Histo: Gynaecological pathology Pt.3

Question 1

What three types of tissue do ovaries consist of?

Answer 1

• Surface epithelium
• Ovarian stroma
• Germ cells

Question 2

List three types of primary specific ovarian tumour. Which is the most common

Answer 2

• Epithelial tumours - make up 60% of all ovarian tumours and 95% of malignant ovarian tumours
• Sex cord stromal tumours
• Germ cell tumours

Question 3

Which age groups do epithelial, germ cell, and sex cord stromal tumours predominantly affect?

Answer 3

Epithelial: 45-65 years
Germ cell: bimodal, peak at 15-21, and 65-69
Sex cord stromal: mainly postmenopausal women but can also affect children

Question 4

List some risk factors for ovarian cancer.

Answer 4

• Genetic predisposition (family history of breast/ovarian cancer)
• Nulliparity
• Early menarche
• Late menopause
• Infertility
• Endometriosis
• HRT
• Inflammation (PID)

Question 5

List some benign epithelial ovarian tumours. Which is most common?

Answer 5

• Serous cystadenoma (most common)
• Cystadenofibroma
• Mucinous cystadenoma
• Brenner tumour

Question 6

What are borderline tumours?

Answer 6

• Tumours where their biological behaviour cannot be predicted based on histology
• Low but definite malignant potential

Question 7

What is the most common malignant ovarian tumour?

Answer 7

High grade serous carcinoma (cystadenocarcinoma) (80%)

• Aggressive
• Mutated p53
• Associated with BRCA1 and BRCA2

Question 8

What proportion of ovarian cancers are familial?

Answer 8

Up to 10%

Question 9

Which heritable mutations account for 90% of familial ovarian cancers

Answer 9

BRCA1 and BRCA2

Question 10

Which 2 ovarian cancers are associated with endometrosis?

Answer 10

Endometroid carcinoma
Clear cell carcinoma

Question 11

List four types of sex cord stromal tumours.

Answer 11

• Fibroma
• Granulosa cell tumour - may produce oestrogen
• Thecoma - may produce oestrogen (rarely androgens)
• Sertoli-Leydig cell tumour - may be androgenic

Question 12

What syndrome are ovarian fibromas associated with?

Answer 12

Meigs’s sydrome
Triad of:

• Ovarian tumour
• Ascites
• Pleural effusion

(Also associated with Brenner’s tumour)

Question 13

What are the key features of germ cell tumours?

Answer 13

• Account for 20% of ovarian tumours
• 95% are benign
• Mainly occur in < 20 years

Question 14

What are the four main types of germ cell tumour?

Answer 14

• Dysgerminoma - no differentiation (female equivalent of male seminoma)
• Teratoma - from embryonic tissues
• Endodermal sinus tumour - from extraembryonic tissue (e.g. yolk sac)
• Choriocarcinoma - from trophoblastic cells which would form the placenta

Question 15

What are the key features of a mature teratoma?

Answer 15

• Most common type of germ cell tumour
• Benign
• Can be solid or cystic
• May show numerous different mature tissue types
• Teeth and hair are common

Question 16

What are the key features of an immature teratoma?

Answer 16

• Indicates presence of embryonic elements (most commonly neural tissue)
• Malignant tumour that grows rapidly, penetrates the capsule and forms adhesions
• Spreads within peritoneal cavity and metastasis to the lymph nodes, lungs, liver and other organs

Question 17

What is a mature cystic teratoma with malignant transformation?

Answer 17

When any type of mature tissue within a teratoma becomes malignant (most commonly squamous cell carcinoma)

Question 18

Name two secondary ovarian tumours.

Answer 18

Krukenberg Tumour

• Bilateral metastases composed of mucin-producing signet ring cells
• Usually of breast or gastric origin

Metastatic colorectal cancer

• 4-10% of CRC metatasise to ovaries