Ovarian and Breast Path

Question 1

What does an elevation in serum CA 125 indicate?

Answer 1

Indicates ovarian carcinoma = malignant surface epithelial tumor

Question 2

What is the mesovarium?

Answer 2

Portion of the broad ligament of the uterus that suspends the ovaries. Basically the ovaries sit posterior to the broad ligament, attached by the mesovarium

Question 3

What is the most common stage that ovarian cancer is diagnosed at?

Answer 3

Stage III (lymph node involvement)

Question 4

Are benign or malignant ovarian tumors more common?

Answer 4

Benign tumors 4x more common than malignant

Question 5

What kind of ovarian tumors arise from

(a) surface epithelium
(b) germ cells
(c) follicles or ovarian stroma

Answer 5

3 groups of ovarian tumors since surface epithelium has the metastatic potential to develop into tons of types

(a) Epithelial tumors = carcinomas/adenomas
(b) germ cell tumors
(c) sex cord tumors

Question 6

What is the most common ovarian tumor

Answer 6

75% are epithelial tumors

• 15% germ cell tumors
• 10% sex cord tumors

Question 7

What decreases the risk of ovarian cancer

Answer 7

Fewer ovulations (b/c ovulations => inclusion cysts => increased risk)

• pregnancy
• OCP
• hysterectomy

Question 8

Increases risk of ovarian cancer

Answer 8

-infertility, post menopausal HRT, personal history of breast and/or endometrial cancer, Jewish heritage

Question 9

Two genetic mutations associated w/ ovarian cancer

Answer 9

(1) BRCA1 and BRA2 mutations increases risk for breast and ovarian cancer
(2) Mutations in mismatch repair genes (HNPCC = Lynch syndrome) increases risk for colon, uterine, and ovarian cancer

Question 10

What is the most common cause of abnormal uterine bleeding in post-menopausal women

Answer 10

Atrophy of the endometrium

-ovary stops producing estrogen => endometrial lining degrades

Question 11

What is the most common malignant tumor of the female genital tract?

Answer 11

Endometrial carcinoma

-split into 2 pathogenic types

Question 12

What are cribriform glands?

Answer 12

Back to back arrangement of glands

• seen in endometrioid adenocarcinoma (which occurs in background of endometrial hyperplasia)
• basically very minimal separating the glands => glands are very close together

Question 13

Hobnail cell

Answer 13

Indicative of endometrial serous carcinoma

-nucleus in the apical portion of the cytoplasm

Question 14

What are the most common tumors of the uterus?

Answer 14

Fibroids = Leiomyomata = benign tumor of the uterine smooth muscle cells

Question 15

What is a chocolate cyst?

Answer 15

Endometriosis in the ovary- accumulates blood which gives the brown appearance

Question 16

Staghorn clusters

Answer 16

Characteristic cytologic finding of fibroadenoma (benign breast neoplasm)

Question 17

Apocrine hyperplasia

Answer 17

Feature of nonproliferative fibrocystic changes of the breast

Aprocrine hyperplasia = cysts lined by large polygonal cells w/ abundant granular eosinophilic cytoplasm

Question 18

What percent of breast cancers have metastasis at presentation?

Answer 18

1/3 of breast cancers present w/ metastases (stage IV)

Question 19

What is the most important prognostic factor for breast cancer?

Answer 19

Lymph node involvement

Question 20

Peau d’orange

Answer 20

“skin of an orange peel”

-physical exam finding of inflammatory carcinoma when there is lymphatic involvement and sometimes when there’s infection. get rapid swelling and nipple changes

Question 21

What percent of breast cancers are ER+ or ER/PR+

Answer 21

2/3

Question 22

What breast tumor “pushes out” instead of infiltrating into the tissue?

Answer 22

Medullary Carcinoma

-malignant but good prognosis (better than invasive carcinoma)

Question 23

What breast tumor has characteristic apocrine snots?

Answer 23

Tubular carcinoma

-excellent prognosis