M2: Ovarian Pathology

Question 1

What are the 2 categories of ovarian masses and their sub groups

Answer 1

cystic

• simple
• bilateral and multiple

ovarian tumors (the 3 types refer to the layer of the ovary that they arise from)

• epithelial
• germ cell
• sex cord or stromal

Question 2

describe follicular cysts

what do they develop into

Answer 2

normal cysts that develop as a result of stimulation from LH and FSH which cause the ovary to mature the oocyte

develop into corpus luteum after rupture

Question 3

describe corpus luteal cysts

how do they appear on US

Answer 3

a follicular cyst after ovulation

complex appearance, often containing debris due to hemorrhage

Question 4

when will corpus luteal cysts resolve w/o preg?

with preg?

Answer 4

w/o preg: about 8 wks if large

w/ preg: 12-15 wks

Question 5

what are paraovarian cysts

are they surrounded by ovarian tissue

Answer 5

a remnant of embryonic ducts

never surrounded by ovarian tissue (don’t change size with cycle)

Question 6

do paraovarian cysts produce symptoms

Answer 6

not usually

Question 7

describe urachal cysts

where are they located

Answer 7

a remnant of the development of the bladder

located midline, anterior abdo wall b/w the belly button and the bladder

Question 8

describe omental cysts

where are they located

Answer 8

found along the omentum

Usually located higher in the pelvis or abdo

Question 9

describe theca lutean cysts

Answer 9

multiple bilateral cysts caused by excessive hCG

… can undergo hemorrhage, rupture or torsion

Question 10

theca lutean cysts are associated with which risk factors

Answer 10

multiple gestations
molar preg
choriocarcinoma
hyperstimulation syndrome
fertility drugs

Question 11

describe PCOS syndrome

Answer 11

multiple cysts on the ovaries caused by unopposed estrogen w/ no surge of LH

Question 12

does ovulation occur w/ PCOS

Answer 12

no, many immature follicles never mature or rupture

Question 13

is there an increased androgen secretion from the ovarian stroma w/ PCOS

Answer 13

yes

Question 14

another name for PCOS

Answer 14

stein-leventhal syndrome

Question 15

symptoms of PCOS

Answer 15

obesity
hirsutism (abnorm. growth of hair on face and body)
infrequent menses (oligomenorrhea)
infertility

Question 16

PCOS can be associated with what type of cancer

Answer 16

endo cancer

Question 17

what is the most extreme form of PCOS called

Answer 17

hyperthecosis or thecosis

Question 18

how is PCOS diagnosed

Answer 18

blood work (increased testosterone)

pelvic US are to investigate PCOS but can’t give a definitive diagnosis

Question 19

how does PCOS appear on US

Answer 19

“string of pearls”

Question 20

ovarian torsion is associated w/ what other pelvic pathology

Answer 20

ovarian masses…. is it rare in normal pelvises/ovaries

Question 21

symptoms of ovarian torsion

Answer 21

acute sharp pain

Question 22

what are the 2 types of ovarian torsion

Answer 22

incomplete

complete

Question 23

describe the US appearance of incomplete ovarian torsion

Answer 23

large, edematous ovaries w/ multiple cysts (fluid retention due to congestion)

Question 24

describe the US appearance of complete ovarian torsion

Answer 24

increased or decreased echotexture due to infarct or hemorrhage (depending on when the hemorrhages occurred)

Question 25

how should you evaluate ovarian torsion

Answer 25

use colour and spectral doppler

Question 26

3 types of neoplastic tumors

Answer 26

epithelial tumors germ cell tumors sec cord/stromal/connective tissue tumors

Question 27

7 neoplastic epithelial tumors

Answer 27

``` serous cystadenoma serous cystadenocarcinoma mucinous cystadenoma mucinous cystadenocarcinoma endometrioid carcinoma clear cell carcinoma brenner's tumor ```

Question 28

describe a serous cystadenoma

Answer 28

simple cystic tumor, common and benign may have multiple septations and produces serum (thin fluid)

Question 29

in what age group does a serous cystadenoma occur

Answer 29

menstruating age grp

Question 30

what is a serous cystadenocarcinoma

Answer 30

malignant tumor

Question 31

what other pathology of the abdo is serous cystadenocarcinoma associated with

Answer 31

ascites and enlarged para-aortic lymph nodes

Question 32

whats the most common malignant ovarian cancer accounts for what % of ovarian cancers

Answer 32

serous cystadenocarcinoma (60%)

Question 33

describe a mucinous cystadenoma are they large?

Answer 33

benign tumor low level echoes (mucin) or can be complex.... very large

Question 34

what is the risk w/ mucinous cystadenomas?

Answer 34

they can rupture due to large size

Question 35

what is a mucinous cystadenocarcinoma

Answer 35

rare, malignant mass

Question 36

what other pathology of the abdo is mucinous cystadenocarcinoma associated with

Answer 36

ascites

Question 37

what is the risk w/ mucinous cystadenocarcinomas?

Answer 37

higher risk of rupture than mucinous cystadenomas risk of pseudomyxoma peritonei which is a large adhesion from the mucin in the ascites

Question 38

what is a endometrioid carcinoma are they large

Answer 38

a mass that is usually malignant large (10-15 cm),

Question 39

in what age group is an endometrioid carcinoma most common

Answer 39

menopausal age grp, >60

Question 40

endometrioid carcinoma is associated w/ what other pelvic cancer

Answer 40

endometrial cancer

Question 41

describe clear cell carcinoma

Answer 41

malignant mass that is a variant of endometrioid carcinoma

Question 42

clear cell carcinoma has an origin from which duct

Answer 42

mullerian duct

Question 43

another name for clear cell carcinoma

Answer 43

mesonephroid

Question 44

describe a Brenner's tumor what is its echotexture

Answer 44

benign, rare mass solid

Question 45

another name for Brenner's tumor

Answer 45

transitional cell tumor

Question 46

other names for paraovarian cysts

Answer 46

cysts of morgagni | paratubular serosal cysts

Question 47

which abdo pathology is commonly seen with hyperstimulation

Answer 47

ascited, because the ovaries are leaking fluid into the pelvis and abdomen.... this can cause shock

Question 48

why isnt it common to do aspirations of cystic ovarian masses

Answer 48

when the needle is removed, then the cancerous cells are introduced to the pelvis and can easily spread.

Question 49

most common symptom of ovarian cancer

Answer 49

bloating

Question 50

which 2 pathologies in the abdo and lungs are highly suspicious for ovarian cancer

Answer 50

pleural effusion | ascities

Question 51

why are theca lutean cysts associated w/ multiple gestations

Answer 51

more placental tissue, so more hCG

Question 52

is obesity a reliable symptom of PCOS

Answer 52

no

Question 53

4 types of germ cell tumors

Answer 53

cystic teratoma solid teratoma dysgerminoma endodermal sinus tumor

Question 54

describe a cystic teratoma what is its characteristic appearance

Answer 54

usually benign containing fat, fluid, calcifications (teeth or hair) tip of the iceberg appearance

Question 55

in what age group are cystic teratomas more commonly seen

Answer 55

usually young females, but affect all age groups

Question 56

what are the risks of a cystic teratoma

Answer 56

may undergo torsion | 2% may become malignant

Question 57

other names for cystic teratomas

Answer 57

mature teratoma | dermoid

Question 58

what is a rokitansky nodule

Answer 58

a hyperechoic, discrete and round protrusion w/in a dermoid

Question 59

describe a solid teratoma

Answer 59

mass that ranges from benign to highly malignant

Question 60

in what age group are solid teratomas more commonly seen

Answer 60

young children and young women

Question 61

another name for a solid teratoma

Answer 61

immature teratoma

Question 62

describe a dysgerminoma

Answer 62

a rare malignant and highly radio sensitive mass

Question 63

in what age group are dysgerminoma more commonly seen

Answer 63

young women

Question 64

what is the male counterpart of a dysgerminoma

Answer 64

seminoma

Question 65

dysgerminoma is associated w/ what other cancer

Answer 65

choriocarcinoma

Question 66

dysgerminoma produce which hormone

Answer 66

hCG

Question 67

what is a choriocarcinoma

Answer 67

the malignant form of persistent trophoblastic disease

Question 68

describe an endodermal sinus tumor

Answer 68

a malignant, rapid growing tumor

Question 69

w/ endodermal sinus tumors, which lab values will be elevated

Answer 69

AFP

Question 70

describe the prognosis and recurrence rate of endodermal sinus tumors

Answer 70

poor prognosis, high recurrence

Question 71

another name for endodermal sinus tumor

Answer 71

yolk sac tumor

Question 72

sex cord or stromal tumors are made out of what type of tissue

Answer 72

connective tissue

Question 73

3 types of sex cord/stromal tumors

Answer 73

granulosa cell tumor sertoli-leydig cell tumor fibroma and fibrosarcoma

Question 74

describe granulosa cell tumors

Answer 74

tumor that is usually benign and produces estrogen

Question 75

what are the symptoms of granulosa cell tumors

Answer 75

precocious puberty in children | irregular cycles in adults due estrogen

Question 76

what are the risks associated w/ granulosa cell tumors

Answer 76

increased risk of endo cancer

Question 77

describe sertoli-leydig cell tumors

Answer 77

usually benign but can become malignant

Question 78

what hormones do sertoli-leydig cell tumors produce

Answer 78

androgens

Question 79

symptoms of sertoli-leydig cell tumors

Answer 79

masculinization

Question 80

another name for sertoli-leydig cell tumors

Answer 80

androblastoma

Question 81

in what age group are sertoli-leydig cell tumors found

Answer 81

adolescence

Question 82

describe a fibroma

Answer 82

benign tumor

Question 83

in what age group do fibromas occur

Answer 83

postmenopausal

Question 84

name for the malignant form of fibromas

Answer 84

fibrosarcoma

Question 85

fibromas are associated w/ what syndrome

Answer 85

Meigs' syndrome

Question 86

what is Meigs' syndrome

Answer 86

hydrothorax and ascites w/ an ovarian mass... once the mass is removed the syndrome resolves

Question 87

describe secondary ovarian tumors

Answer 87

primary carcinoma of a different organ thats spread (mets) to the ovary

Question 88

are secondary ovarian tumors quite common

Answer 88

yes

Question 89

where do secondary ovarian tumors usually originate

Answer 89

GI or breast

Question 90

what is a krukenberg's tumor

Answer 90

a bilateral metastatic ovarian tumors that produce mucin (thick ascites)

Question 91

which cancer is the 4th leading cause of death in women

Answer 91

ovarian cancer

Question 92

how do most patients w/ ovarian cancer present

Answer 92

lots of ascites and 75% present w/ advanced disease (silent killer)

Question 93

risk factors of ovarian cancer

Answer 93

- >50, specifically 60-70 yrs - nulliparous, low parity or delayed childbearing - early onset menses or late onset menopause - HRT over 10 yrs - fam. Hx of ovarian or breast cancer

Question 94

the risk for developing ovarian cancer is directly proportional to what

Answer 94

the number of years ovulating and epithelial ovarian cancer

Question 95

which 2 female cancers are strongly associated w/ one another

Answer 95

breast and ovarian

Question 96

how much of a higher risk do women who have breast cancer have of developing ovarian cancer

Answer 96

2X

Question 97

how much of a higher risk do women who have ovarian cancer have of developing breast cancer

Answer 97

3-4X

Question 98

the mutations of which genes increase the risk of breast an ovarian cancer

Answer 98

BRCA 1 and BRCA 2

Question 99

the mutations of which genes MAY increase the risk of colon cancer

Answer 99

MSH 2 and MLH 1

Question 100

which sonographic signs are more indicative of malignancy in an ovarian mass

Answer 100

irregular walls, thick septations, >5cm, ascites, distal mets... look for invasion of other organs, vascularity

Question 101

what antibody in the blood is used to detect ovarian cancer

Answer 101

Ca 125... can be helpful to detect recurrence

Question 102

Ca 125 is most sensitive for which types of ovarian tumors

Answer 102

nonmucinous tumors

Question 103

where is the epithelium found in the ovary

Answer 103

periphery

Question 104

where are the germ cells found in the ovary

Answer 104

cortex

Question 105

where is the c-tissue found in the ovary

Answer 105

stroma

Question 106

where is mucin usually produced in the body

Answer 106

intestinal lining

Question 107

in general, are solid tumors usually indicative of being benign or malignant?

Answer 107

malignant

Question 108

will dermoids/cystic teratomas have colour flow

Answer 108

no

Question 109

how large does an ovary have to become to increase the risk of torsion

Answer 109

4-5cm

Question 110

rokitansky nodules contain mostly which type of tissue

Answer 110

sebum

Question 111

which masses have a higher malignant potential, masses that are more or less differentiated?

Answer 111

less

Question 112

another name for fibroma

Answer 112

adenofibroma

Question 113

another name for granulosa cell tumor

Answer 113

thecoma or theca-luteal tumor