Ovarian cancer Flashcards
What are granulosa cell tumors?
Type of sex cord stromal tumor that secretes estrogen
low grade malignancy. bimodal (2 age groups)
- Present w/ large multicystic mass, abnormal bleeding, PRECOCIOUS PUBERTY, endometrial hyperplasia.
- Pathology w/ coffee-bean nuclei (Call Exner bodies).
- Tumor marker=inhibin.
Juvenile type=5%
Adult type: mild-age and older women.
What are germ cell tumors?
1/3 of all ovarian neoplasms. most common gyn malignancy in pre-adolescents.
- most are unilateral, do fertility sparing surgery
- Dermoid (mature cystic teratoma)=most common subtype.
- Malignant: dysgermimoma, yolk sac tumor, immature teratoma
Others: Choriocarcinoma, endodermal sinus, gonadoblastoma (malignant only if associated dysgermimoma elements)
- READ GYN WILLIAMS PAG 32541
What are protective factors for ovarian cancer?
OC use > 5 years, breastfeeding, full term pregnancy, multiparity, BTL, hysterectomy w/ oophorectomy.
What are immunohistochemical markers for serous ovarian tumors?
cytokeratin 7 (CK7), Ca-125, PAX8, WT1, KRT7
Risk factors for ovarian cancer?
1.3% lifetime risk (1 in 75)
- RF: family hx, uninterrupted ovulation (nulliparity, early menarche, late menopause, whites, person hx breast cancer, HRT, PID)
- Protective factors: breastfeeding, OCP use, BSO by age 40
- median age diagnosis: 63!!
What are BRCA1/2?
AD genes. If BRCA1 (17q21), 40% chance of ovarian cancer.
- If BRCA2 (13q12), 20% chance.
What are low malignant potential tumors?
AKA Borderline (10-15% epithelial ovarian cancer)
- nuclear atypia, epithelial stratification, papillary projections, cellular pleomorphism, mitotic activity, microinvasion
What are serous tumors?
> 50% epithelial tumors
- path: psamomma bodies
- ciliated tubal epithelial
- not usually malignant
What are endometriosis tumors?
15-20% epithelial tumors
- good prognosis
What are mucinous tumors?
5-10% epithelial tumors.
- advanced stage are resistant to chemo, poor prognosis
- columnar endocervical epithelium
Pseudomyxoma peritonei, CEA=tumor marker
What is clear cell adenocarcinoma tumors?
5-10% epithelial tumors
- assoc w/ endometriosis
- Path: clear and “hobnail” cells
- mesonephric tissue histogenesis
What are sheets of lymphocytes associated with?
Dysgermimoma
- +B-HCG and LDH
“Distant germans betta have long distance”
- dysgerminoma, B-HCG, LDH
- sensitive to radiation
- cytoplasmic glycogen!
What are Schiller-Duval associated with?
Endodermal sinus tumor/yolk sac
- +AFP
“Egg Yolks can be AWESOME FRESH PICKS if you keep them in the CHILLER”
- Yolk sac, AFP, Schiller Duval
- RAPID GROWTH
- MALIGNANT
- extraembryonic tissue
- central capillary surrounded by connective tissue and peripheral columnar cells
What are Call-Exner bodies associated with?
Granulosa cell tumor
- micro follicular pattern with numerous small cavities - eosinophils present.
What are Psamomma bodies associated with?
serous tumor
- ciliated tubal epithelium
What are malignant cytotrophoblast associated with?
Choriocarcinoma
What are signet cells associated with?
Krukenberg tumor
What are tumor markers for ovarian cancer?
Ca-125
Human epidymis protein 4
What are biomarkers for immature teratoma?
+AFP, LDH, CA-125
“Immature ladies are from pasadena California”
- immature teratoma, AFP, Ca-125
- fetal embryonic tissue
- MALIGNANT
What are biomarkers for embryonal carcinoma?
B-HCG, AFP
“Embryos are betta AS FRESH PICKS”
- embryonal carcinoma, b-hcg, AFP
- malignant, embryonic tissue
What ultrasound findings for adnexal masses suggest malignancy?
Cyst >10cm
papillary or solid components
Irregularity
Ascites
High color doppler flow
What is ultrasound finding for endometrioma?
benign!
- homogenous appearing cyst with low-level echoes
What is ultrasound finding for mature teratoma?
hypo echoic attenuating components with multiple small homogenous interfaces
What is an immature teratoma?
most common variant of malignant germ cell tumors, account for 50%
- derive from 3 germ layers: ectoderm, mesoderm, endoderm
- more common than benign mature cystic teratoma (dermoid)
- tumor markers normal
- Large masses, go to peritoneum
- Neuroectoderm tissue predominant; GRADED by amount of immature NEURAL tissue they contain!!
What is Meig’s syndrome?
triad of benign ovarian tumor with ascites and pleural effusion that resolves after resection of the tumor
- 1% tumors undergo malignant transformation
What are random facts about ovary?
most common primary ovarian malignant: serous cystadenocarcinoma
most common ovarian neoplasm: mature cystic teratoma (dermoid)
Most common ovarian mass: functional cyst
What are gonadal-stromal ovarian tumors?
3-5% of ovarian tumors
- Granulosa cell
- Fibroma (thecoma elements, w/ Meig syndrome)
- Thecoma (produce estrogen)
- Sertoli-Leydig (testicular gonad, crystal of Reinke, testosterone production)
- Lipid cells (testosterone)
- Gynandroblastoma (both ovarian + testicular, MALIGNANT
What is a Brenner tumor?
type of epithelial ovarian cancer
- transitional urothelium
- Walthard cell rests
What are Leydig cells associated with?
Hilus cell tumors
What are pseudoxanthoma cells associated with?
Endometrioid cysts
What are fibrous septa and lymphocytes associated with?
Dysgermimoma
What are nesting tumors associated with
Brenners and granulosa
What are bleomycin and adriamycin associated with?
Bleomycin: pulmonary fibrosis
Adriamycin: Cardiotoxic
What is vincristine and vinblastine?
“Crist my nerves and Blast my bones”
Vincristine: neuro toxic
Vinblastine: Marrow toxic
What are 5-FU and cytoxan associated with?
5-FU: cerebellar ataxis
Cytoxan: hemorrhagic cystitis, SIADH
