Gyn Path 3: Ovarian Cancer

Question 1

What are the broad classes of ovarian tumors? What are their frequencies?

Answer 1

1. Surface epithelial (70%)
2. Germ cell (15%)
3. Sex-cord stroma (10%)
4. Metastases (Krukenberg)

Question 2

What is the origin of surface epithelial tumors? (2)

Answer 2

Inclusion cyst: for serous, mucinous

Endometriosis: endometrioid, clear cell

Question 3

How are surface epithelial cells classified?

Answer 3

Cell type: Serous, mucinous, endometrioid, clear cell

Biological malignancy

Question 4

Describe the benign appearance of cystadenoma and cystadenofibromas:

Answer 4

“Water balloon” appearance: Smooth with thin walls

NOT papillary or solid

Question 5

What are cell types of cystadenoma and cystadenofibromas?

Answer 5

Serous, mucinous, endometrioid

Question 6

Describe the gross appearance of ovarian carcinoma (2)

Answer 6

Mix of cystic areas and solid areas

Hemorrhage and necrosis

Question 7

Describe the histological appearance of serous carcinomas (4)

Answer 7

Papillae, slit like spaces, solid areas
Large atypical cells
Necrosis/hemorrhage
Mitoses

Question 8

Describe the histological appearance of mucinous-type ovarian carcinoma

Answer 8

Glands and solid areas

Atypical mucinous epithelial cells

Question 9

Describe the histological appearance of endometrioid type carcinoma

Answer 9

Just like endometrial carcinoma (branching/complex ducts with atypia)

Question 10

Describe the histological appearance of clear cell carcinoma

Answer 10

Glands, papillae, solid areas

Atypical cells with clear cytoplasm

Question 11

When does ovarian cancer usually present? How does present clinically? (4)

Answer 11

It usually presents in late stages after it has spread

GUAB: Presents with bloating, abdominal pain, urinary and GI symptoms

Question 12

What are the two common locations of ovarian cancer spread?

Answer 12

Peritoneal surfaces

Omentum

Question 13

What is the staging of ovarian cancer?

Answer 13

I: Ovaries
II: Tubes, uterus, pelvic organs
III: Lymph nodes, pelvis, omentum
IV: Distant mets

Question 14

What is the prognosis for ovarian cancer? Know overall, early and late

Answer 14

Early stage: 90%
Late stage: 20%
Overall: 30-50%

Question 15

What is the most common malignant ovarian tumor?

Answer 15

Serous carcinoma– 45% malignant ovarian tumors

Question 16

What are risk factors for serous carcinoma? (3)

Answer 16

Nulliparity, family history, BRCA1/2

Question 17

What is the difference between low grade and high grade serous carcinoma? (2)

Answer 17

Low grade: arises from serous borderline tumor; KRAS or BRAF mutations

High grade: arise from fallopian tube epithelium; p53 mutations and BRCA1/2

Question 18

Where do most BRCA1/2 high grade serous carcinomas arise from?

Answer 18

Fallopian tube epithelium

Question 19

What are mutations associated with endometrioid-type carcinoma? (4)

Answer 19

KRAS, PTEN, ß-catenin, microsatellite instability

Question 20

What is a borderline tumor?

Answer 20

Features between benign and malignant….

Question 21

Describe the gross appearance of a serous borderline tumor

Answer 21

Cystic tumor with papillary growth

Question 22

Describe the histologic appearance of a mucinous borderline tumor. Is there stromal invasion?

Answer 22

Cysts lined by mucinous cells
Small papillary proliferations
Some atypia
NO STROMAL INVASION

Question 23

Describe the histology for a serous borderline tumor. Is there stream invasion?

Answer 23

Complex branching papillary architecture
Stratification
Ciliated cells
NO STROMAL INVASION

Question 24

What are implants? What is their importance in determining a prognosis?

Answer 24

Implants are extra ovarian lesions

If they are non-invasive prognosis more like cystadenoma (100%). If invasive prognosis more resembles low-grade carcinoma (30-60%)

Question 25

What are the two types of germ cell tumors?

Answer 25

Mature cystic teratoma | Dysgerminoma

Question 26

Which germ-cell tumor predominates?

Answer 26

Most germ cell tumors are benign dermoid cysts

Question 27

In which age group are germ cell tumors most common?

Answer 27

Dysgerminoma is most common malignant tumor for 0-30 age group 80% of dermoid cysts occur during reproductive years

Question 28

What complications occur with dermoid cysts? (5)

Answer 28

``` Torsion Infection Perforation Rupture (acute abdomen) Malignant transformation ```

Question 29

Describe gross appearance of dermoid cyst:

Answer 29

Gross. Sebaceous material, fat, hair, teeth all that shit

Question 30

Describe the histologic appearance of dermoid cyst:

Answer 30

Big cyst | Lots of ectopic tissues-- skin, sebaceous material, fat

Question 31

Dysgerminoma epidemiology: prevalence When does it usually present?

Answer 31

Prevalence: 1% all ovarian germ cell tumors, but 50% of malignant germ cell tumors 20-30% malignant of ovarian tumors encountered during pregnancy Usually diagnosed in 2nd/3rd decades

Question 32

What is the prognosis for dysgerminomas?

Answer 32

Good-- 80-90% survival for high stage disease

Question 33

What is the histology of dysgerminomas?

Answer 33

Similar to seminomas

Question 34

What is a granulosa cell tumor? What is the prognosis?

Answer 34

A malignant sex-cord stromal tumor. 60-90% ten year survival

Question 35

Granulosa cells cause ____ because unlike most tumors they produce ______

Answer 35

Granulosa cells cause endometrial hyperplasia or carcinoma because they secrete estrogens

Question 36

Describe gross appearance of granulosa cell tumors

Answer 36

Hemorrhage, solid yellow/tan cut surface | Can also be cystic

Question 37

Describe key histologic features of granulosa cell tumors (2)

Answer 37

Coffee bean nuclei | Call-exner bodies (follicles)

Question 38

Describe gross appearance of thecoma

Answer 38

Solid bright yellow cut

Question 39

Describe the histologic appearance of thecomas

Answer 39

Spindle/ovoid cells with clear lipid-containing cytoplasm

Question 40

Describe the gross features of ovarian fibromas:

Answer 40

Solid white/tan cut surface | Can be bilateral

Question 41

What two rare syndromes are ovarian fibromas associated with?

Answer 41

Gorlin's: will see multiple fibromas | Meig's syndrome: ascites and pleural effusion

Question 42

Describe the histologic appearance of fibromas (3)

Answer 42

Bundles of spindle cells Bands of collage No atypia; rare mitoses

Question 43

How to do you differentiate between primary mutinous tumors and metastatic tumors to ovary?

Answer 43

Primary: Large usually unilateral Mets: Multiple small, bilateral

Question 44

What is gross appearance of Krukenberg tumor? (2)

Answer 44

Bilateral ovarian masses | Solid tumor with nodules

Question 45

What is the histologic appearance of Krukenburg tumors?

Answer 45

Signet ring cells: cytoplasm filled within mucin so nucleus is pushed to side