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Reproductive > Lec 7 Ovary Neoplasia > Flashcards

Lec 7 Ovary Neoplasia Flashcards

1
Q

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

A
  • surface epithelium –> carcinoma
  • stroma and sex cords [progenitor of follicles] –> sex cord stromal tumors
  • oocytes –> germ cell tumors
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2
Q

What is sister mary josephs nodes?

A

metastatic implant in umbilical skin

associated wtih ovarian cancer

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3
Q

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

A

benign 95% of the time

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4
Q

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

A

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

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5
Q

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

A
  • 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
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6
Q

What does high AFP suggest?

A

malignant cell tumor

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7
Q

How do you definitively diagnose ovarian cancer?

A

aspiration of ascites fluid and pathologic diagnosis of malignant cells

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8
Q

What is major type of ovarian neoplasms?

A

70% are epithelial tumors

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9
Q

When does ovarian cancer usually occur?

A

after menopause

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10
Q

What are some risk factors for ovarian cancer?

A
  • increased ovulation
  • diet [high animal fat]
  • talc exposure
  • genetics
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11
Q

What are the 2 types of genetic ovarian cancer?

A
  • Breast/Ovarian cancer syndrome associated with BRCA1 or BRCA2
  • Lynch syndrome associated with mutation in mismatch repair genes
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12
Q

What is risk of cancer with BRCA1?

A

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

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13
Q

What are presenting symptoms of epithelial ovarian cancer?

A

non-specific

  • bloating
  • abdominal distension
  • pressure effect on bladder/rectum
  • constipation
  • vaginal bleeding
  • indigestion
  • acid reflux
  • weight loss
  • early satiety
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14
Q

What is mucinous cystadenoma?

A

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

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15
Q

What ovarian tumor is the largest tumor in human body?

A

mucinous cystadenoma

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16
Q

What is morphology of benign serous and mucinous cystadenomas?

A

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

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17
Q

What is the most common ovarian neoplasm?

A

serous cystadenoma

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18
Q

What is structure of serous cystadenoma?

A

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

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19
Q

WHat is the most common malignant ovarian epithelial tumor?

A

serous cystadenocarcinoma

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20
Q

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

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

need laparotomy for diagnosis/staging

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21
Q

What is papillary serous carcinoma?

A

usually bilateral
most common malignant epithelial neoplasm

microscopically = papillary structures lined by malignant epithelial cells

22
Q

Why do you have delayed diagnosis of ovarian cancer?

A
  • insidious onset
  • non-specific symptoms
  • symptoms occur late when disease has spread
  • no good screening test
23
Q

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

A

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

24
Q

What serum tumor marker for dysgerminoma?

A

LDH

25
Q

What serum tumor marker for endodermal sinus tumor?

A

AFP

26
Q

What serum tumor markers for choriocarcinoma?

A

AFP and bHCG

27
Q

What serum tumor marker for epithelial ovarian cancer?

A

CA-125

28
Q

What serum tumor marker for granulosa cell tumor?

A

inhibin

29
Q

What serum tumor marker for sertoli-leydig cell tumor?

A

testosterone

30
Q

Are germ cell tumors usually benign or malignant?

A

90% benign = dermoids [teratomas]

5 to 10% are malignant

31
Q

Who is at risk for malignant germ cell tumors?

A

kids and teens

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

32
Q

Who is at risk for gonadoblastoma that progresses to dysgerminoma?

A

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

33
Q

What is dysgerminoma?

A

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

34
Q

What is prognosis of dysgerminomas?

A

good response to radiation and chemo

35
Q

How do germ cell tumors presetn?

A

ab pain and abdominal mass

may have ascites, rupture, or torsion

36
Q

What is most common benign germ cell tumor?

A

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

cured by cystectomy

37
Q

Who gets embryonal carcinoma?

A

rare malignant tumor; seen in patients 15 yo

38
Q

What are characteristics of embryonal carcinoma?

A

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

39
Q

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

A

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

40
Q

What are characteristics of immature teratoma?

A

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

41
Q

What are characteristics of choriocarcinoma?

A

usually associated wtih pregancy = malignant trasnformation of placental trophoblast cells
composed of malignant trophoblasts

may cause precocious puberty, uterine bleeding, amenorrhea

42
Q

What age group gets sex cord stromal tumors?

A

older women except for juvenile granulosa tumor

43
Q

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

A

unilateral ovarian mass
may secrete sex steroids –> estrogen or testosterone

present wtih postmenopasual bleeding

tend to recur locally

44
Q

What is presentation of juvenile granulosa cell turmos?

A

cured after primary removal

sexual precocity, breast tenderness, apperance of pubic and axillary hari, abnormal uterine bleedign

45
Q

What are signs of fibrothecoma and sertoli-leydig tumors

A

androgenic –> oligomenorrhea, hirsuitism, temporal balding, deepening of voice, breast atrophy

symptoms will regress after surgical removal

46
Q

What is most common malignant sex cord stromal tumor?

A

granulosa cell tumor

47
Q

What is most common benign sex cord stromal tumor?

A

fibrotehcoma

48
Q

What do you see in granulosa cell tumor on histology?

A

polygonal cells with deep longitudinal groove = coffee bean nucleus

49
Q

What characterizes the microfollicular variant of juvenile granulosa cell tumors?

A

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

50
Q

What is a fibroma/thecoma?

A

usually rare

most ovarian tumors are mixed = fibrothecomas

Reproductive (14 decks)

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