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DERS (reproductive) > L38- Ovarian Pathology II > Flashcards

L38- Ovarian Pathology II Flashcards

1
Q

Endometroid Tumors:

  • (1) and (2) somewhat common associations with tumor development
  • (3) are the genetic associations
  • (4)% bilateral + 5yr survival
A

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%

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2
Q

Endometroid Tumors:

  • (1) gross appearance
  • (2) microscopic appearance
A

1- solid and cystic, small, papillae, velvety surface

2- resembles endometrial cancer = not normal endometrium (like in endometriosis)

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3
Q

Clear Cell Adenocarcinoma:

  • (1) prevalence, aggressiveness
  • (2) developmental association
  • (3) cells
  • (4) pathogenesis
A

1- uncommon, aggressive
2- endometriosis
3- clear cells
4- unclear pathogenesis

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4
Q

Brenner Tumor:

  • cancer of (1) cells
  • (benign/malignant)
  • (3) gross appearance
A

1- transitional epithelial cells (like bladder) + dense fibrous tissue

2- usually benign (malignant may appear transitional cell carcinoma)

3- solid, yellow

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5
Q

Germ Cell Tumors, describe distribution

A

(15-20% ovarian cancers)
95% benign cystic teratomas

5% malignant (children, young adults)

-teratoma, dysgerminoma, endodermal sinus tumor (yolk sac tumor), choriocarcinoma (non-gestational)

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6
Q

list the types of teratomas

A
  • mature
  • immature
  • monodermal: struma ovarii, carcinoid
  • malignant transformation (–> SCC usually, sometime thyroid, melanoma)
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7
Q

Mature Teratoma:

  • aka (1)
  • (2) most affected group
  • mostly (uni/bi)-lateral
  • (4) gross appearance and content
A

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

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8
Q

Immature Teratoma:

  • (1) most affected group
  • (2) gross appearance and content
A

1- young women

2: (cannot distinguish 3 germ layers)
- bulky, solid, hemorrhage, necrosis
- wide embryonic tissue variety: primitive neuroectoderm / neuroepithelium

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9
Q

Immature Teratoma grading and prognosis

A

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
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10
Q

list the specialized teratomas

A

(aka monodermal)
Struma ovarii- hyperthyroidism

Carcinoid tumor- carcinoid syndrome

Strumal carcinoid- combination

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11
Q

Yolk Sac tumor = (1):

  • (2) incidence
  • (3) most affected group
  • mostly (benign/malignant)
A

1- endodermal sinus tumor
2- rare
3- children, young women
4- malignant (chemotherapy has improved prognosis from quickly fatal)

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12
Q

Endodermal Sinus tumor, aka (1):

  • (2) are excellent markers
  • (3) and (4) are the main microscopic features
A

1- yolk sac tumor
2- AFP, AAT
3- pink cytoplasmic inclusions w/ AFP
4- Schiller Duval bodies: epithelial layers surrounding vessels resembling glomeruli

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13
Q

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)
A

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

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14
Q

Dysgerminoma:

  • (1) gross appearance
  • (2) microscopic appearance
A

1- unilateral solid tumor: homogenous gray-pink, soft fleshy tumor

2- large round uniform cells, clear cytoplasm, central regular nuclei, no stroma, lymphocyte infiltration

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15
Q

Choriocarcinoma (non-gestational):

  • (benign/malignant) + aggressiveness
  • similar to (2) tumors
  • (3) are good markers
A

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)

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16
Q

Choriocarcinoma (non-gestational):

  • (1) appearance
  • (2) unique feature of spread
A

1- hemorrhage, necrosis; pleomorphisms, giant cells, multinucleation

2- primary tumor regresses as secondaries persist

17
Q

list the rare germ cell tumors

A
  • embryonal carcinoma
  • polyembryoma
  • mixed germ cell tumor
18
Q

Sex Cord Stromal Tumor:

  • (1) derivation tissue
  • (2) most affected age group
  • (3) is key microscopic feature
A

(5% ovarian tumors)
1- ovarian stroma
2- 2/3 postmenopausal
3- granulosa + theca w/ or w/o lutinisation = Exner bodies

19
Q

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).

A

1- estrogen
2- feminizing features –> precocious puberty, endometrial hyperplasia / carcinoma

3- androgens
4- masculinization

20
Q

Granulosa Theca Cell Tumors:

  • (large/small) tumor with (un-/predictable) behavior
  • (3) unique recurrence property
A

1/2- small, unpredictable – 5-25% malignant

3- late, 10-20 yrs after primary, indolent growth

21
Q

Fibroma/Thecomas:

  • (benign/malignant)
  • (2) content
  • (3) appearance
A

1- benign

2- fibroblasts (fibroma) OR plump spindle cells with fat (thecomas)

3- solid white to yellow mass

22
Q

Fibroma/Thecomas:

  • strange associations with (1) and (2)
  • occasional association with (3)
A

1- ascites, 40%

2- hydrothorax on R side (Meig’s syndrome)

3- basal cell nevus syndrome

23
Q

Androblastoma = (1):

  • (benign/malignant)
  • (3) most affected group
A

1- sertoli leydig cell tumor

2- benign (5% recur, metastasis)

3- any age, peaks 20-40 y/o

24
Q

describe the 2 types of effects from a Sertoli Leydig Cell tumor

A

(androblastoma)
Defeminization: breast atrophy, amenorrhea, sterility, hair loss

Masculinization: hirsutism, male hair distribution, clitoral hypertrophy, voice changes

25
Q

list the ‘other’ / rare sex cord stromal tumors

A

pure leydig cell tumors:

  • rare, Reinke crystalloids, masculinization
  • elevated 17 ketosteroid excretion –> unresponsive to cortisone suppression

gonadoblastoma: germ cell tumor + sex cord tumor

26
Q

Secondary Metastatic Ovarian tumors:

  • from mostly (non-/gynecological) tumors
  • mostly in (older/younger) patients
  • mostly (uni/bi)-lateral
A

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

27
Q

Krukenberg Tumor:

  • (1) definition
  • (2) cell appearance
  • (3) prevalence and prognosis
A

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

28
Q

most common ovarian tumor is…..

A

epithelial (serous) tumor

29
Q

most common ovarian malignancy is…..

A

serous adenocarcinoma

30
Q

most common bilateral tumor is…..

A

serous adenocarcinoma, metastasis

Note- bilateral mucinous carcinomas are very uncommon, think metastatic first

31
Q

divide the tumors based on age of onset

A

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

32
Q

Pair the Ovarian Tumor with the following hormones:

  • (1) excess estrogen
  • (2) excess androgens
  • (3) excess estrogen and androgen
A

1- granulosa theca (+ carcinoma of breast, uterus)

2- Sertoli Leydig tumor

3- PCOD (not tumor)

33
Q

Pair the Ovarian Tumor with the following hormones:

  • (1) hCG excess
  • (2) thyroxine
  • (3) 5-HT
A

1- choriocarcinoma

2- struma ovarri / dermoid cyst

3- carcinoid syndrome / dermoid cyst

34
Q

list the solid ovarian tumors based on neoplastic status

A

Neoplastic:

  • serous cystadenoma/carcinoma
  • mucinous cystadenoma/carcinoma
  • dermoid cyst

Non-Neoplastic:

  • follicular cyst
  • corpus luteum cyst
  • chocolate cyst
  • PCOD
35
Q

list the ovarian tumors based on size

A

SMALL: Brenner, granulosa, endometroid

LARGE (= hemorrhagic, necrotic): malignant epithelial. malignant teratoma, germ cell

DERS (reproductive) (14 decks)

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