Lec 7 Ovary Neoplasia

Question 1

What tissues are the 3 possible sources of primary ovary neoplasms?

Answer 1

• surface epithelium –> carcinoma
• stroma and sex cords [progenitor of follicles] –> sex cord stromal tumors
• oocytes –> germ cell tumors

Question 2

What is sister mary josephs nodes?

Answer 2

metastatic implant in umbilical skin

associated wtih ovarian cancer

Question 3

Is unilateral mass in reproductive aged woman likely to be benign or malignant?

Answer 3

benign 95% of the time

Question 4

What should you think if mass < 6-8cm?

Answer 4

probbaly functional follicular cyst and will resolve spontaneously over a menstrual cycle or two

Question 5

What blood tests should you do in woman with ovarian mass?

Answer 5

• hCG to rule out pregnancy
• AFP and LDH in young girls to rule out malignant germ cell tumor
• CA-125 in postmenopausal women to rule out ovarian cancer

Question 6

What does high AFP suggest?

Answer 6

malignant cell tumor

Question 7

How do you definitively diagnose ovarian cancer?

Answer 7

aspiration of ascites fluid and pathologic diagnosis of malignant cells

Question 8

What is major type of ovarian neoplasms?

Answer 8

70% are epithelial tumors

Question 9

When does ovarian cancer usually occur?

Answer 9

after menopause

Question 10

What are some risk factors for ovarian cancer?

Answer 10

• increased ovulation
• diet [high animal fat]
• talc exposure
• genetics

Question 11

What are the 2 types of genetic ovarian cancer?

Answer 11

• Breast/Ovarian cancer syndrome associated with BRCA1 or BRCA2
• Lynch syndrome associated with mutation in mismatch repair genes

Question 12

What is risk of cancer with BRCA1?

Answer 12

50-80% lifetime risk of breast cancer; 15-45% lifetime risk epithelial ovarian cancer

Question 13

What are presenting symptoms of epithelial ovarian cancer?

Answer 13

non-specific

• bloating
• abdominal distension
• pressure effect on bladder/rectum
• constipation
• vaginal bleeding
• indigestion
• acid reflux
• weight loss
• early satiety

Question 14

What is mucinous cystadenoma?

Answer 14

multiloculate large tumor lined by single layer of mucus-secreting epithelium

Question 15

What ovarian tumor is the largest tumor in human body?

Answer 15

mucinous cystadenoma

Question 16

What is morphology of benign serous and mucinous cystadenomas?

Answer 16

smooth-lined cysts showing single cell serous or mucinous epithlium

vs carcinomas: rough-surfaced cysts with solid areas lined by stratified epithelium forming papillary structures

Question 17

What is the most common ovarian neoplasm?

Answer 17

serous cystadenoma

Question 18

What is structure of serous cystadenoma?

Answer 18

thin walled; often uni-locular; lined with fallopian-like epithelium
often bilateral

Question 19

WHat is the most common malignant ovarian epithelial tumor?

Answer 19

serous cystadenocarcinoma

Question 20

What tests/lab findings in epithelial ovarian tumors to distinguish benign from cancer?

Answer 20

• CA125 not good discriminators of benign lesions from malignant in premenopausal but good in post-menopausal

need laparotomy for diagnosis/staging

Question 21

What is papillary serous carcinoma?

Answer 21

usually bilateral
most common malignant epithelial neoplasm

microscopically = papillary structures lined by malignant epithelial cells

Question 22

Why do you have delayed diagnosis of ovarian cancer?

Answer 22

• insidious onset
• non-specific symptoms
• symptoms occur late when disease has spread
• no good screening test

Question 23

What is most likely cause of adnexal mass in young girl?

Answer 23

malignant germ cell tumor = most commonly in this category is dysgerminoma

Question 24

What serum tumor marker for dysgerminoma?

Answer 24

LDH

Question 25

What serum tumor marker for endodermal sinus tumor?

Answer 25

AFP

Question 26

What serum tumor markers for choriocarcinoma?

Answer 26

AFP and bHCG

Question 27

What serum tumor marker for epithelial ovarian cancer?

Answer 27

CA-125

Question 28

What serum tumor marker for granulosa cell tumor?

Answer 28

inhibin

Question 29

What serum tumor marker for sertoli-leydig cell tumor?

Answer 29

testosterone

Question 30

Are germ cell tumors usually benign or malignant?

Answer 30

90% benign = dermoids [teratomas] | 5 to 10% are malignant

Question 31

Who is at risk for malignant germ cell tumors?

Answer 31

kids and teens more at risk for dysgerminoma if abnormal testis + Y chromosome = true hermaphrodite or mixed gonadal dysgenesis

Question 32

Who is at risk for gonadoblastoma that progresses to dysgerminoma?

Answer 32

patients with DSD, turners; complete androgen insensitiviy; pure gonadal dysgenesis

Question 33

What is dysgerminoma?

Answer 33

malignant tumor of primordial germ cells sheet sof uniform fried egg cells large cells wtih clear cytoplasm and central nuclei cords of malignant cells = separated by fibrous stroma and interspersed with inflammatory cells

Question 34

What is prognosis of dysgerminomas?

Answer 34

good response to radiation and chemo

Question 35

How do germ cell tumors presetn?

Answer 35

ab pain and abdominal mass | may have ascites, rupture, or torsion

Question 36

What is most common benign germ cell tumor?

Answer 36

mature cystic teratoma = mature tissues from any of the germ line layers cured by cystectomy

Question 37

Who gets embryonal carcinoma?

Answer 37

rare malignant tumor; seen in patients 15 yo

Question 38

What are characteristics of embryonal carcinoma?

Answer 38

papillary or gland like structure lots of mitoses; very aggressive multinucleated cells may be present secrete hCG

Question 39

What are characteristics of yolk sac [endodermal sinus] tumor?

Answer 39

aggressive in ovaries/testes and sacrococcygeal area in young kids yellow, friable hemorrhagic solid mass AFP tumor marker have have schiller-duval bodies = invaginated papillary structure with central blood vessel

Question 40

What are characteristics of immature teratoma?

Answer 40

malignant counterpart to mature cystic teratoma immature tissue components particularly of neuroectoderm immature/embryonic-like neural tissue

Question 41

What are characteristics of choriocarcinoma?

Answer 41

usually associated wtih pregancy = malignant trasnformation of placental trophoblast cells composed of malignant trophoblasts may cause precocious puberty, uterine bleeding, amenorrhea

Question 42

What age group gets sex cord stromal tumors?

Answer 42

older women except for juvenile granulosa tumor

Question 43

What are clinical manifestations of sex cord stromal tumors in adult?

Answer 43

unilateral ovarian mass may secrete sex steroids --> estrogen or testosterone present wtih postmenopasual bleeding tend to recur locally

Question 44

What is presentation of juvenile granulosa cell turmos?

Answer 44

cured after primary removal sexual precocity, breast tenderness, apperance of pubic and axillary hari, abnormal uterine bleedign

Question 45

What are signs of fibrothecoma and sertoli-leydig tumors

Answer 45

androgenic --> oligomenorrhea, hirsuitism, temporal balding, deepening of voice, breast atrophy symptoms will regress after surgical removal

Question 46

What is most common malignant sex cord stromal tumor?

Answer 46

granulosa cell tumor

Question 47

What is most common benign sex cord stromal tumor?

Answer 47

fibrotehcoma

Question 48

What do you see in granulosa cell tumor on histology?

Answer 48

polygonal cells with deep longitudinal groove = coffee bean nucleus

Question 49

What characterizes the microfollicular variant of juvenile granulosa cell tumors?

Answer 49

cell exner bodies = cells with multiple small rounded spaces composed of radially arranged rim of granulosa cells surrounding central space wtih pink proteinaceous material

Question 50

What is a fibroma/thecoma?

Answer 50

usually rare | most ovarian tumors are mixed = fibrothecomas