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Reproduction > Gyn path 3: Ovarian Cancer > Flashcards

Gyn path 3: Ovarian Cancer Flashcards

1
Q

Name the 4 classifications of ovarian cancers

A
  1. Surface epithelium
  2. Germ cell
  3. Sex cord stroma
  4. Metastasis to ovaries
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2
Q

Name the types (ie cell type origins) of surface epithelial cell tumors

A

Serous, mucinous, endometrioid, clear cell (malig only)

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3
Q

Name the types of germ cell tumors

A

Teratoma (mature and immature)

Dysgerminoma

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4
Q

Name the types of sex cord stroma tumors

A

Granulosa cell tumor

Fibroma/thecoma

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5
Q

What are the three “flavors” of surface epithelial tumors?

A

Benign (cystadenoma, adenofibroma)
Borderline
Malignant (carcinoma)

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6
Q

Putting it together what is the classification of surface epithelial tumors

A

A: Cell type

  • serous
  • mucinous
  • endometrioid

B: Biologic malignancy (architecture and nuc atypia)

  • Benign
  • Borderline
  • Malignant
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7
Q

What do serous epithelial cells look like

A

Ciliated epithelial cells similar to lining of tube

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8
Q

What do endometrioid epithelial cells look like

A

Stratified elongated epithelial cells, similar to lining of endometrium

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9
Q

What do mucinous epithelial cells look like

A

cells with intracytoplasmic mucin, similar to endocervical or intestinal cells

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10
Q

What are the two theories of origin of surface epithelial tumors?

A
  1. Inclusion cysts (appear to arise from underlying mesothelium)
  2. Foci of endometriosis (will give rise to endometrioid)
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11
Q

Describe the epithelial cells in benign cystadenomas

A

They are lined by single layer of bland epithelial cells (this is a cystic tumor and can be quite large)

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12
Q

If an ovarian mass is solid and cystic it is likely…

A

malignant

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13
Q

If an ovarian mass is completely cystic it is likely…

A

benign

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14
Q

if ovarian mass is completely solid it is likely…

A

either benign or malignant

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15
Q

Describe the histology of serous carcinoma

A
  • Papillae, slit like spaces, solid areas
  • Markedly atypical cells
  • Necrosis, hemorrhage
  • Many mitoses, including atypical forms
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16
Q

What is the most common type of ovarian carcinoma?

A

Serous carcinoma (we have lots of serous epithelium)

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17
Q

Describe the histology of mucinous carcinoma

A
  • Glands and solid areas

- Atypical, mucinous epithelial cells

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18
Q

Describe the histology of endometrioid carcinoma

A

-Resembles usual endometrial carcinomas

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19
Q

Describe the histology of clear cell carcinoma

A
  • Glands, papillae, solid areas

- Markedly atypical cells with clear cytoplasm

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20
Q

What is the typical spread of ovarian cancer?

A

To peritoneal surfaces then omentum

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21
Q

When are pts asymptomatic?

A

In early stage, so usually caught very late

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22
Q

What are the symptoms of advanced disease?

A
  • Bloating
  • Abdominal pain
  • Urinary or GI sympt (compression)
  • Asymptomatic
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23
Q

What is stage I ovarian cancer?

A 
Confined to ovaries
1a: one ovary
1b: both
Use surgery, no chemo for above
1c: surface involvement, rupture or pos cytology 
Use surgery and chemo
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24
Q

What is stage II ovarian cancer?

A

Spread to tubes, uterus or other pelvic organs

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25
Q

What is stage III ovarian cancer?

A

Lymph node metastasis, spread outside pelvis or to omentum

26
Q

What is stage IV ovarian cancer?

A

Distant metastasis

27
Q

What is early stage prognosis?

A

90%

28
Q

What is late stage prognosis?

A

20% 5 year survival (most pts)

29
Q

What is the overall 5 year survival?

A

30-50%

30
Q

What are the risk factors for serous carcinoma?

A
  • Nulliparity
  • Fam hx
  • BRCA 1/2
31
Q

What is the genetics of low grade serous carcinoma?

A

KRAS or BRAF mutations

32
Q

What is the genetics of high grade serous carcinoma?

A

p52, BRCA 1/2

33
Q

What is common among ovarian tumors with the BRCA mutation?

A

Almost all are high grade serous carcinoma and many arise from the fallopian tube epithelium

34
Q

What are the molec alterations in mucinous carcinoma?

A

Very few, KRAS early

35
Q

What are the molec alterations in endometrioid carcinoma?

A

PTEN, KRAS, B-catenin, microsatellite instability

36
Q

What is a common cancer that comes along with endometrioid carcinoma?

A

Uterine endometrial carcinoma

37
Q

What can endometrioid carcinoma coexist with?

A

15-20% coexist with endometriosis and can have the same PTEN mutation

38
Q

Describe borderline epithelial tumors

A
  • Clinical and pathologic features in between benign and malignant tumors
  • Low malignant potential
  • May be associated with extra-ovarian lesions on peritoneal surfaces, omentum and lymph nodes
  • No invasion
39
Q

Describe the gross appearance of serous borderline tumor

A

Combination of surface and intracystic papillary growth

40
Q

Describe the gross appearance of mucinous borderline tumor

A
  • Cystic tumor with focal solid area or multilocular cystic tumor
  • Cannot distinguish from carcinoma grossly
41
Q

Describe histologic appearance of mucinous borderline tumor

A
  • Cyst of variable sizes
  • Lined by mucinous cells
  • Small papillary proliferations
  • Stratification of nuclei
  • Mild to moderate nuclear atypia
  • NO STROMAL INVASION
42
Q

Describe histologic appearance of serous borderline tumor

A
  • Complex, branching papillary architecture
  • Proliferating, moderately atypical epithelial cells
  • Cellular stratification
  • Many cells have cilia
  • NO STROMAL INVASION
43
Q

What are implants?

A

With serous borderline tumors in the ovary, the patient can have implants in the peritoneum. They are extra-ovarian lesions that can be invasive (like low grade carcinoma) or not invasive (benign), they are not considered metastases.

44
Q

What is the prognosis of stage I borderline ovarian tumors

A

100% survival

45
Q

What is the prognosis of borderline ovarian tumors with invasive implants?

A

30-60% (like low grade carcinoma)

46
Q

What are the two ypes of germ cell tumors?

A

Mature cystic teratoma (dermoid cyst=benign) and dysgerminoma (malignant)

47
Q

Describe dermoid cyst

A
  • Benign
  • 80% during repro years
  • Rarely familial
  • Prone to complications like torsion, infection, perforation, rupture, malignant transformation-rare
48
Q

What is the most common form of germ cell tumor in ovary?

A

Dermoid cyst

49
Q

Describe dysgerminoma

A
  • Uncommon, but most common malignant germ cell tumor
  • Can be bilateral
  • 80-90% prognosis
50
Q

What are the two types of sex-cord stromal tumors?

A
  • Adult granulosa cell tumor

- Ovarian fibroma/thecoma

51
Q

Describe granulosa-stromal cell tumors

A
  • Have malignant potential, though not lethal
  • Rare metastasis, late recurrence locally
  • Can produce estrogens and cause endometrial hyperplasia or carcinoma
  • Solid yellow cut surface with areas of hemorrhage, completely cystic
52
Q

What does a granulosa cell tumor look like histologically?

A
  • Coffee bean nuclei

- Call-Exner bodies (small follicle-like structures)

53
Q

What do thecomas look like?

A
  • Gross: Contain lipid, yellow

- Histology: Spindle or ovoid cells with clear cytoplasm containing lipid

54
Q

What does an ovarian fibroma look like?

A

Gross:
Solid, white cut surface
NO HORMONE PRODUCTION
Associated with meigs’ syndrome and Gorlin’s syndrome

Histology:
Bundles of spindle cells
bands of collagen
no nuc atypia
only rare mitoses
55
Q

What is the type of metastses to ovary that we learned about?

A

Krukenbeg tumor (metas of GI tumor to ovaries)

56
Q

Small, bilateral tumors are almost always…

A

metastatic

57
Q

What are the common primary sites of metastases?

A

Colon, pancreas, gallbladder, stomach, cervix, breast

58
Q

What can metastases mimic?

A

Primary mucinous ovarian tumors (primary are usually unilateral and large though)

59
Q

Describe krukenberg tumor

A

GrosS: Bilateral ovarian masses (multiple), ovaries only mildly enlarged, solid tumor, GI origin

Histology:
-Tumor cells have mucin which displace the nuclei (Signet ring tumor cells)

60
Q

What male counterpart does a dysgerminoma resemble?

A

seminoma

61
Q

Is an immature teratoma of the ovary malignant or benign?

A

malignant, but mature are always benign

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