Gyn path 3: Ovarian Cancer Flashcards
Name the 4 classifications of ovarian cancers
- Surface epithelium
- Germ cell
- Sex cord stroma
- Metastasis to ovaries
Name the types (ie cell type origins) of surface epithelial cell tumors
Serous, mucinous, endometrioid, clear cell (malig only)
Name the types of germ cell tumors
Teratoma (mature and immature)
Dysgerminoma
Name the types of sex cord stroma tumors
Granulosa cell tumor
Fibroma/thecoma
What are the three “flavors” of surface epithelial tumors?
Benign (cystadenoma, adenofibroma)
Borderline
Malignant (carcinoma)
Putting it together what is the classification of surface epithelial tumors
A: Cell type
- serous
- mucinous
- endometrioid
B: Biologic malignancy (architecture and nuc atypia)
- Benign
- Borderline
- Malignant
What do serous epithelial cells look like
Ciliated epithelial cells similar to lining of tube
What do endometrioid epithelial cells look like
Stratified elongated epithelial cells, similar to lining of endometrium
What do mucinous epithelial cells look like
cells with intracytoplasmic mucin, similar to endocervical or intestinal cells
What are the two theories of origin of surface epithelial tumors?
- Inclusion cysts (appear to arise from underlying mesothelium)
- Foci of endometriosis (will give rise to endometrioid)
Describe the epithelial cells in benign cystadenomas
They are lined by single layer of bland epithelial cells (this is a cystic tumor and can be quite large)
If an ovarian mass is solid and cystic it is likely…
malignant
If an ovarian mass is completely cystic it is likely…
benign
if ovarian mass is completely solid it is likely…
either benign or malignant
Describe the histology of serous carcinoma
- Papillae, slit like spaces, solid areas
- Markedly atypical cells
- Necrosis, hemorrhage
- Many mitoses, including atypical forms
What is the most common type of ovarian carcinoma?
Serous carcinoma (we have lots of serous epithelium)
Describe the histology of mucinous carcinoma
- Glands and solid areas
- Atypical, mucinous epithelial cells
Describe the histology of endometrioid carcinoma
-Resembles usual endometrial carcinomas
Describe the histology of clear cell carcinoma
- Glands, papillae, solid areas
- Markedly atypical cells with clear cytoplasm
What is the typical spread of ovarian cancer?
To peritoneal surfaces then omentum
When are pts asymptomatic?
In early stage, so usually caught very late
What are the symptoms of advanced disease?
- Bloating
- Abdominal pain
- Urinary or GI sympt (compression)
- Asymptomatic
What is stage I ovarian cancer?
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
What is stage II ovarian cancer?
Spread to tubes, uterus or other pelvic organs
What is stage III ovarian cancer?
Lymph node metastasis, spread outside pelvis or to omentum
What is stage IV ovarian cancer?
Distant metastasis
What is early stage prognosis?
90%
What is late stage prognosis?
20% 5 year survival (most pts)
What is the overall 5 year survival?
30-50%
What are the risk factors for serous carcinoma?
- Nulliparity
- Fam hx
- BRCA 1/2
What is the genetics of low grade serous carcinoma?
KRAS or BRAF mutations
What is the genetics of high grade serous carcinoma?
p52, BRCA 1/2
What is common among ovarian tumors with the BRCA mutation?
Almost all are high grade serous carcinoma and many arise from the fallopian tube epithelium
What are the molec alterations in mucinous carcinoma?
Very few, KRAS early
What are the molec alterations in endometrioid carcinoma?
PTEN, KRAS, B-catenin, microsatellite instability
What is a common cancer that comes along with endometrioid carcinoma?
Uterine endometrial carcinoma
What can endometrioid carcinoma coexist with?
15-20% coexist with endometriosis and can have the same PTEN mutation
Describe borderline epithelial tumors
- 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
Describe the gross appearance of serous borderline tumor
Combination of surface and intracystic papillary growth
Describe the gross appearance of mucinous borderline tumor
- Cystic tumor with focal solid area or multilocular cystic tumor
- Cannot distinguish from carcinoma grossly
Describe histologic appearance of mucinous borderline tumor
- Cyst of variable sizes
- Lined by mucinous cells
- Small papillary proliferations
- Stratification of nuclei
- Mild to moderate nuclear atypia
- NO STROMAL INVASION
Describe histologic appearance of serous borderline tumor
- Complex, branching papillary architecture
- Proliferating, moderately atypical epithelial cells
- Cellular stratification
- Many cells have cilia
- NO STROMAL INVASION
What are implants?
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.
What is the prognosis of stage I borderline ovarian tumors
100% survival
What is the prognosis of borderline ovarian tumors with invasive implants?
30-60% (like low grade carcinoma)
What are the two ypes of germ cell tumors?
Mature cystic teratoma (dermoid cyst=benign) and dysgerminoma (malignant)
Describe dermoid cyst
- Benign
- 80% during repro years
- Rarely familial
- Prone to complications like torsion, infection, perforation, rupture, malignant transformation-rare
What is the most common form of germ cell tumor in ovary?
Dermoid cyst
Describe dysgerminoma
- Uncommon, but most common malignant germ cell tumor
- Can be bilateral
- 80-90% prognosis
What are the two types of sex-cord stromal tumors?
- Adult granulosa cell tumor
- Ovarian fibroma/thecoma
Describe granulosa-stromal cell tumors
- 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
What does a granulosa cell tumor look like histologically?
- Coffee bean nuclei
- Call-Exner bodies (small follicle-like structures)
What do thecomas look like?
- Gross: Contain lipid, yellow
- Histology: Spindle or ovoid cells with clear cytoplasm containing lipid
What does an ovarian fibroma look like?
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
What is the type of metastses to ovary that we learned about?
Krukenbeg tumor (metas of GI tumor to ovaries)
Small, bilateral tumors are almost always…
metastatic
What are the common primary sites of metastases?
Colon, pancreas, gallbladder, stomach, cervix, breast
What can metastases mimic?
Primary mucinous ovarian tumors (primary are usually unilateral and large though)
Describe krukenberg tumor
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)
What male counterpart does a dysgerminoma resemble?
seminoma
Is an immature teratoma of the ovary malignant or benign?
malignant, but mature are always benign
