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PATHOLOGY > gynae path - ovary > Flashcards

gynae path - ovary Flashcards

1
Q

what are the classifications of ovarian cysts

A

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

endometriotic cyst - expand with constant bleeding into it

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2
Q

primary ovarian tumours

A

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

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3
Q

epidemiology of epithelial ovarian tumours

A

65% of all ovarian tumours
95% malignant ovarian tumours

50% in age 45-65

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4
Q

epidemiology of germ cell ovarian tumours

A

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

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5
Q

epidemiology of sex cord stromal ovarian tumours

A

post-menopause

some subtypes age 25-30

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6
Q

what are the epithelial ovarian tumours

A
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7
Q

features of serous epitheial ovarian tumours

A
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8
Q

features of mucinous epitheial ovarian tumours

A
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9
Q

features of endometrioid epithelial ovarian tumours

A
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10
Q

features of clear cell epithelial ovarian tumours

A
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11
Q

features of brenner epitheial ovarian tumours

A
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12
Q

features of seromucinous epitheial ovarian tumours

A
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13
Q

what are the benign epithelial tumours

A
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14
Q

what are the borderline epithelial tumours

A

serous
mucinous
endometrioid
clear cell
seromucinous
brenner

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15
Q

features of borderline epithelial ovarian tumours

A

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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16
Q

RFs for malignant epithelial ovarian cancer

A

nulliparity
infertility
early menarche
late menopause

Fhx - ovarian and breast cancers

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17
Q

epidemiology of malignant epithelial ovarian ca

A

common

difficult to dx

develops resistance to therapeutic agents

low survival

18
Q

familial syndromes -> ovarian cancer and their inheritance

A

all autosomal dominant

  • familial breast-ovarian cancer syndrome - BRCA1 and 2
  • site specific ovarian cancer - BRCA1 and 2
  • cancer family syndrome ie Lynch II
19
Q

features of having familial syndrome associated with ovarian cance r

A

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

20
Q

lynch II syndrome and ovarian cancer

A

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

21
Q

features of high grade serous ovarian ca

A

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

22
Q

why do homologous recombinatuion deficiency testing

A
  • 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
23
Q

features of low grade serous carcinoma of ovary

A

indolent
arise de novo or from borderline tumours

mutations: KRAS, BRAF

24
Q

features of mucinous ovarian ca

A

rare

morphologically similar to mucinous tumours of GI tract

KRAS mutation

25
Q

what are the secondary ovarian tumours

A

metastatic colorectal carcinoma

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

26
Q

what are the associations with clear cell ovarian ca

A
27
Q

what are the sex cord stromal tumours

A

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

28
Q

what are fibromas

A

stromal tumour
benign
no endocrine production

29
Q

what are granulosa cell tumours

A

sex cord tumour
variable behaviour
may produce oestrogen

30
Q

what are thecomas

A

stromal tumour
benign
may secrete oestrogen or rarely androgens

31
Q

what are sertoli-leidig cell tumours

A

mixed sex cord-stromal tumours
variable behaviour
may be androgenic

32
Q

molecular changes in adult type granulosa cell tumour

A

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

33
Q

molecular change in microcystic stromal tumour

A

mutation in CTNNB1

strong +ve for beta-catenin

34
Q

summarise DICER-1 syndrome

A

-> 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
35
Q

summarise Peutz-Jeghers syndrome

A

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

36
Q

sumamrise the germ cell tumours

A

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

37
Q

features of mature teratoma

A

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

38
Q

features of immature teratoma

A

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

39
Q

summarise mature cystic teratoma with malignant transformation

A

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

40
Q

what are the px factors in ovarian malignancies

A

stage
type
grade
size of residual disease
tumour response to therapy

41
Q

mutations associated with type of epithelial ovarian cancer

A

PATHOLOGY (94 decks)

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