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Gynae-Gao > Gynae-Gao > Flashcards

Gynae-Gao Flashcards

1
Q

Adult granulosa cell tumors- uni or bilateral

A

Unilateral

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2
Q

Mutation characteristic of adult granulosa cell tumors

A

FOXL2

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3
Q

IHC to distinguish between granulosa cell tumors and thecomas

A

reticulin

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4
Q

How do low grade serous and high grade serous differ?

A
  1. Mitotic rate higher in HGSC

2. Total absence of p53 IHC seen in HGSC rather than LGSC

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5
Q

IUD removed, endometrial bx shows lymphoid follicles with increased plasma cells… what is true?

A

acute salpingitis often a/w this condition

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6
Q

Examining hysterectomy labeled as “fibroid uterus”, single lesion found in myometrium. Dx of PECOMA made…. PECOMAS

A
  1. PECOMA is morpho/IHC similar to epithelioid AML, lymphangioleiomyoma, clear cell “ sugar tumors”
  2. Patchy HMB-45 positivity
  3. Can be positive for SMA and desmin
  4. NOT all PEComas are malignant
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7
Q

Serous carcinoma vs. mesothelioma IHC

A

PAX8 (positive in serous, neg meso),
ER (positive in serous, neg meso),
Calretinin (positive in mesothelioma, neg serous);
WT-1 positive in both

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8
Q

What can you NOT diagnose on endometrial curettage….

A

endometrial stromal nodule

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9
Q

germline mutations in gynae tumors…

A

BRCA1- HGSC
SMARCA4- ovarian small cell carcinoma, hypercalcemic type
DICER1- sertoli leydig cell tumor

[FOXL2 is NOT germline]

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10
Q

Ddx of elevated serum hCG

A

Choriocarcinoma
Molar pregnancy
Germ cell tumor

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11
Q

Gynae tumors a/w Peutz-Jeghers

A

Endocervical gastric type adenocarcinoma
Adnexal mucinous neoplasms
Sex cord tumor with annular tubules

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12
Q

Features of uterine adenosarcoma

A
  1. Leaflike architecture
  2. Sarcomatous overgrowth
  3. Rhabdomyoblastic differentiation
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13
Q

LSIL a.w HPV

A

6 +11

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14
Q

Can LSIL be a/w HPV 16/18?

A

YES….weird…..

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15
Q

Feature to distinguish low grade endometrial stromal sarcoma from endometrial stromal nodule

A

INFILTRATIVE BORDER

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16
Q

P53 and dVIN

A

P53 abnormal in dVIN, however it is difficult to interpret as a diagnostic IHC marker

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17
Q

dVIN or uVIN more likely to progress to invasive carcinoma?

A

DIFFERENTIATED VIN

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18
Q

Can benign leiomyomas have tumor cell necrosis?

A

NO.

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19
Q

Is infiltrative border required for dx of leiomyosarcoma

A

NO.

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20
Q

Can CD10 and desmin reliably distinguish smooth muscle tumor from endometrial stromal neoplasm?

A

NO.

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21
Q

Gross characteristics of ovarian polycystic disease

A

rounded and slightly enlarged ovaries; bilateral disease usually
multiple small subcortical follicles, typically similar in size

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22
Q

Micro features of PCOS

A

Fibrous and thick ovarian capsule
Hyperplastic ovarian stroma (+/- luteinized)
No stigmata of prior ovulation

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23
Q

List nonneoplastic cysts found in the ovary

A
  1. Epithelial inclusion cyst
  2. Follicular cyst
  3. Corpus luteum cyst
  4. Endometriotic cyst
  5. PCOS
  6. Hyperreatico luteinalis
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24
Q

Micro-epithelial inclusion cyst

A

single layer with flat to cuboidal to columnar lining (+/- ciliated)
< 1 cm (if >1cm serous cystadenoma)

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25
Q

Micro-follicular cyst

A

2.5- 10 cm
Uniloculated with an inner layer made of granulosa cells and outer theca cells
NOTE: large solitary luteinized follicular cyst of pregnancy and puerperium may show nuclear pleomorphism and hyperchromasia

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26
Q

Micro-corpus luteum cyst

A

lined by luteinized granulosa cells with an outer layer of luteinized theca cells

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27
Q

Micro-endometriotic cyst

A

Endometrial glandular epithelium lining the cyst, often denuded in areas
Underlying endometrial stroma and/or hemosiderin laden macrophages

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28
Q

Micro-hyperreactio luteinalis

A

Multiple follicular cysts with luteinized theca and granulosa layers
Edema within the stroma and theca layer
Luteinized stroma

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29
Q

When should the term “mixed carcinoma” of the ovary be used?

A

When 2 or more distinctive subtypes of surface ep carcinoma are identified
When each distinctive subtype represents >10% of the tumor
When the relative proportions should be specified
When this may have prognostic significance

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30
Q

Why NB to carefully examine the ovarian surface?

A

Important to stage tumors limited to the ovary, as surface involvement may influenze treatment
Patients with a fam hx of ovarian and/or breast cancer may have small carcinomas centered at the ovarian surface that are potentially lethal

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31
Q

Why is it important to know the integrity of the ovary, and whether there is a rupture?

A

If the tumor has ruptured, malignant cels may have spilled into the abdominal cavity
In tumors that have an admixture of benign, borderline, and/or malignant areas, it may also be NB to know which area is ruptured

32
Q

Why is it important to classify epithelial tumors of the ovary based on histology?

A

Dif histo present at dif stages
Require dif tx/adjuvant tx
May have dif responses to CTX
Are different in prognosis and survival rate

33
Q

CAP Ovarian tumors

A 
Specimen
Procedure
LN sampling
specimen integrity
Primary tumor site
Ovarian surface involvement
tumor size
histo type
histo grade
implants
Extent of involvement of other tissues/organs
Peritoneal ascitic fluid
Pleural fluid
optional: 
- LVI
- Tx effect
- additional path findings
- ancillary studies
- clinical history
34
Q

How to gross omentum?

A

If tumor grossly identifiable, representative sections are enough.
For borderline tumors or immature teratoma with grossly apparent implants, multiple sections of the implants should be taken
Take 5-10 sections of grossly normal omentum

35
Q

What is the important of LVI in ovarian epithelial carcinomas?

A

Presence or absence of LVI does NOT impact tumor staging
Prognostic significance has NOT been demonstrated
In some cases, such as otherwise well-differentiatedd mucinous carcinoma, the presence of LVI should raise suspicious for METASTATIC disease to the ovary

36
Q

What is the most common histologic type of familial ovarian carcinoma?

A

High grade serous carcinoma

37
Q

What is the mutation a/w HGSC

A

BRCA1/2

38
Q

How should the ovaries and tubes be submitted in patients with BRCA mutations or with suspected increased risk of hereditary breast or ovarian cancer?

A

All ovarian and tubal tissue should be serially sections and submitted in toto– ovaries are sectioned at 2-3 mm
SEE-FIM tubes:
- amputate distal fimbriated ends (2cm) and section parallel to long axis of fallopian tube to maximize the amount of tubal epithelium available available for histo exam
- remainder of the ft is submitted as serial cross sections as 2-3mm intervals

39
Q

List the types of serous neoplasms of the ovary

A
  1. Serous cystadenoma/ cystadenofibroma
  2. Serous borderline tumors
  3. SBT, micropapillary variant
  4. LGSC
  5. HGSC
40
Q

Micro- serous cystadenoma

A

Cystic or papillary with broad papillae

Single layer of ciliated cuboidal to columnar lining cells (similar to ft)

41
Q

Micro-serous borderline tumors

A

Papillary branches with increased epithelial complexity
Stratified epithelial lining with tufting
Mild to moderate cytological atypia
Microinvasion: <5 mm based on WHO [others say <3mm or <10mm^2]

42
Q

Micro-SBT micropapillary variant

A 
Long, nonbranching, nonhierarchical papillae with very little stromal core
Cribiform pattern (may be present)
43
Q

Micro- LGSC

A

Papillary or micropapillary, with stromal invasion
Psamomma bodies (may be present)
Low mitotic rate
No significant nuclear pleomorphism

44
Q

Micro- HGSC

A

Heterogeneous patterns: complex papillary, solid, glandular
Significant cytological atypia, with bizarre nuclei
Markedly increased mitotic rate

45
Q

Mgmt serous cystadenoma

A

Unilateral oophorectomy, no further tx

46
Q

Mgmt borderline SBT

A

With or without noninvasive implants requires no further treatment; those with invasive implants require further staging/treatment

47
Q

Mgmt serous carcinoma

A

Full staging
Postop chemotherapy
(sometimes neoadjuvant chemo)

48
Q

Prognosis serous cystadenoma

A

100% survival

49
Q

Prognosis SBT

A

Mixed prognosis; noninvasive implants (good prognosis), invasive implants (same prognosis as LGSC)

50
Q

Prognosis LGSC

A

poor, tend to recur within a longer time period

51
Q

Prognosis HGSC

A

poor, progress more rapidly

52
Q

Significance of finding SBT in lymph nodes

A

Occurs in 1/3 of patients with SBT who had lymphadenectomy
Requires EXCLUSION of all of the following:
- endosalpingiosis involving lymph nodes
- psamommatous calcifications without epithelial cells
- nodal mesothelial hyperplasia
- metastatic LGSC involving lymph nodes
Definitive SBT in a lymph node is a/w more frequent invasive or noninvasive implants, but is NOT an independent prognostic fact

53
Q

What are the two types of peritoneal implants a/w SBTs…

A
  1. Noninvasive (including epithelial and desmoplastic)

2. Invasive implants

54
Q

Significance of peritoneal implants in SBTs

A

Current literature suggests that the survival rate is nearly 100% for SBTs with noninvasive implants
SBTs with invasive implants have increased recurrence rates and are a/w worse prognosis, much like LGSC

55
Q

Classification of endometrioid neoplasms of the ovary

A

Benign: endometrioid cystadenoma or cystadenofibroma
Borderline: endometrioid borderline tumor
Malignant: endometrioid adenocarcinoma

56
Q

Name 1 benign finding a/w endometrioid neoplasms..

A

ENDOMETRIOSIS

57
Q

Micro cystadenofibroma

A

Branching angular glands and cysts, usually resembling those of proliferative or minimally hyperplastic endometrium
+ fibrous stroma

58
Q

Micro borderline endometrioid tumor

A

Spectrum of epithelial proliferation, glandular crowding, cytological atypica, resembling hyperplastic endometrium with or without atypia
Areas of microinvasion (<5mm) or intraepithelial carcinoma (possible)

59
Q

Micro endometrioid adenocarcinoma

A

Morphologically resembles endometrioid adenocarcinoma of the endometrium
Has 2 main patterns of invasion:
1. Confluent or expansile growth pattern shows extensive glandular branching, budding, cribiform architecture and/or complex papillary proliferation
2. Destructive invasion

60
Q

How to grade endometrioid adenocarcinoma of the ovary?

A

Numerous grading systems….

  1. Silverberg grading system: based on architecture patterns, nuclear grade, mitotic activity
  2. FIGO grading system: similar to endometrioid adenocarcinoma of endometrium
  3. Binary nuclear grading system
61
Q

Molecular alterations in endometrioid adenocarcinoma of ovary

A

AIRD1A, PTEN, PIK3CA, MMR, CTTNB1, TP53

62
Q

CTTNB1 molecular alteration of endometrioid adenocarcinoma of ovary a/w….

A

Low grade tumor, often with squamous differentiation

63
Q

TP53 molecular alteration of endometrioid adenocarcinoma of ovary a/w…..

A

High grade tumors

64
Q

Prognosis of benign endometrioid tumors of ovary

A

EXCELLENT

65
Q

Prognosis of borderline endometrioid tumors of ovary

A

EXCELLENT

66
Q

Prognosis of malignant endometrioid adenocarcinoma of ovary

A

Better prognosis vs. serous carcinoma
A high proportion of endometrioid adenocarcinoma presents as stage I disease
The higher the FIGO stage, the worse the prognosis
5 year survival rate for patients with stage I tumors is >75%, compared to <10% for patients with stage IV tumors

67
Q

What is the clinical significance of synchronous ovarian and endometrial primary endometrioid adenocarcinoma vs. metastatic endometrial adenocarcinoma to the ovary

A

Synchronous primary tumors are a/w excellent prognosis when the tumor is limited to the endometrium and ovary

68
Q

Distinguishing metastatic endometrial endometrioid adenocarcinoma of the ovary from synchronous ovarian and endometrial primary adenocarcinomas….SYNCHRONOUS:

A

Myometrial invasion: superficial
LVI: absent
Endometriosis: present (+/- atypia)
Ovarian involvement: parenchymal location, solitary, unilateral
Spread of tumor to other locations: absent

69
Q

Distinguishing metastatic endometrial endometrioid adenocarcinoma of the ovary from synchronous ovarian and endometrial primary adenocarcinomas…..METASTATIC:

A

Myometrial invasion: deep
LVI: present
Endometriosis: absent
Ovarian involvement: surface, small tumor, multinodular, bilateral
Spread of tumor to other locations: present

70
Q

List the different types of clear cell neoplasms of the ovary:

A

Benign: clear cell cystadenoma or cystadenofibroma
Borderline: borderline clear cell tumor (rare)
Malignant: clear cell carcinoma

71
Q

Name 1 associated benign finding for clear cell neoplasms of ovary

A

ENDOMETRIOSIS

72
Q

Micro clear cell carcinoma of ovary

A

Patterns: solid, tubulocystic, mixed
Hobnailed cells with relatively uniform hyperchromatic nuclei, prominent nucleoli
Clear OR eosinophilic cytoplasm, with relatively low mitotic activity
Presence of hyaline globules or psamomma bodies (possible)
Hyalinized stroma

73
Q

Ddx clear cell carcinoma of ovary

A

Serous carcinoma
Endometrioid carcinoma with clear cell changes
Yolk sac tumor
Dysgerminoma
Metastatic clear cell carcinoma from an extraovarian site
Steroid cell tumors

74
Q

How to handle a cystic, mucinous ovarian mass at time of frozen section

A
  • weigh and measure
  • inspect capsule for intactness, record any surface lesions or rupture
  • ink the outer surface
  • cut and open as many cystic components as possible, if multiloculated
  • examine for solid/papillary areas and submit more than 1 block for FS, if needed
75
Q

How to handle a cystic, mucinous ovarian mass- GROSSING

A
  • sample 1 block per cm of tumors greatest dimension, and any suspicious areas (solid, papillary, necrosis) more sections may be requires
  • sample fallopian tubes
  • assess any other tissue sent with ovarian mass and sample appropriately:
    omentum/ uterus/cervix (endomyometrium with serosa)/ opposite ovary +/- ft, appendix and/or other tissue
76
Q

Morphology of ovarian mucinous borderline tumor

A
  • no invasive component or only microinvasion
  • complex and stratified mucinous lining (seromucinous or intestinal types)
  • papillary protrusions (possible)
  • mild to moderate atypia
77
Q

Top ddx of ovarian mucinous borderline tumor

A

Adenocarcinoma - primary or secondary

Gynae-Gao (1 decks)

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