
Immature teratoma
Lab findings in PCOS
- LH/FSH ratio >3:1
- Increase in serum free testosterone and androstenedione
- Decrease in serum sex hormone binding globulin (SHBG)
- Normal to decreased serum FSH
- Increased insulin
Estrogen secreting tumor
post menopausal bleeding
M/E: small, cuboidal to polygonal cells may grow in anastomosing cords, sheets, or strands; with small, distinctive, glandlike structures filled with an acidophilic material
Granulosa cell tumor
Revised Rotterdam criteria for PCOS
2/3 to be satisfied for diagnosis
* Oligo or anovulation
* Clinical and/or biochemical signs of hyperandrogenism
* Polycystic ovaries
Major pathogenic mechanism for increase in free testosterone in PCOS
Decreased sex hormone binding globulin secondary to obesity and hyperinsulinemia
How does hyperinsulinemia lead to increased androgen levels?
- Increased insulin–> decreased IGBP-1–> Increased IGF1 in ovarian theca–> stimulates IGF1 receptors–> >increased androgens
- Increased insulin–>decreased SHBG–> stromal hyperthecosis.
Classic appearance of ovaries on ultrasound in PCOS
Bilateral, enlarged, polycystic, subcortical cysts resembling a string of pearls.
Mechanism of anovulation in PCOS
Individuals with PCOS have consistently elevated estrogen levels, leading to apersistent imbalance in the LH/FSH ratio (>3:1). Because FSH remains low relative to LH, there is no maturation and release of a single, dominant ovarian follicle (ie,anovulation).
Long-term health risks of PCOS
Increased risk of endometrial cancer, breast cancer, hyperlipidemia, insulin resistance, diabetes mellitus type 2, infertility
Functional cyst formed due to failure of a mature follicle to rupture during ovulation
Asymptomatic/ mild cyclical pain
Formed during follicular phase of the menstrual cycle
Simple, thin-walled cyst
Follicular cyst
- Cyst associated with pain during the luteal phase, after ovulation
- Formed due to excessive hemorrhage from corpus luteum after ovulation
- Cyst lining- luetininzed granulosa cells
Luteal cyst
- Ovarian cyst associated with elevated hCG
- Bilateral
Theca lutein cyst
Unilateral ovarian mass
Flushing, bronchospasm, diarrhea, tricuspid regurgitation
GI tumor and hepatic metastases excluded
Ovarian carcinoid
Type of monodermal teratoma secreting 5HT
Precurosr lesions for high grade serous carcinomas (Type II )
Serous intraepithelial carcinomas (STIC)
Diagnosis?
* smooth , shiny cyst wall
* clear fluid
* lining of cyst wall- ciliated columnar epithelium
Serous cystadenoma (benign serous tumor)
Karyotype of a mature teratoma
46 XX
Meig syndrome components
Ovarian fibroma + right sided pleural effusion+ ascites
2 syndromes associated with ovarian fibromas
Meigs syndrome
Basal cell nevus syndrome
