Ovarian and Fallopian Tubr Tumors Flashcards
MCC of gynecologic DEATH
Ovarian carcinoma
65% of all ovarian tumors and 95 % of all ovarian cancers are
EPITHELIAL TUMORS
5% to 10% of ovarian cancer is metastatic from other primary tumors in the body
GIT - Krukenberg tumor
breast
endometrium
WHO Classification - Ovarian Cancer
EPITHELIAL (65%)
Serous Mucinous Endometrioid Clear cell (Mesonephroid) Brenner)
WHO Classification - Ovarian Cancer
SEX CORD < 0.01
Granulosa cell
Thecoma-fibroma
Sertoli-Leydig
WHO Classification - Ovarian Cancer
GERM CELL (6%)
Primitive (Dysgerminoma, Yolk Sac)
Teratoma
WHO Classification - Ovarian Cancer
GERM CELL SEX CORD (<0.01)
Gonadoblastoma
WHO Classification - Ovarian Cancer
MISCELLANEOUS
Tumors of rete ovarii
Small cell ca
Large cell ca
Wilms tumor
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)
Protective Factors for Ovarian Cancer
Use of OCPs (> 5 years) Multiparity Breastfeeding Tubal ligation Hysterectomy
Symptoms of Ovarian Cancer
bloating, early satiety, dyspepsia, abdominal pain, pelvic pain
back pain, urinary frequency/urgency
constipation, fatigue, dyspareunia, menstrual changes
The PRIMARY DIAGNOSTIC TOOL for investigating an adnexal mass
Pelvic Ultrasound
The MC MALIGNANT epithelial cell tumors
The MC type of epithelial ovarian cancer
Serous Cystadenocarcinomas
large, cystic, bilateral
Elevated in 80% of epithelial cell cancers
Useful in tracking the effect of treatment and recurrence of epithelial ovarian ca
CA 125
Mainstay of treatment of epithelial cell tumors
SURGERY TAHBSO omentectomy cytoreduction or debulking bilateral pelvic and paraaortic lymph node sampling
Treatment AFTER surgery of epithelial ovarian cancer
COMBINATION CHEMOTHERAPY
IV Carboplatin, Paclitacel or Docetaxel
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
