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Repro > Gyn Path 3: Ovarian Cancer > Flashcards

Gyn Path 3: Ovarian Cancer Flashcards

1
Q

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

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

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

A

Inclusion cyst: for serous, mucinous

Endometriosis: endometrioid, clear cell

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3
Q

How are surface epithelial cells classified?

A

Cell type: Serous, mucinous, endometrioid, clear cell

Biological malignancy

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4
Q

Describe the benign appearance of cystadenoma and cystadenofibromas:

A

“Water balloon” appearance: Smooth with thin walls

NOT papillary or solid

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5
Q

What are cell types of cystadenoma and cystadenofibromas?

A

Serous, mucinous, endometrioid

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6
Q

Describe the gross appearance of ovarian carcinoma (2)

A

Mix of cystic areas and solid areas

Hemorrhage and necrosis

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7
Q

Describe the histological appearance of serous carcinomas (4)

A

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

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8
Q

Describe the histological appearance of mucinous-type ovarian carcinoma

A

Glands and solid areas

Atypical mucinous epithelial cells

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9
Q

Describe the histological appearance of endometrioid type carcinoma

A

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

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10
Q

Describe the histological appearance of clear cell carcinoma

A

Glands, papillae, solid areas

Atypical cells with clear cytoplasm

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11
Q

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

A

It usually presents in late stages after it has spread

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

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12
Q

What are the two common locations of ovarian cancer spread?

A

Peritoneal surfaces

Omentum

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13
Q

What is the staging of ovarian cancer?

A

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

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14
Q

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

A

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

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15
Q

What is the most common malignant ovarian tumor?

A

Serous carcinoma– 45% malignant ovarian tumors

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16
Q

What are risk factors for serous carcinoma? (3)

A

Nulliparity, family history, BRCA1/2

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17
Q

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

A

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

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

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18
Q

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

A

Fallopian tube epithelium

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19
Q

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

A

KRAS, PTEN, ß-catenin, microsatellite instability

20
Q

What is a borderline tumor?

A

Features between benign and malignant….

21
Q

Describe the gross appearance of a serous borderline tumor

A

Cystic tumor with papillary growth

22
Q

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

A

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

23
Q

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

A

Complex branching papillary architecture
Stratification
Ciliated cells
NO STROMAL INVASION

24
Q

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

A

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%)

25
Q

What are the two types of germ cell tumors?

A

Mature cystic teratoma

Dysgerminoma

26
Q

Which germ-cell tumor predominates?

A

Most germ cell tumors are benign dermoid cysts

27
Q

In which age group are germ cell tumors most common?

A

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

28
Q

What complications occur with dermoid cysts? (5)

A 
Torsion 
Infection
Perforation
Rupture (acute abdomen)
Malignant transformation
29
Q

Describe gross appearance of dermoid cyst:

A

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

30
Q

Describe the histologic appearance of dermoid cyst:

A

Big cyst

Lots of ectopic tissues– skin, sebaceous material, fat

31
Q

Dysgerminoma epidemiology: prevalence

When does it usually present?

A

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

32
Q

What is the prognosis for dysgerminomas?

A

Good– 80-90% survival for high stage disease

33
Q

What is the histology of dysgerminomas?

A

Similar to seminomas

34
Q

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

A

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

35
Q

Granulosa cells cause ____ because unlike most tumors they produce ______

A

Granulosa cells cause endometrial hyperplasia or carcinoma because they secrete estrogens

36
Q

Describe gross appearance of granulosa cell tumors

A

Hemorrhage, solid yellow/tan cut surface

Can also be cystic

37
Q

Describe key histologic features of granulosa cell tumors (2)

A

Coffee bean nuclei

Call-exner bodies (follicles)

38
Q

Describe gross appearance of thecoma

A

Solid bright yellow cut

39
Q

Describe the histologic appearance of thecomas

A

Spindle/ovoid cells with clear lipid-containing cytoplasm

40
Q

Describe the gross features of ovarian fibromas:

A

Solid white/tan cut surface

Can be bilateral

41
Q

What two rare syndromes are ovarian fibromas associated with?

A

Gorlin’s: will see multiple fibromas

Meig’s syndrome: ascites and pleural effusion

42
Q

Describe the histologic appearance of fibromas (3)

A

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

43
Q

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

A

Primary: Large usually unilateral
Mets: Multiple small, bilateral

44
Q

What is gross appearance of Krukenberg tumor? (2)

A

Bilateral ovarian masses

Solid tumor with nodules

45
Q

What is the histologic appearance of Krukenburg tumors?

A

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

Repro (29 decks)

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