Module 3: Ovaries: Germ Cell Tumors & Sex Cord Flashcards
Next primary ovarian tumor class are the germ cell tumors which make up about 15-20% of ovarian tumors. First is the mature cystic teratoma/Dermoid cyst. What are the symptoms and what is the gross/histology seen on 6a/6b.
Women of reproductive age
Loves the right ovary
–asymptomatic (incidental finding of calcified tooth on xray or ultrasound)
Histology 6b: 2 layers
**Top layer: Keratinized epidermis made of ectoderm with teeth and hair (Hair follicle seen in image)
**Lower Layer: sebaceous glands and sweat glands made from mesoderm
What are the complications seen with mature cystic teratoma?
Rupture
Torsion
Infertility (unknown reasons)
1% of ectoderm can become invasive squamous cell carcinoma
Immature teratomas are the next type of teratomas, what age of patients are these seen in and what is the histological appearance?
Solid Malignant — cant see hair or teeth
Prepubertal/teenage girls
Histology: presence of neruoepithelium = really aggressive
remember its solid so it can undergo torsion
Now moving on to the specialized teratoma (monodermal teratomas). There are two types, first type is Struma Ovarii. What are the symptoms ?
Women of reproductive age
- -non functional and asymptomatic
- -however can in rare cases make thyroid hormones (T3,4) and patients become hyperthyroid (weight loss, fine tremor, palpitations, sweating, and heat intolerance)
- -if this goes on for long periods the thyroid becomes atrophied due to low TSH
- -if you do a radioactive iodine uptake on these patients you will see the uptake in the ovary not the thyroid because its atrophied
What is the histological 6c image of struma ovarii?
Histology: well differentiated thyroid follicles lined by simple cuboidal epithelium with a colloid in the lumen of the follicle
The second specialized teratoma (monodermal teratoma) is Carcinoid timor. What are the symptoms?
Asymptomatic: rarely functional
IF functional: Elevated serotonin
—carcinoid syndrome: flushing, wheezing and diarrhea
–5-HIAA in the urine
If carcinoid syndrome results from a carcinoid tumor of the ovary what are the findings?
Chromogranin and synaptofysin in the blood
Neuroendocrine (Kolchisky) cells of origin
–salt and pepper chromatin
Histology: nests of well differentiated neuroendocrine cells (salt and pepper cells)
The next germ cell tumor to be discussed is a dysgerminoma. What is seen on gross and histology for this? Slide 7
Gross: Solid Soft Flesh Primary Ovarian Tumor
Histology: Fried egg appearance: nests/sheets of monomorphic cells with prominent nucleus and nucleolus with pale cytoplasm that contains glycogen (pale b/c H and E not PAS)
–scanty fibrostroma: containing non-neoplastic reactive lymphocytes
Dysgerminoma is asymptomatic and generally seen in what kind of patients?
Gonadal Dysgenesis
–Turners Syndrome
What are the tumor markers for Dysgerminoma?
LDH main tumor marker
–beta hCg if fried eggs make syncytiotrophobalsts
Dysgerminoma tumor is malignant ,what is the spread and prognosis?
Spread (same as all other malignant primary ovarian tumors): lymph nodes – iliac and para-aortic
Radio and Chemo sensitive so good prognosis
Fried egg appearance seen on histology is similar in appearance to what other tumors?
Medullary carcinoma
Seminoma Testis
The third germ cell tumor is Ovarian Choriocarcinoma (non-gestational). What do you see on histology for this tumor? Slide 8
Malignant Cytotrophoblasts --single nucleus (mono-nucleated) ---pale (toward left) Synctiotrophoblasts (toward right) --multi nucleated --basophilic
What is the tumor marker for Choriocarcinoma?
BetaHCG
What is the presentation for a choriocarcinoma?
Worst prognosis of ovarian cancers
–unilateral and solid (highly aggressive)
Young/teenage girls
–hyperemesis in the morning due to elevated betaHCG
–disruption of normal menstruation
–positive pregnancy in urine and blood
What is seen on ultrasound for a patient with a choriocarcinoma?
Nothing in uterus or fallopian tubes
–see a solid, unilateral and malignant mass on ovary