Gyn. Path. 3

Question 0

Where’s epithelium from which ovarian epithelial carcinomas arise? (2 areas)

Answer 0

Surrounding the ovary.

Epithelial inclusion cysts.

Question 1

4 types of ovarian tumor in order of decreasing prevalence/indcidence?

Answer 1

Epithelial - 70%
Germ Cell
Sex Cord Stromal
Metastases

Question 2

What’s an epithelial inclusion cyst?

Answer 2

After ovulation, a section of epithelium can invaginate and form a cyst - it’s like endocytosis, but bigger.

Question 3

What are the 2 categories of ovarian epithelial tumors that we care about?

Answer 3

Serous

Mucinous

Question 4

3 levels of malignancy as determined in histology of ovarian epithelial tumors?

Answer 4

Benign
Low Malignant Potential (LMP/Borderline)
Malignant

Question 5

What do benign cystadenomas look like in histology?

Answer 5

Single layer of epithelial cells that look normal.

Question 6

What gross features about an ovarian epithelial tumor suggest malignancy?

Answer 6

Mixed cystic and solid areas.

Hemorrhage and necrosis.

Question 7

How does being solid vs. cystic help you determine malignancy?

Answer 7

Mostly cystic - most likely benign.
Mostly solid - toss-up.
Cystic and solid - most likely malignant.

Question 8

Where/how does ovarian carcinoma typical spread?

Answer 8

Typically spreads via exfoliation to peritoneal surfaces, omentum.
(can also spread via lymphatics)

Question 9

4 stages of ovarian cancer spread?

Answer 9

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

Question 10

Prognosis for ovarian cancer?

Answer 10

Typically quite poor - 30-50% 5 year survival.

Prognosis is better if caught at an early stage, but these often present very late.

Question 11

Where might high grade serous ovarian carcinoma commonly arise from in women with BRCA1 or 2 mutations?

Answer 11

From the fallopian tube epithelium.

these tumors may wind up on the peritoneum too, not just the ovary

Question 12

Mutations associated with low grade serous carcinoma?

Answer 12

KRAS and BRAF (rarely p53)

Question 13

Mutation associated with high grade serous carcinoma?

Answer 13

p53 - recall that this is similar to high grade, Type II endometrial carcinoma.

Question 14

What are the genetic associations with high-grade serous, mucinous, and endometrioid carcinoma?

Answer 14

High-grade serous: p53, BRCA1/2
Mucinous: KRAS (“few genetic alterations”)
Endometrioid: PTEN, KRAS, beta-Catenin, microsatellite instability

Question 15

Why might you think a borderline / LMP ovarian epithelial tumor is worse than it is? What’s the dividing line between LMP and carcinoma?

Answer 15

It can spread to extra-ovarian sites - “Implants” - e.g. peritoneum and omentum.
But there is NO STROMAL INVASION.
(implant =/= metastasis)

Question 16

What’s the somewhat confusing thing about classifying ovarian tumors and grading extra-ovarian implants?

Answer 16

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.

Question 17

Ways to distinguish, grossly, primary ovarian tumors from metastases?

Answer 17

Metastases tend to be smaller and bilateral.

Question 18

What’s a Krukenberg tumor? Gross and histological features?

Answer 18

Metastasis from breast or stomach to ovary.
Solid tumor.
On histology: signet ring cells (mucin-filled).

Question 19

What’s the most common germ cell tumor in women?

Answer 19

Benign dermoid cysts a.k.a. mature teratomas a.k.a. nasty creepy hair, tooth, cartilage things.

Question 20

What’s the most common malignant (ovarian? germ cell?) tumor in women aged 0-30?

Answer 20

Dysgerminoma (analogous to seminoma, including being very radiosensitive)

Question 21

5 complications of dermoid cysts?

Answer 21

Torsion
Infection
Perforation of peritoneum
Rupture
Malignant transformation (rare: 1-2%)

Question 22

When mature teratomas do transform, what do they usually become?

Answer 22

Squamous cell carcinomas.

Question 23

What’s the most common sex-cord / stromal tumor?

Answer 23

Thecoma-fibroma, benign.

Question 24

Most common malignant sex-cord/stromal tumor?

Answer 24

Granulosa cell tumor.

Question 25

Why are thecomas bright yellow, grossly?

Answer 25

They have lots of lipid. (cholesterol for steroids)

Question 26

What do ovarian fibromas look like, grossly? What 3 things do you need to know about them?

Answer 26

Solid tan-white.
They don’t produce lipid.
Associated with Meigs’ syndrome.
Associated with Gorlin’s syndrome.

Question 27

What is Meigs’ syndrome?

Answer 27

Ascites and pleural effusion associated with ovarian fibroma.

Question 28

What is Gorlin’s syndrome?

Answer 28

Nevoid basal cell carcinoma syndrome…. which basically means you have a bunch of ovarian fibromas.

Question 29

What can malignant granulosa tumors induce? Why?

Answer 29

Type I (endometrioid) endometrial carcinoma, because this carcinoma is sensitive to the estrogen being pumped out by the granulosa cell tumor.