Female GU Pathology III: Ovary and Fallopian Tube

Question 1

Follicular Cysts

Answer 1

Result from unruptured Graafian follicles or ruptured follicle that immediately seals.

Question 2

Corpus luteum cysts

Answer 2

Result from delayed resolution of a corpus luteum’s central cavity - hemorrhage into a corpus luteum may result in hemorrhagic corpus luteum cyst

Question 3

Polycystic Ovarian Syndrome

Answer 3

Excess secretion of androgens due to increased LH cause anovulation leading to ovarian cysts and enlarged ovaries

Question 4

What is the action of LH?

Answer 4

LH stimulates theca cells to produce androgens

Question 5

What is PCOS associated with?

Answer 5

Increased insulin resistance and T2 diabetes

Question 6

Androgen is converted in adipose tissue to estrone resulting in what long‐term potential complication of PCOS?
A. Cervical squamous cell cancer
B. Uterine endometrioid endometrial cancer
C. Uterine serous papillary endometrial cancer
D. Leiomyosarcoma of uterus

Answer 6

B. Uterine endometrioid endometrial cancer

Question 7

What are some symptoms of PCOS?

Answer 7

• Hirsutism
• Virilism
• Acne

Question 8

How does obesity cause estrogen excess?

Answer 8

Androgens are converted to estrone in the adipose tissue

Question 9

What are seem therapies for PCOS?

Answer 9

• Weight Loss

- Metformin

Question 10

What is the most common ovarian tumor?

Answer 10

Surface Epithelial Tumors

Question 11

What are the 2 types of surface epithelial tumors?

Answer 11

• Serous

- Mucinous

Question 12

• Cyst with thin and smooth surface
• Single layer of lining cells similar to that of fallopian tube mucosa
• No cytologic atypic
• No invasion

Answer 12

Benign Serous Cystadenoma

Question 13

• Papillary structures with destructive stromal invasion

- May have presence of psamomma bodies

Answer 13

Serous Cystadenocarcinoma

Question 14

What is the most common type of surface epithelial tumor?

Answer 14

Serous

Question 15

• Multiple cystic mass filled by sticky, gelatinous fluid
• Lining epithelium single row of uniform mucin-filled columnar cells with basal nuclei.
• Absent or minimal cellular stratification, no or minimal cellular atypia

Answer 15

Mucinous Cystadenoma

Question 16

• Destructive stromal invasion, cytologic atypic and filled by sticky, gelatinous fluid

Answer 16

Mucinous Cystadenocarcinoma

Question 17

What are some risk factors for cystadenocarcinomas?

Answer 17

• Nulliparity

- Family Hx

Question 18

What tumor marker is used to monitor therapy response in cystadenocarcinomas?

Answer 18

CA‐125

Question 19

Borderline Tumors

Answer 19

• Morphology and behavior “in between” benign and malignant
• Limited invasive potential
• Better prognosis than overtly malignant
carcinomas

Question 20

Who are germ cell tumors often seen in?

Answer 20

Most common ovarian cancer in children and adolescent females

Question 21

Teratoma

Answer 21

Tumor of germ cell origin that is differentiated embryonic tissue and is comprised of more than one neoplastic cell type

Question 22

• Comprise 90% of all teratomas

* Derive from all germ layers – Ectoderm, Endoderm, Mesoderm

Answer 22

Benign Mature Teratoma

Question 23

Struma Ovarii

Answer 23

A large amount of ovary is thyroid tissue

Question 24

Malignant Teratoma

Answer 24

VERY rare - only 1% of all teratomas and have some malignant component -> SCC/thyroid carcinoma/melanoma

Question 25

- Uncommon tumor, composed of mature and immature (primitive cells) embryonal type tissues - Most commonly diagnosed in prepubertal girls, adolescents and young woman - Rapidly growing tumor with frequent capsular rupture

Answer 25

Immature Teratoma

Question 26

- Ovarian counterpart of the testicular seminoma - Most common malignant germ cell tumor of ovary - LDH tumor marker

Answer 26

Dysgerminoma

Question 27

What germ cell tumor is radiosensitive?

Answer 27

Dysgerminoma

Question 28

With what germ cell tumor are Schiller‐Duvall Bodies seen?

Answer 28

Endodermal Sinus Tumor

Question 29

Histology - Large cells with clear cytoplasm - Stroma with lymphocytes

Answer 29

Dysgerminoma

Question 30

- Neoplasm attempts to recapitulate placental tissue; trophoblasts and syncystiotrophoblasts without chorionic villi - hCG tumor marker

Answer 30

Choriocarcinoma

Question 31

What tumor has AFP as a marker?

Answer 31

Endodermal Sinus Tumor

Question 32

What class of ovarian tumors has these features: • Originate from undifferentiated gonadal mesenchyme • Any age • Most benign, low malignant potential • Hormonally active

Answer 32

Sex‐Cord Stromal Tumors

Question 33

Most common ovarian tumor with estrogen production.

Answer 33

Granulosa Cell Tumor

Question 34

This tumor is associated with androgen production and tends to be virilizing.

Answer 34

Leydig Cell Tumor

Question 35

‐ Fibroblasts (fibroma) ‐ Lipid‐laden theca cells (theca) - May produce estrogen

Answer 35

Thecoma-Fibroma

Question 36

What tumor is associated with Meigs Syndrome?

Answer 36

Thecoma-Fibroma

Question 37

What are the features of Meigs Syndrome?

Answer 37

‐ Right sided pleural effusions ‐ Ascites ‐ Ovarian mass

Question 38

Call-Exner Bodies

Answer 38

Gland like structures filled with eosinophilic material seen in granulosa cell tumors

Question 39

- Metastatic mucinous tumor to both ovaries | - Most commonly gastric carcinoma origin

Answer 39

Krukenberg Tumor

Question 40

A 60‐year‐old woman presented with diffuse abdominal pain and distension of the abdomen. Evaluation revealed disseminated gelatinous ascites and multifocal peritoneal epithelial implants, secreting copious globules of extracellular mucin. Which of the following should be at the top of the differential diagnosis with respect to underling cause of her condition? A. Gastric carcinoid; ovarian serous cystadenoma B. Appendiceal carcinoid; ovarian serous cystadenocarcinoma C. Appendiceal mucinous cystadenoma; ovarian Brenner tumor D. Appendiceal mucinous cystadenocarcinoma; ovarian mutinous cystadenocarcinoma E. Gastric GIST; ovarian mucinous cystadenoma

Answer 40

D. Appendiceal mucinous cystadenocarcinoma; ovarian mutinous cystadenocarcinoma

Question 41

Pseudomyxoma peritonii

Answer 41

Extensive intraperitoneal mucous

Question 42

Acute Salpingitis

Answer 42

Ascending sexually transmitted; most common organisms: Gonococcus and Chlamydia