Lecture 21: Gynecologic Pathology 3 Flashcards
What are the classification of the ovarian tumors?
- Surface epithelial
- Germ cell
- Sex-cord stromal
- Metastatic
What are the subtypes of surface epithelial ovarian tumors?
- Benign
- serous
- mucinous
- Borderline (low malignant/potential serous)
- mucinous
- Malignant
- serous
- mucinous
- endometrioid
- clear cell
Where do surface epithelial ovarian tumors arise from?
Arise from the surface epithelium of the ovary and from epithelial INCLUSION CYSTS
What are differences between serous and mucionous cytadenomas?
Mucin have intracytoplasmic Mucin (like intestinal cells)
Serous don’t have cytoplasmic
inclusions
Why the benign cystadenoma nomenclature?
Cysts are included
Adenoma = glandular but benign
How do you get inclusion cysts?
Ovulation is violent
After egg is ovulated, the surface epithelium might invaginate to give you inclusion cysts
What does carcinoma look like in contrast with benign?
Necrosis and hemorrhage
What ovarian masses are most suspicious for malignancy?
There are both solid and cystic
Completely cystic masses are mostly benign (as in the water
Balloon effect)
Completely solid masses can be benign or malignant
What are the characteristics of serous carcinoma?
- papillae, slit like spaces, solid areas
- atypical cells with many mitoses
- NECROSIS, hemorrhage
What does ovarian carcinoma mucinous type look like?
Glands and solid areas
Atypical MUCINOUS epithelial cells
What are the 4 types of malignant surface epithelial ovarian carcinomas?
- Serous
- Mucinous
- Clear cell
- Endometrioid
What do borderline tumors look like?
All solid, could be either benign or malignant
What are borderline epithelial tumors?
- clinical and pathologic features in between benign and frankly malignant tumors
- much better prognosis than carcinomas
- more epithelial proliferation and atypia than in benign tumors
- May be associated with extraovarian lesions on
i. peritoneal surfaces
ii. omentum
iii. lymph nodes - NO INVASION
You cannot tell if something is a borderline tumor until you look underneath the microscope
How do ovarian carcinomas spread?
Spread over i. PERITONEAL surfaces ii. omentum No signs or symptoms in early stage Most patients present with ADVANCED disease
What symptoms of ovarian carcinomas can present?
- bloating
- abdominal pain
- urinary
- GI symptoms
What is the most common malignant ovarian tumor?
Ovarian SEROUS carcinoma
Where do ovarian carcinomas arise in women with BRCA1 and BRCA2?
High grade serous carcinoma
AND
A significant percentage of these BRCA related tumors arise from the FALLOPIAN TUBE epithelium
What genetic signatures indicated low grade serous carcinoma?
KRAS
BRAF
What genetic signatures indicate high grade serous carcinoma?
P53
BRCA1 and BRCA2
What is a dermoid cyst?
A mature cystic teratoma
Very rare to have transformation
BENIGN
How does dermoid cyst present?
Greasy as shit with teeth
You can have any type cell within
What is a dysgerminoma?
Most common malignant germ cell tumor
But only 1% of all ovarian germ cell tumors
What is the histological characteristic of ovarian germ cell tumor?
Dermoid cyst/cystic teratoma
You can have any type of cells in there!!
What are the two types of sex cord stromal tumors?
- Granulosa cell tumor MALIGNANT
2. Thecoma and/or fibroma tumor BENIGN
What are the characteristics of granulosa cell tumor?
Mos malignant sex-cord stromal tumor
Malignant potential
What is the characteristic of thecoma-fibroma tumor?
A type of sex-cord stromal tumor
Secrete estrogen
Most BENIGN
What ovarian tumors can produce hormones?
The sex-cord stromal tumors! Granulosa cell tumor Thecoma-fibroma tumors The secrete estrogen motherfuckerr Estrogen then causes endometrial hyperplasia/carcinoma
What do follicles look like histologically? Granulosa cells?
Follicles = call-Exner bodies
Granulosa cells = grooved nuclei = coffee bean
What does thecoma look like?
Yellow
Lipid droplets
What is significant about ovarian fibroma?
NO HORMONE PRODUCTION
Associated with two rare syndromes
1. Meigs’ syndrome: ascites and pleural effusion accompanying ovarian fibroma
2. Gorlin’s syndrome: nevoid basal cell carcinoma syndrome (multiple fibromas)
What is a Krukenberg tumor?
Metastatic ovarian cancer
Comes from pancreas, colon, stomach, cervix
Solid tumor
Bilateral ovarian masses
What are the histologic characteristics of krukenburg tumor?
Signet rings
