Gyn. Path. 3 Flashcards
Where’s epithelium from which ovarian epithelial carcinomas arise? (2 areas)
Surrounding the ovary.
Epithelial inclusion cysts.
4 types of ovarian tumor in order of decreasing prevalence/indcidence?
Epithelial - 70%
Germ Cell
Sex Cord Stromal
Metastases
What’s an epithelial inclusion cyst?
After ovulation, a section of epithelium can invaginate and form a cyst - it’s like endocytosis, but bigger.
What are the 2 categories of ovarian epithelial tumors that we care about?
Serous
Mucinous
3 levels of malignancy as determined in histology of ovarian epithelial tumors?
Benign
Low Malignant Potential (LMP/Borderline)
Malignant
What do benign cystadenomas look like in histology?
Single layer of epithelial cells that look normal.
What gross features about an ovarian epithelial tumor suggest malignancy?
Mixed cystic and solid areas.
Hemorrhage and necrosis.
How does being solid vs. cystic help you determine malignancy?
Mostly cystic - most likely benign.
Mostly solid - toss-up.
Cystic and solid - most likely malignant.
Where/how does ovarian carcinoma typical spread?
Typically spreads via exfoliation to peritoneal surfaces, omentum.
(can also spread via lymphatics)
4 stages of ovarian cancer spread?
Stage I - confined to one or both ovaries
Stage II - spread to oviducts/uterus, other pelvic organs
Stage III - spread to lymph nodes, omentum, outside pelvis
Stage IV - distant metastases
Prognosis for ovarian cancer?
Typically quite poor - 30-50% 5 year survival.
Prognosis is better if caught at an early stage, but these often present very late.
Where might high grade serous ovarian carcinoma commonly arise from in women with BRCA1 or 2 mutations?
From the fallopian tube epithelium.
these tumors may wind up on the peritoneum too, not just the ovary
Mutations associated with low grade serous carcinoma?
KRAS and BRAF (rarely p53)
Mutation associated with high grade serous carcinoma?
p53 - recall that this is similar to high grade, Type II endometrial carcinoma.
What are the genetic associations with high-grade serous, mucinous, and endometrioid carcinoma?
High-grade serous: p53, BRCA1/2
Mucinous: KRAS (“few genetic alterations”)
Endometrioid: PTEN, KRAS, beta-Catenin, microsatellite instability
Why might you think a borderline / LMP ovarian epithelial tumor is worse than it is? What’s the dividing line between LMP and carcinoma?
It can spread to extra-ovarian sites - “Implants” - e.g. peritoneum and omentum.
But there is NO STROMAL INVASION.
(implant =/= metastasis)
What’s the somewhat confusing thing about classifying ovarian tumors and grading extra-ovarian implants?
The tumor is graded based on what’s going on in the ovary.
But prognosis most dependent on whether or not the implants are invasive.
Ways to distinguish, grossly, primary ovarian tumors from metastases?
Metastases tend to be smaller and bilateral.
What’s a Krukenberg tumor? Gross and histological features?
Metastasis from breast or stomach to ovary.
Solid tumor.
On histology: signet ring cells (mucin-filled).
What’s the most common germ cell tumor in women?
Benign dermoid cysts a.k.a. mature teratomas a.k.a. nasty creepy hair, tooth, cartilage things.
What’s the most common malignant (ovarian? germ cell?) tumor in women aged 0-30?
Dysgerminoma (analogous to seminoma, including being very radiosensitive)
5 complications of dermoid cysts?
Torsion Infection Perforation of peritoneum Rupture Malignant transformation (rare: 1-2%)
When mature teratomas do transform, what do they usually become?
Squamous cell carcinomas.
What’s the most common sex-cord / stromal tumor?
Thecoma-fibroma, benign.
Most common malignant sex-cord/stromal tumor?
Granulosa cell tumor.
Why are thecomas bright yellow, grossly?
They have lots of lipid. (cholesterol for steroids)
What do ovarian fibromas look like, grossly? What 3 things do you need to know about them?
Solid tan-white.
They don’t produce lipid.
Associated with Meigs’ syndrome.
Associated with Gorlin’s syndrome.
What is Meigs’ syndrome?
Ascites and pleural effusion associated with ovarian fibroma.
What is Gorlin’s syndrome?
Nevoid basal cell carcinoma syndrome…. which basically means you have a bunch of ovarian fibromas.
What can malignant granulosa tumors induce? Why?
Type I (endometrioid) endometrial carcinoma, because this carcinoma is sensitive to the estrogen being pumped out by the granulosa cell tumor.
