M2: Ovarian Pathology Flashcards
What are the 2 categories of ovarian masses and their sub groups
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
describe follicular cysts
what do they develop into
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
describe corpus luteal cysts
how do they appear on US
a follicular cyst after ovulation
complex appearance, often containing debris due to hemorrhage
when will corpus luteal cysts resolve w/o preg?
with preg?
w/o preg: about 8 wks if large
w/ preg: 12-15 wks
what are paraovarian cysts
are they surrounded by ovarian tissue
a remnant of embryonic ducts
never surrounded by ovarian tissue (don’t change size with cycle)
do paraovarian cysts produce symptoms
not usually
describe urachal cysts
where are they located
a remnant of the development of the bladder
located midline, anterior abdo wall b/w the belly button and the bladder
describe omental cysts
where are they located
found along the omentum
Usually located higher in the pelvis or abdo
describe theca lutean cysts
multiple bilateral cysts caused by excessive hCG
… can undergo hemorrhage, rupture or torsion
theca lutean cysts are associated with which risk factors
multiple gestations molar preg choriocarcinoma hyperstimulation syndrome fertility drugs
describe PCOS syndrome
multiple cysts on the ovaries caused by unopposed estrogen w/ no surge of LH
does ovulation occur w/ PCOS
no, many immature follicles never mature or rupture
is there an increased androgen secretion from the ovarian stroma w/ PCOS
yes
another name for PCOS
stein-leventhal syndrome
symptoms of PCOS
obesity
hirsutism (abnorm. growth of hair on face and body)
infrequent menses (oligomenorrhea)
infertility
PCOS can be associated with what type of cancer
endo cancer
what is the most extreme form of PCOS called
hyperthecosis or thecosis
how is PCOS diagnosed
blood work (increased testosterone)
pelvic US are to investigate PCOS but can’t give a definitive diagnosis
how does PCOS appear on US
“string of pearls”
ovarian torsion is associated w/ what other pelvic pathology
ovarian masses…. is it rare in normal pelvises/ovaries
symptoms of ovarian torsion
acute sharp pain
what are the 2 types of ovarian torsion
incomplete
complete
describe the US appearance of incomplete ovarian torsion
large, edematous ovaries w/ multiple cysts (fluid retention due to congestion)
describe the US appearance of complete ovarian torsion
increased or decreased echotexture due to infarct or hemorrhage (depending on when the hemorrhages occurred)
how should you evaluate ovarian torsion
use colour and spectral doppler
3 types of neoplastic tumors
epithelial tumors
germ cell tumors
sec cord/stromal/connective tissue tumors
7 neoplastic epithelial tumors
serous cystadenoma serous cystadenocarcinoma mucinous cystadenoma mucinous cystadenocarcinoma endometrioid carcinoma clear cell carcinoma brenner's tumor
describe a serous cystadenoma
simple cystic tumor, common and benign
may have multiple septations and produces serum (thin fluid)
in what age group does a serous cystadenoma occur
menstruating age grp
what is a serous cystadenocarcinoma
malignant tumor
what other pathology of the abdo is serous cystadenocarcinoma associated with
ascites and enlarged para-aortic lymph nodes
whats the most common malignant ovarian cancer
accounts for what % of ovarian cancers
serous cystadenocarcinoma (60%)
describe a mucinous cystadenoma
are they large?
benign tumor
low level echoes (mucin) or can be complex…. very large
what is the risk w/ mucinous cystadenomas?
they can rupture due to large size
what is a mucinous cystadenocarcinoma
rare, malignant mass
what other pathology of the abdo is mucinous cystadenocarcinoma associated with
ascites
what is the risk w/ mucinous cystadenocarcinomas?
higher risk of rupture than mucinous cystadenomas
risk of pseudomyxoma peritonei which is a large adhesion from the mucin in the ascites
what is a endometrioid carcinoma
are they large
a mass that is usually malignant
large (10-15 cm),
in what age group is an endometrioid carcinoma most common
menopausal age grp, >60
endometrioid carcinoma is associated w/ what other pelvic cancer
endometrial cancer
describe clear cell carcinoma
malignant mass that is a variant of endometrioid carcinoma
clear cell carcinoma has an origin from which duct
mullerian duct
another name for clear cell carcinoma
mesonephroid
describe a Brenner’s tumor
what is its echotexture
benign, rare mass
solid
another name for Brenner’s tumor
transitional cell tumor
other names for paraovarian cysts
cysts of morgagni
paratubular serosal cysts
which abdo pathology is commonly seen with hyperstimulation
ascited, because the ovaries are leaking fluid into the pelvis and abdomen…. this can cause shock
why isnt it common to do aspirations of cystic ovarian masses
when the needle is removed, then the cancerous cells are introduced to the pelvis and can easily spread.
most common symptom of ovarian cancer
bloating
which 2 pathologies in the abdo and lungs are highly suspicious for ovarian cancer
pleural effusion
ascities
why are theca lutean cysts associated w/ multiple gestations
more placental tissue, so more hCG
is obesity a reliable symptom of PCOS
no
4 types of germ cell tumors
cystic teratoma
solid teratoma
dysgerminoma
endodermal sinus tumor
describe a cystic teratoma
what is its characteristic appearance
usually benign
containing fat, fluid, calcifications (teeth or hair)
tip of the iceberg appearance
in what age group are cystic teratomas more commonly seen
usually young females, but affect all age groups
what are the risks of a cystic teratoma
may undergo torsion
2% may become malignant
other names for cystic teratomas
mature teratoma
dermoid
what is a rokitansky nodule
a hyperechoic, discrete and round protrusion w/in a dermoid
describe a solid teratoma
mass that ranges from benign to highly malignant
in what age group are solid teratomas more commonly seen
young children and young women
another name for a solid teratoma
immature teratoma
describe a dysgerminoma
a rare malignant and highly radio sensitive mass
in what age group are dysgerminoma more commonly seen
young women
what is the male counterpart of a dysgerminoma
seminoma
dysgerminoma is associated w/ what other cancer
choriocarcinoma
dysgerminoma produce which hormone
hCG
what is a choriocarcinoma
the malignant form of persistent trophoblastic disease
describe an endodermal sinus tumor
a malignant, rapid growing tumor
w/ endodermal sinus tumors, which lab values will be elevated
AFP
describe the prognosis and recurrence rate of endodermal sinus tumors
poor prognosis, high recurrence
another name for endodermal sinus tumor
yolk sac tumor
sex cord or stromal tumors are made out of what type of tissue
connective tissue
3 types of sex cord/stromal tumors
granulosa cell tumor
sertoli-leydig cell tumor
fibroma and fibrosarcoma
describe granulosa cell tumors
tumor that is usually benign and produces estrogen
what are the symptoms of granulosa cell tumors
precocious puberty in children
irregular cycles in adults due estrogen
what are the risks associated w/ granulosa cell tumors
increased risk of endo cancer
describe sertoli-leydig cell tumors
usually benign but can become malignant
what hormones do sertoli-leydig cell tumors produce
androgens
symptoms of sertoli-leydig cell tumors
masculinization
another name for sertoli-leydig cell tumors
androblastoma
in what age group are sertoli-leydig cell tumors found
adolescence
describe a fibroma
benign tumor
in what age group do fibromas occur
postmenopausal
name for the malignant form of fibromas
fibrosarcoma
fibromas are associated w/ what syndrome
Meigs’ syndrome
what is Meigs’ syndrome
hydrothorax and ascites w/ an ovarian mass… once the mass is removed the syndrome resolves
describe secondary ovarian tumors
primary carcinoma of a different organ thats spread (mets) to the ovary
are secondary ovarian tumors quite common
yes
where do secondary ovarian tumors usually originate
GI or breast
what is a krukenberg’s tumor
a bilateral metastatic ovarian tumors that produce mucin (thick ascites)
which cancer is the 4th leading cause of death in women
ovarian cancer
how do most patients w/ ovarian cancer present
lots of ascites and 75% present w/ advanced disease (silent killer)
risk factors of ovarian cancer
- > 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
the risk for developing ovarian cancer is directly proportional to what
the number of years ovulating and epithelial ovarian cancer
which 2 female cancers are strongly associated w/ one another
breast and ovarian
how much of a higher risk do women who have breast cancer have of developing ovarian cancer
2X
how much of a higher risk do women who have ovarian cancer have of developing breast cancer
3-4X
the mutations of which genes increase the risk of breast an ovarian cancer
BRCA 1 and BRCA 2
the mutations of which genes MAY increase the risk of colon cancer
MSH 2 and MLH 1
which sonographic signs are more indicative of malignancy in an ovarian mass
irregular walls, thick septations, >5cm, ascites, distal mets… look for invasion of other organs, vascularity
what antibody in the blood is used to detect ovarian cancer
Ca 125… can be helpful to detect recurrence
Ca 125 is most sensitive for which types of ovarian tumors
nonmucinous tumors
where is the epithelium found in the ovary
periphery
where are the germ cells found in the ovary
cortex
where is the c-tissue found in the ovary
stroma
where is mucin usually produced in the body
intestinal lining
in general, are solid tumors usually indicative of being benign or malignant?
malignant
will dermoids/cystic teratomas have colour flow
no
how large does an ovary have to become to increase the risk of torsion
4-5cm
rokitansky nodules contain mostly which type of tissue
sebum
which masses have a higher malignant potential, masses that are more or less differentiated?
less
another name for fibroma
adenofibroma
another name for granulosa cell tumor
thecoma or theca-luteal tumor
