gynae path - ovary Flashcards by Emily Southall

what are the classifications of ovarian cysts

non-neoplastic
* follicular
* luteal
* PCOS - anovulation, hirsuitism, virilism, obesity, common

endometriotic cyst - expand with constant bleeding into it

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primary ovarian tumours

epithelial - surface epithelium
sex-cord stomal - granulosa and stromal
germ cell - ovum
miscellaneous

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epidemiology of epithelial ovarian tumours

65% of all ovarian tumours
95% malignant ovarian tumours

50% in age 45-65

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epidemiology of germ cell ovarian tumours

bimodal distribution
* 15-21yrs
* 65-69yrs

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epidemiology of sex cord stromal ovarian tumours

post-menopause

some subtypes age 25-30

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what are the epithelial ovarian tumours

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features of serous epitheial ovarian tumours

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features of mucinous epitheial ovarian tumours

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features of endometrioid epithelial ovarian tumours

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features of clear cell epithelial ovarian tumours

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features of brenner epitheial ovarian tumours

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features of seromucinous epitheial ovarian tumours

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what are the benign epithelial tumours

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what are the borderline epithelial tumours

serous
mucinous
endometrioid
clear cell
seromucinous
brenner

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features of borderline epithelial ovarian tumours

tumours where the behaviour cannot be predicted on histological grounds
very low but definite met potential
morphologically similar tumours may present differently
respect basement membrane - not invasive cancer

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RFs for malignant epithelial ovarian cancer

nulliparity
infertility
early menarche
late menopause

Fhx - ovarian and breast cancers

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epidemiology of malignant epithelial ovarian ca

common

difficult to dx

develops resistance to therapeutic agents

low survival

familial syndromes -> ovarian cancer and their inheritance

all autosomal dominant

familial breast-ovarian cancer syndrome - BRCA1 and 2
site specific ovarian cancer - BRCA1 and 2
cancer family syndrome ie Lynch II

features of having familial syndrome associated with ovarian cance r

cancer much earlier
increased risk of cancer
>90% are serous: ovarian, peritoneal, fallopian tube

lynch II syndrome and ovarian cancer

responsible for 3% of ovarian ca

mainly endometrioid and clear cells
normally serous is most common so test for lynch if have endometrioid or clear cell

features of high grade serous ovarian ca

most are malignant

agressive

p53 mutation

BRCA1 or 2 abnormalities - genes encode proteins for DNA repair

cells can originate from epithelial cells of ovary or the fallopian tube

why do homologous recombinatuion deficiency testing

identify hereditory cases
BRCA2 is better than 1 or BRCA-negative in high grade serous ca
BRCA has influence on response to chemo
benefit from targetted PARP inhibitors

features of low grade serous carcinoma of ovary

indolent
arise de novo or from borderline tumours

mutations: KRAS, BRAF

features of mucinous ovarian ca

rare

morphologically similar to mucinous tumours of GI tract

KRAS mutation

what are the secondary ovarian tumours

metastatic colorectal carcinoma krukenberg tumours * bilateral mets of mucin producing signet ring cells * gastric/breast origin

what are the associations with clear cell ovarian ca

what are the sex cord stromal tumours

pure stromal * fibroma * thecoma * microcystic stromal tumour pure sex cord * adult type and juvelile granulosa cell tumour mixed sex cord-stromal tumours * sertoli leydig cell tumour

what are fibromas

stromal tumour benign no endocrine production

what are granulosa cell tumours

sex cord tumour variable behaviour may produce oestrogen

what are thecomas

stromal tumour benign may secrete oestrogen or rarely androgens

what are sertoli-leidig cell tumours

mixed sex cord-stromal tumours variable behaviour may be androgenic

molecular changes in adult type granulosa cell tumour

somatic mutation of **Forkhead transcription factor FOXL2** transcription factor that regulates cell proliferation and apoptosis

molecular change in microcystic stromal tumour

mutation in CTNNB1 strong +ve for beta-catenin

summarise DICER-1 syndrome

-> hereditory predisposition to sex-cord stromal tumours * germline mutation in DICER1 gene - encodes RNAse III endoribonuclease * familial multinodular goitre with sertoli/leydig cell tumour * tumour susceptability includes pleuropulonry blastoma in childhood * found in 60% of seroli-leydig cell tumours

summarise Peutz-Jeghers syndrome

germline mutation in STK11 sex cord stromal tumour with annular tubules indolent

sumamrise the germ cell tumours

20% of ovarian tumours 95% are benign mainly in 1st or 2nd decade

features of mature teratoma

benign solid/cystic may show many lines of differentiation but all mature adult type tissues teeth and hair v common

features of immature teratoma

presence of **embryonic elements** neural tissue malignant neoplasm quick growing **penetrates the capsule** forms adhesions to surrounding structures **spreads in peritoneal cavity** by implantation met to -> **LN, lung, liver**, others grading system according to primitive elements

summarise mature cystic teratoma with malignant transformation

**malignancy of any of the components** rare usually post-menopausal mostly squamous cell ca also * carcinoid * thyroid * basal cell ca * malignant melanoma * intestinal adenocarcinoma * leiomyosarcoma * chondrosarcoma * angiosarcoma

what are the px factors in ovarian malignancies

stage type grade size of residual disease tumour response to therapy

mutations associated with type of epithelial ovarian cancer