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OBG > OBG: Neoplasms > Flashcards

OBG: Neoplasms Flashcards

1
Q

Risk factors for Ovarian cancer

A

Old age 65+
Endometriosis

BRCA1/BRCA2 mutation
HNPCC syndrome (Lynch syndrome)
Family history

Elevated number of lifetime ovulations:
Infertility/low number of pregnancies
Early menarche
late menopause

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2
Q

Ovarian cancer Protective factors

A

Bilateral salpingo-oophorectomy (BSO)
Breastfeeding
Oral contraceptives
Parity

B-BOP

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3
Q

CA-125 is used as a tumor marker for epithelial ovarian cancer but can also be elevated in (3)

A

endometriosis
cirrhosis
malignancies (ex: uterine leiomyoma)

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4
Q

___ should be the first step in evaluating women with suspicious ovarian masses.

A

Pelvic ultrasonography

TVUS

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5
Q

___ ovarian tumor marker is CA-125

Premenopausal women: Elevated CA-125 points to a ___ process.

Postmenopausal women: Elevated CA-125 should raise concern for ___.

A

Epithelial

benign

malignancy

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6
Q

Sex cord-stromal tumors

Granulosa cell tumor marker is ___

A

inhibin

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7
Q

Dysgerminoma Germ cell tumor markers (2)

A

LDH

β-hCG

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8
Q

Yolk sac tumor Germ cell tumor marker (1)

A

AFP

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9
Q

Immature teratoma Germ cell tumor markers (3)

A

CA-125
AFP
LDH

(CAL is immature)

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10
Q

Choriocarcinoma Germ cell tumor marker (1)

A

β-hCG (super elevated)

Also elevated in GTD, but not as much)

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11
Q

Embryonal carcinoma Germ cell tumor markers (2)

A

AFP
β-hCG

(testicular cancer mostly in young and middle-aged men)

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12
Q

___ is absolutely contraindicated in ovarian tumors because it may directly spread tumor cells to the peritoneum!

A

Fine needle aspiration

*Surgical evaluation
Recommended method for diagnosing ovarian cancer

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13
Q

Ovarian mass workup (3)

A
  1. Pelvic U/S
  2. Tumor markers
  3. Laparotomy/Laparoscopy

(NO Biopsy or fine needle aspiration b/c SEEDING risk)

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14
Q

Treatment of ovarian cancer (2):

A

Surgical Resection

Chemotherapy (Carboplatin/paclitaxel)

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15
Q

Ovarian cancer screening/prevention (3):

A

ONLY for high-risk individuals:

1st) do a Familial risk assessment
2nd) Genetic counseling/testing for (BRCA1, BRCA2, or Lynch)
3rd) If + genetic screen: consider ppx bilateral salpingo-oophorectomy (rrBSO) if no wish to conceive.

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16
Q

Pregnancy luteoma

Rare, benign tumors 2/2 elevated hormone levels during pregnancy

May be Asymptomatic or cause _____

Diagnostics:
Pelvic u/s → SOLID adnexal mass
(Unilateral or Bilateral?) _____

Treatment:
________

A

Androgen hypersecretion and manifest with virilization of the mother or the fetus.

Can be unilateral or bilateral

Observation
Most regress spontaneously post partum.

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17
Q

Types of epithelial ovarian tumors (7)

A 
serous cystadenoma (benign)
mucinous cystadenoma (benign)
Brenner tumor (benign)
Serous Cystadenocarcinoma (Malignant)
Mucinous Cystadenocarcinoma (Malignant)
Endometrioid carcinoma (Malignant)
Endometriosis Clear cell tumors (Malignant)
18
Q

Cystadenocarcinomas are often (uni or bilateral?)

A

bilateral

19
Q

Psammoma bodies are a typical feature in these 2 ovarian epithelial cell tumors

A 
serous cystadenoma (benign)
Serous Cystadenocarcinoma (Malignant)
20
Q

Endometriosis-associated tumors are filled with chocolate-colored fluid (2)

A

Endometrioma

Clear cell tumors

21
Q

On U/S
1. Unilocular cystic mass & Absent flow on Doppler

  1. Multilocular cystic mass & Large
A
  1. serous cystadenoma (benign)

2. mucinous cystadenoma (benign)

22
Q

Epithelial ovarian Tumor with:

mixed cystic/solid components and heterogeneous texture

May contain papillary projections and/or thick septations

A

Serous Cystadenocarcinoma (Malignant)

23
Q

Types of ovarian germ cell tumors (6)

A

Teratomas
-Dermoid cysts [mature cystic teratoma] (Benign)
-Struma ovarii [mature teratoma] (Benign)
-Immature teratoma (Malignant)
Yolk sac tumor [endodermal sinus tumor] (Malignant)
Dysgerminoma (Malignant)
Nongestational choriocarcinoma (Malignant)

24
Q

Types of sex cord-stromal tumors of the ovary (4)

A

Ovarian fibroma (Benign)
Theca cell tumor [Thecoma] (Benign)
Sertoli-Leydig cell tumor (Benign, usually)
Granulosa cell tumor (Malignant)

25
Q

Most common type of sex cord-stromal malignancy

∼ 90%

A

Granulosa cell tumor (Malignant)

Avg age: 50-55

26
Q

Clusters of spindle-shaped cells (fibroblasts) on histology of this tumor

A

Ovarian fibroma (Benign)

27
Q

Presents with lower abdominal discomfort and/or a pulling-sensation in the inguinal area

May be associated with Meigs syndrome!

A

Ovarian fibroma (Benign)

surgical removal of the tumor leads to complete resolution of symptoms.

28
Q

Which sex cord tumor presents with abnormal post-menpausal bleeding due to estrogen production.

Ultrasound appearances include:
Well-defined Hypoechoic, solid mass with clear margins
&
Visible endometrial thickening

A

Theca cell tumor [Thecoma] (Benign)

***Mass can be Echogenic or Anechoic too though

29
Q

Which sex cord tumor is associated with increased risk of endometrial cancer?

A

Granulosa cell tumor (Malignant)

30
Q

Most common of all germ cell tumors (90% of all cases)
&
Most common ovarian tumor in women < 30 years

A

Dermoid cysts [mature cystic teratoma] (Benign)

31
Q

Germ cell tumor with peak age: women < 20 years of age

A

Immature Teratoma (Malignant)

32
Q

Most common malignant ovarian germ cell tumor in adolescents and young women (but not most common over all)

A

Dysgerminoma (Malignant)

33
Q 
Germ cell tumor on u/s with:
Heterogeneous/ Hyperechoic mass
Echogenic shadowing
Absent internal vascularity 
and/or 
fluid-fluid levels
A

Dermoid cysts [mature cystic teratoma] (Benign)

34
Q

Germ cell tumor on u/s with:
Large tumor with a solid component containing smaller, fluid-filled cysts
and/or
Small areas of calcification

A

Immature Teratoma (Malignant)

35
Q

Germ cell tumor on u/s with:

Large, solid, well- vascularized, multilobulated tumor that is well-defined relative to its surroundings

A

Dysgerminoma (Malignant)

36
Q

Germ cell tumor Macroscopic appearance:
yellow, friable mass
Schiller-Duval bodies (resemble glomeruli)

A

Yolk sac tumor [endodermal sinus tumor] (Malignant)

37
Q

Germ cell tumor with:

Cytotrophoblasts/syncytiotrophoblasts without chorionic villi

A

Nongestational Choriocarcinoma (Malignant)

38
Q 
Germ cell tumor with:
 somatic tissue (hair, teeth, sebaceous glands) from any of the three embryonic germ layers.
A

Dermoid cysts [mature cystic teratoma] (Benign)

39
Q

Germ cell tumor composed of immature neuroectodermal tissue

A

Immature teratoma (Malignant)

40
Q

Fibroids (Leiomyomas)

Treatment options that preserve fertility (4)

Treatment options that will affect fertility (2)

A

First-line:
1. OCPs & progestin-only pill

Second-line:

  1. GnRH agonists*: (leuprolide, goserelin, nafarelin) reduce tumor size and vascularization
    * Optimal tx prior to surgery for no more than 6m
  2. Androgenic agonists: (danazol): suppress growth
  3. Myomectomy: surgical removal of fibroids
    - ———
  4. Uterine artery embolization
  5. Hysterectomy

OBG (8 decks)

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