L38- Ovarian Pathology II Flashcards
Endometroid Tumors:
- (1) and (2) somewhat common associations with tumor development
- (3) are the genetic associations
- (4)% bilateral + 5yr survival
1- concomitant endometrial carcinomas (not metastasis), 15-30%
2- endometriosis, 15-20%
3- PTEN, KRAS, β-catenin, MSI
4-
40% bilateral
5yr survival = 4-50%
Endometroid Tumors:
- (1) gross appearance
- (2) microscopic appearance
1- solid and cystic, small, papillae, velvety surface
2- resembles endometrial cancer = not normal endometrium (like in endometriosis)
Clear Cell Adenocarcinoma:
- (1) prevalence, aggressiveness
- (2) developmental association
- (3) cells
- (4) pathogenesis
1- uncommon, aggressive
2- endometriosis
3- clear cells
4- unclear pathogenesis
Brenner Tumor:
- cancer of (1) cells
- (benign/malignant)
- (3) gross appearance
1- transitional epithelial cells (like bladder) + dense fibrous tissue
2- usually benign (malignant may appear transitional cell carcinoma)
3- solid, yellow
Germ Cell Tumors, describe distribution
(15-20% ovarian cancers)
95% benign cystic teratomas
5% malignant (children, young adults)
-teratoma, dysgerminoma, endodermal sinus tumor (yolk sac tumor), choriocarcinoma (non-gestational)
list the types of teratomas
- mature
- immature
- monodermal: struma ovarii, carcinoid
- malignant transformation (–> SCC usually, sometime thyroid, melanoma)
Mature Teratoma:
- aka (1)
- (2) most affected group
- mostly (uni/bi)-lateral
- (4) gross appearance and content
1- dermoid cyst
2- young women, active reproductive yrs
3- 90% unilateral
4: (all 3 layers are individually apparent)
- skin, adnexa, sebaceous glands = cheesy material
- hair, teeth, bone cartilage, thyroid, fat, mature brain tissue
Immature Teratoma:
- (1) most affected group
- (2) gross appearance and content
1- young women
2: (cannot distinguish 3 germ layers)
- bulky, solid, hemorrhage, necrosis
- wide embryonic tissue variety: primitive neuroectoderm / neuroepithelium
Immature Teratoma grading and prognosis
Low Grade:
I- rare foci of immature neural tissue
-<1 LPF (low power field)
-very good prognosis
High Grade: II- 2-3 LPF III- 4 LPF -prophylactic chemotherapy -no recurrence w/in 2 yrs --> excellent cure rate
list the specialized teratomas
(aka monodermal)
Struma ovarii- hyperthyroidism
Carcinoid tumor- carcinoid syndrome
Strumal carcinoid- combination
Yolk Sac tumor = (1):
- (2) incidence
- (3) most affected group
- mostly (benign/malignant)
1- endodermal sinus tumor
2- rare
3- children, young women
4- malignant (chemotherapy has improved prognosis from quickly fatal)
Endodermal Sinus tumor, aka (1):
- (2) are excellent markers
- (3) and (4) are the main microscopic features
1- yolk sac tumor
2- AFP, AAT
3- pink cytoplasmic inclusions w/ AFP
4- Schiller Duval bodies: epithelial layers surrounding vessels resembling glomeruli
Dysgerminoma:
- (1) incidence and most affected group
- associated with h/o (2)
- similar appearance to (3)
- (benign/malignant) tumor
- local tumor is treated by (5)
1- 2% ovarian cancers, children and young women
2- gonadal dysgenesis
3- seminoma testis, medullary carcinoma breast
4- malignant, 1/3 are aggressive
5- surgery and its very chemosensitive
Dysgerminoma:
- (1) gross appearance
- (2) microscopic appearance
1- unilateral solid tumor: homogenous gray-pink, soft fleshy tumor
2- large round uniform cells, clear cytoplasm, central regular nuclei, no stroma, lymphocyte infiltration
Choriocarcinoma (non-gestational):
- (benign/malignant) + aggressiveness
- similar to (2) tumors
- (3) are good markers
1- malignant, highly fatal, early and widespread metastasis to lung, liver, viscera
2- uterine / placental choriocarcinoma, except no chemotherapy response like these tumore
3- hCG (urine, blood)
Choriocarcinoma (non-gestational):
- (1) appearance
- (2) unique feature of spread
1- hemorrhage, necrosis; pleomorphisms, giant cells, multinucleation
2- primary tumor regresses as secondaries persist
list the rare germ cell tumors
- embryonal carcinoma
- polyembryoma
- mixed germ cell tumor
Sex Cord Stromal Tumor:
- (1) derivation tissue
- (2) most affected age group
- (3) is key microscopic feature
(5% ovarian tumors)
1- ovarian stroma
2- 2/3 postmenopausal
3- granulosa + theca w/ or w/o lutinisation = Exner bodies
Sex cord stromal tumors can cause an increase in (1) allowing for (2) to possibly result. Rarely (3) is produced instead of (1) causing (4).
1- estrogen
2- feminizing features –> precocious puberty, endometrial hyperplasia / carcinoma
3- androgens
4- masculinization
Granulosa Theca Cell Tumors:
- (large/small) tumor with (un-/predictable) behavior
- (3) unique recurrence property
1/2- small, unpredictable – 5-25% malignant
3- late, 10-20 yrs after primary, indolent growth
Fibroma/Thecomas:
- (benign/malignant)
- (2) content
- (3) appearance
1- benign
2- fibroblasts (fibroma) OR plump spindle cells with fat (thecomas)
3- solid white to yellow mass
Fibroma/Thecomas:
- strange associations with (1) and (2)
- occasional association with (3)
1- ascites, 40%
2- hydrothorax on R side (Meig’s syndrome)
3- basal cell nevus syndrome
Androblastoma = (1):
- (benign/malignant)
- (3) most affected group
1- sertoli leydig cell tumor
2- benign (5% recur, metastasis)
3- any age, peaks 20-40 y/o
describe the 2 types of effects from a Sertoli Leydig Cell tumor
(androblastoma)
Defeminization: breast atrophy, amenorrhea, sterility, hair loss
Masculinization: hirsutism, male hair distribution, clitoral hypertrophy, voice changes
list the ‘other’ / rare sex cord stromal tumors
pure leydig cell tumors:
- rare, Reinke crystalloids, masculinization
- elevated 17 ketosteroid excretion –> unresponsive to cortisone suppression
gonadoblastoma: germ cell tumor + sex cord tumor
Secondary Metastatic Ovarian tumors:
- from mostly (non-/gynecological) tumors
- mostly in (older/younger) patients
- mostly (uni/bi)-lateral
1- both: colonic, appendiceal, gastric, breast
2- younger Pts
3- 70% bilateral (10% of bilateral are metastatic)
Note- primary tumor may not appear for yrs
Krukenberg Tumor:
- (1) definition
- (2) cell appearance
- (3) prevalence and prognosis
1- metastatic ovarian tumor –> 70% from gastric adenocarcinomas (instestinal, appendiceal, breast, gallbladder, biliary tract, pancreatic, bladder)
2- mucin filled –> signet ring cells
3- most common ovarian metastatic carcinoma in young women with poor prognosis
most common ovarian tumor is…..
epithelial (serous) tumor
most common ovarian malignancy is…..
serous adenocarcinoma
most common bilateral tumor is…..
serous adenocarcinoma, metastasis
Note- bilateral mucinous carcinomas are very uncommon, think metastatic first
divide the tumors based on age of onset
Young/very young:
- Benign
- germ cell (cystic teratoma, malignant teratoma)
Middle age/Postmenopausal:
- Malignant
- epithelial, granulosa, theca tumor
Note- must -correlate with clinical, gross, histological appearance for both
Pair the Ovarian Tumor with the following hormones:
- (1) excess estrogen
- (2) excess androgens
- (3) excess estrogen and androgen
1- granulosa theca (+ carcinoma of breast, uterus)
2- Sertoli Leydig tumor
3- PCOD (not tumor)
Pair the Ovarian Tumor with the following hormones:
- (1) hCG excess
- (2) thyroxine
- (3) 5-HT
1- choriocarcinoma
2- struma ovarri / dermoid cyst
3- carcinoid syndrome / dermoid cyst
list the solid ovarian tumors based on neoplastic status
Neoplastic:
- serous cystadenoma/carcinoma
- mucinous cystadenoma/carcinoma
- dermoid cyst
Non-Neoplastic:
- follicular cyst
- corpus luteum cyst
- chocolate cyst
- PCOD
list the ovarian tumors based on size
SMALL: Brenner, granulosa, endometroid
LARGE (= hemorrhagic, necrotic): malignant epithelial. malignant teratoma, germ cell
