Ovarian and Fallopian Tubr Tumors Flashcards by Jamaira Belmes

MCC of gynecologic DEATH

Ovarian carcinoma

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65% of all ovarian tumors and 95 % of all ovarian cancers are

EPITHELIAL TUMORS

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5% to 10% of ovarian cancer is metastatic from other primary tumors in the body

GIT - Krukenberg tumor
breast
endometrium

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WHO Classification - Ovarian Cancer

EPITHELIAL (65%)

Serous
Mucinous
Endometrioid
Clear cell (Mesonephroid)
Brenner)

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WHO Classification - Ovarian Cancer

SEX CORD < 0.01

Granulosa cell
Thecoma-fibroma
Sertoli-Leydig

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WHO Classification - Ovarian Cancer

GERM CELL (6%)

Primitive (Dysgerminoma, Yolk Sac)

Teratoma

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WHO Classification - Ovarian Cancer

GERM CELL SEX CORD (<0.01)

Gonadoblastoma

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WHO Classification - Ovarian Cancer

MISCELLANEOUS

Tumors of rete ovarii
Small cell ca
Large cell ca
Wilms tumor

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Risk Factors for Ovarian Cancer

Familial ovarian ca
Family hx of breast and/or ovarian ca
Personal hx of breast ca
Increasing age
Early menarche (<12)
Infertility
Nulliparity
Late onset menopause (> 50)
Obesity (BMI > 30)

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Protective Factors for Ovarian Cancer

Use of OCPs (> 5 years)
Multiparity
Breastfeeding
Tubal ligation
Hysterectomy

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Symptoms of Ovarian Cancer

bloating, early satiety, dyspepsia, abdominal pain, pelvic pain

back pain, urinary frequency/urgency
constipation, fatigue, dyspareunia, menstrual changes

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The PRIMARY DIAGNOSTIC TOOL for investigating an adnexal mass

Pelvic Ultrasound

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The MC MALIGNANT epithelial cell tumors

The MC type of epithelial ovarian cancer

Serous Cystadenocarcinomas

large, cystic, bilateral

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Elevated in 80% of epithelial cell cancers

Useful in tracking the effect of treatment and recurrence of epithelial ovarian ca

CA 125

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Mainstay of treatment of epithelial cell tumors

SURGERY
TAHBSO
omentectomy
cytoreduction or debulking
bilateral pelvic and paraaortic lymph node sampling

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Treatment AFTER surgery of epithelial ovarian cancer

COMBINATION CHEMOTHERAPY

IV Carboplatin, Paclitacel or Docetaxel

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The most commonly used to evaluate the success of treatment to diagnose recurrent disease

CA 125 and CT scan

Treatment for recurrent or persistent cancer

Chemotherapy

Overall 5 year survival rate of ovarian cancer

20%

Stage I - 80-95%
Stage II - 40-70%
Stage III - 30%
Stage IV - <10%

Transitional cell tumor

“coffee bean” appearing nucleus

Solid mass or nests of epithelial cells and a surrounding fibrous stroma

Brenner Tumor

Dermoid cysts/Mature teratoma

80% occur in reproductive life

MC neoplasm in prepubertal female

Benign Cystic Teratoma

MC BENIGN solid tumor of the ovary

Extremely slow growing and unilateral

Whorled pattern

Fibroma

MEIG’S SYNDROME

ovarian fibroma
ascites
hydrothorax

Epithelial cells filled with mucin

Resembles endocervix/GIT

Mucinous tumor

Contains cell with abundant glycogen (HOBNAIL CELLS)

Associated with DES exposure

Clear Cell

MC malignancy in women < 30 years old Grow RAPIDLY, usually UNILATERAL, stage Ia at diagnosis

Germ Cell Tumors

MC type of germ cell tumor

Benign cystic mature teratoma (Dermoid cysts) - 95% | *mature adult tissue - skin, hair, teeth mixed with sebaceous material

Definitive diagnosis of mature teratoma

Cystectomy

MC MALIGNANT germ cell tumor

Dysgerminomas - 50% Immature teratomas - 20% Endodermal sinus (yolk sac) tumor - 20%

Germ cells stroma infiltrated woth LYMPHOCYTES Analogous to SEMINOMA of the tested 10% bilateral

DYSGERMINOMA - LDH

Schiller Duval bodies - numerous hyaline droplets

ENDODERMAL SINUS TUMOR YOLK SAC TUMOR - AFP

Hemorrhagic Highly malignant cytotrophoblast and syncytiotrophoblast

b-hCG

Consists of immature embryonic structures admixed with mature elements

IMMATURE TERATOMA - AFP

Clinical Manifestations of Germ Cell Tumor

pelvic pain d.t. rapid growth, hemorrhage and necrosis pressure symptoms on the bladder or rectum 85% - abdominal pain and pelvic mass

Management for benign teratoma

Ovarian cystectomy or Oophorectomy

Management for malignant Germ Cell Tumor

if fertility is desired - UNILATERAL SALPINGO-OOPHORECTOMY no desire for fertility - TAHBSO

Overall 5 year survival rate for germ cell tumor

dysgerminoma - 85% immature teratomas - 70-80% endodermal sinus tumors - 60-70%

(+) grooved coffee bean nuclei arranged in small clusters around a central cavity (CALL EXNER BODIES) functionally ESTROGENIC produce estradiol and inhibin A/B

Granulosa Theca Cell Tumor cause feminization, precocious puberty, menstrual irregularities, secondary amenorrhea or postmenopausal bleeding

Resemble fetal TESTES functionally TESTOSTEROGENIC

Sertoli Leydig Cell Tumor ``` masculinization breast atrophy hirsutism temporal recession deeper voice acne clitoromegaly ```

Treatment for Sex Cord Tumor

Young women - UNILATERAL SALPINGOOHORECTOMY Postmenopausal - TAHBSO

The 5 year survival rate for patients with sex cord stromal carcinomas

70-90%

Pathognomonic for fallopian tube carcinoma

LATZKO TRIAD * profuse watery discharge * pelvic pain * pelvic mass

Pathognomonic for fallopian tube carcinoma but rarely seen Colicky low abdominal pain d.t. intermittent hydrosalpinx

Hydrops Tubae Profluens