ovarian cancer Flashcards
ovarian pathology can cause?
- pain
- swelling
- endocrine effects -> if neoplasm in ovary are producing hormones
what are the 3 main pathological groups in the ovary?
- cysts
- endometriosis
- tumours
what are the 5 main groups where the cysts within the ovary can arise from?
- follicular e.g. polycystic ovaries
- luteal (corpus luteum)
- endometriotic (secondary to endometrioma)
- epithelial (lined by epithelial cells)
- mesothelial (lined by mesothelial cells)
when can follicular cysts form?
- when ovulation doesn’t occur (polycystic ovaries)
do follicular cysts rupture?
- don’t rupture but growth until they become a cyst
- up to several cm in size
what are follicular cysts lined by?
- granulosa cells
- thin walled
how long for a follicular cyst to resolve?
- usually over a few months
what is endmetriosis?
- endometrial glands and stroma outside outside the uterine body
- can occur within the ovary
what is the term given to endometrial glands and stroma within the myometrium?
adenomyosis
what can endometriosis cause?
- pelvic inflammation - due to breakdown of the glands and stroma
- infertility
- pain
where are common sites for endometriosis?
- ovary - chocolate cyst
- pouch of douglas
- peritoneal surfaces, including uterus (serosa)
- cervix, vulva, vagina
- bladder, bowel
underlying aetiology for endometriosis?
- not well understood
- regurgitation of endometrium through fallopian tubes?
- metaplasia? 1 type of epithelium into another epithelium
- vascular or lymphatic dissemination - gain access to outside uterus
macroscopically what is seen in ovarian endometriosis?
- peritoneal spots or nodules
- fibrous adhesions
- chocolate cysts
microscopically what is seen in ovarian endometriosis?
- endometrial glands and stroma
- haemorrhage, inflammation, fibrosis
what are some complications of endometriosis?
- pain
- cyst formation
- adhesions (inflammation can cause surfaces to stick to each other)
- infertility - due to scarring of tube as a result of inflammation
- ectopic pregnancy
- malignancy - endometrioid carcinoma or clear cell carcinoma (arise from endometriotic cyst)
ovarian tumours can be solid or?
- cystic
what are 5 different classes of ovarian tumours?
- epithelial
- germ cell
- sex cord/stromal
- metastatic - breast or GI
- miscellaneous
understood that epithelial ovarian tumours arise from the mesothelial cell layer that lines the ovarian surface? true or false?
- true and undergoes a metaplastic change to become
serous
mucinous
endometrioid
clear cell
brenner
epithelial ovarian tumours are categorised as ….., ……, or …….
benign - no cytological abnormalities, no stromal invasion, no prolif absent
borderline - cytological abnormalities, prolif, no stromal invasion
malignant - stromal invasion !!!
-> borderline and malignant tumours will be staged according to the Figo staging system
serous carcinoma have 2 distinct entities what are these?
- high grade serous carcinoma
- low grade serous carcinoma
what is precursor for high grade serous carcinoma?
- STIC - serous tubal intraepithelial carcinoma
- arisen from some abnormal cell in fallopian tube
what is precursor for low grade serous carcinoma
- serous borderline tumour
- some atypia and some proliferation and goes on to develop invasive malignancy
- less aggressive
what are cytological abnormalities of high grade serous carcinoma within ovary?
- lots of variation in nuclear size and shape
- large multinucleated cell
- within nuclei also prominent nucleoli
what are similarities of high serous carcinoma in ovary and uterus?
- p53 mutations
what do endometrioid and clear cell carcinoma have an association with?
- strong association with endometriosis of the ovary
- also lynch syndrome - particularly clear cell carcinoma of the ovary
how are endometrioid carcinomas graded in the ovary?
- graded same as uterine tumours
- most are low grade and early stage
how is ovarian cancer diagnosed?
- often made on ascitic fluid
- also important to note once a diagnosis is made: to examine omentum for possible tumour deposits within that
high grade serous carcinoma often presents in an advanced stage with what kind of involvement?
- extensive peritoneal involvement
- which causes ascites - tumour cells produce fluid in abdomen causing the bloating.
- diagnosis often made bases off fluid
what is a brenner tumour?
- benign, tumour of transitional type epithelium, set within a fibrous stroma
- found usually in urothelial tract - bladder, ureters and urethra, but can also be seen in ovary
- borderline and malignant variants are rare
how common are germ cell tumours?
- 15-20% of all ovarian tumours
what is the commonest germ cell tumour of the ovary?
- mature cystic teratoma (benign)
- 95% of germ cell tumours
are germ cell tumours pluripotent true or false?
- true
- any line of differentiation
- often find sebum, hair, skin, bone, teeth, cartilage etc
- also known as ‘dermoid cyst’ but real name is mature cystic teratoma
germ cell tumours have a high risk of malignancy true or false?
rarely become malignant
- somatic malignancy can arise in teratoma e.g. in skin of teratoma can see SCC, or thyroid ca
name some other germ cell tumours other than mature cystic teratoma?
- immature teratoma
- dysgerminoma
- yolk sac tumour
- choriocarcinoma
- mixed germ cell tumour
most common malignant primitive germ cell tumour?
- dysgerminoma
- 1-2% of all malignant ovarian tumours
what is a characteristic finding of a dysgerminoma on microscopy?
- large primitive germ cells with scattered lymphocytes surrounding them
what is the common presentation age of a dysgerminoma?
- children and young women
- avg age 22
name 3 different types of sex cord/stromal tumours?
- fibroma/thecoma (most common)
- granulosa cell tumour
- sertoli-leydig cell tumours
fibromas are a benign sex cord tumour that may produce what hormone?
- produce oestrogen causing uterine bleeding
granulosa cells are considered potentially malignant true or false?
- true
sertoli-leydig cell tumours may produce what hormone?
- androgens
what is the most common mets for ovarian cancer?
- stomach
- colon
- breast
- pancreas
what kind of presentation of ovarian cancer should you consider a metastatic tumour?
- when tumours are BILATERAL and SMALL
what staging is used for ovarian cancer?
- Figo staging
what kind of pathologies present in the fallopian tubes?
- inflammation - termed salpingitis (due to infection - neutrophil polymorphs, lymphocytes, scarring or dilatation of tube)
- cysts and tumours
- serous tubal intraepithelial carcinoma (precursor to high grade serous carcinoma to tube or ovary)
- endometriosis
- ectopic pregnancy
what is an ectopic pregnancy?
- implantation of a conceptus outside the endometrial cavity
- commonest site is fallopian tube - due to fertilisation occuring here and the face that the tubes can be damaged due to PID, endometriosis -> scarring and loss of architecture - so ovum is not wafted into endometrial cavity
- may occur in ovary or peritoneum
what is an acute complication of an ectopic pregnancy in the fallopian tube?
- fatal haemorrhage - of the fallopian tube
what diagnosis should you consider in a female of reproductive age presenting with amenorrhoea and acute hypotension or an acute abdomen?
- ectopic pregnancy
what tumours can arise from endometriosis?
- endometrioid and clear cell tumours
