Malignancy: Ovary Flashcards
Struma Ovarii
Type of teratoma. Thyroid tissue. Unusual forms: cystic, malignant (PTC).
Heterologous Malignant Mixed Mullerian Tumor
Both malignant epithelial AND mesenchymal elements (e.g. cartilage; has to not be native to the uterine corpus; indicating heterologous differentiation)
Homologous Malignant Mixed Mullerian Tumor
Also both malignant & epithelial; mesenchymal elements (but that would normally arise in the uterus, such smooth muscle or endometrial stroma)
Granulosa cell tumor
Many patterns: diffuse, microfollicular, insular, trabecular
Microfollicular: Call-Exner bodies (contains eosinophilic debris lined by grooved nuclei)
Tumor secretes estrogen (which makes it look yellow on gross exam)
Strongly & diffusely positive for inhibin
Serous neoplasm of low malignant potential/borderline tumor VS. invasive serous carcinoma
Lack of stromal invasion in first
Micropapillary type of SBT may have poorer prognosis than the typical type
Metastasis TO the ovary
Signet ring: usually GI (colon or stomach); most common to mets to ovary (often bilateral; called Krukenberg tumors)
Lobular breast carcinoma can also resemble the above.
Ovarian neoplasms in adolescents
Most are of germ cell origin (62% of ovarian malignancies)
Epithelial tumors only 20%, more likely benign
<1-2% of all neoplasms in girls younger than 16 y.o.
60-70% of all GYN neoplasms in childhood and adolescence tho
Malignant in 29-55% of cases
Ovarian neoplasms in adults
Epithelial neoplasms are most common (90% of ovarian malignancies)
Sex cord-stromal tumors and germ cell tumors are 5%
Germ Cell tumors: general
most common malignancy in first 2 decades of life
Most common benign: mature teratoma
Most common malignant: dysgerminoma
Most common sex cord-stromal tumor in pediatrics
juvenile granulosa cell tumor
75% secrete estrogen > leading to sexual pseudoprecocity
5 year survival: 92%
Treatment: unilateral salpingo-oophorectomy
Immature teratoma
Graded based on amount of immature neuroepithelium (neural tubules & immature rossettes) -
Grade 1: < low-power field (4X) on worst slide
Grade 2: no more than 3 low power fields on worst slide
Grade 3: >3 low power fields on any slide
Often associated with yolk-sac tumor (diagnosis then changed to mixed germ cell tumor)
Tumors that produce estrogen
Granulosa cell tumor
Fibrothecoma
Steroid cell tumors
NOT: luteomas (see in pregnant women)
Endometrioid adenocarcinoma of the ovary
Similar histology to counterpart in uterus
Microglandular pattern may mimic an adult granulosa cell tumor
Dysgerminoma
+ PLAP (which is pos in all germ cells tumors)
Identical histology to testicular seminoma
Epithelioid granulomas common
Gonadoblastoma is a known precursor lesion (esp in intersex cases)
Show both isochromosome 12p and polysomy of chromosome 12p
Pulmonary-type small cell carcinoma
Primary to ovary
Extremely rare, approx 20 cases only in literature
Cells are small to medium sized, with finely stippled chromatin; molding; pyknosis and necrosis
Commonly associated with endometrial adenocarcinoma
Aggressive, poor prognosis
Hypercalcemic-type small cell carcinoma
positive for WT-1
What genetic abnormality associated with mixed germ cell tumors with teratomatous component?
Isochromosome 12p
In contrast, pure teratoma (mature and immature) do do not demonstrate that
Embryonal carcinoma markers?
CD30 is major marker used in DDx
AFP: also positive in yolk sac tumors
OCT-4: also positive in dysgerminoma
D2-40: can be positive; usually positive in seminoma/dysgerminoma
Negative for CD117 (which is usually positive dysgerminoma)
Yolk sac tumor
Schiller-Duval bodies
Variants: endodermal sinus, hepatoid, reticular (most common), polyvesicular vitelline (rare)
