Ovarian Cancer Flashcards
3 main features of ovarian pathology?
pain (very severe acute pain in torsion especially)
swelling
endocrine effects (e.g hirsutism etc)
main pathological groups of ovarian pathology?
cysts
endometriosis
tumours
ovarian cysts may arise from what elements of the ovary?
any
- follicular (polycystic ovaries)
- luteal (cystic corpus luteum)
- endometriotic
- epithelial (neoplastic - benign or malignant)
- mesothelial
which ovarian cysts usually self resolve?
follicular
luteal
describe a follicular cyst?
forms when ovulation doesnt occur (polycystic ovaries)
follicle doesnt rupture but grows until it becomes a cyst (can grow up to several cm)
thin walled, lined by granulosa cells
usually resolve in a few months
what is endometriosis and what may it cause?
endometrial glands and stroma outside the uterine body
can cause
- pelvic inflammation
- infertility (can be due to enlargement and inflammation causing reduced function of ovary and blockage of fallopian tubes)
- pain
sites of endometriosis?
ovary (chocolate cyst) pouch of douglas peritoneal surfaces (including uterus) cervix, vulva, vagina bladder, bowel etc
potential pathogenesis of endometriosis?
regurgitation (of glands and stroma)
metaplasia (mesothelium in pelvis undergoes metaplasia to form glands)
vascular/lymphatic dissemnination
macroscopic features of endometriosis?
peritoneal spots or nodules
fibrous adhesions (on surface of ovary)
chocolate cysts
microscopic features of endometriosis?
endometrial glands and cuff of stroma around them
haemorrhage, inflammation, fibrosis
complications of endometriosis?
pain
cyst formation
adhesions
infertility
ectopic pregnancy (due to fusion of the fallopian tube so its closed and the blastocyst gets stuck there)
malignancy (endometroid/clear cell carcinoma of the ovary)
most important ovarian tumour to be aware of?
epithelial (most likely to be malignant)
classifications of ovarian tumours?
epithelial germ cell sex-cord/stromal metastatic miscellaneous
types of epithelial ovarian tumours?
serous mucinous endometrioid clear cell brenner undifferentiated
how do epithelial tumours occur in ovary when there is no epithalium?
mesothelium which lines the ovary is broken when the follicle is released
this mesothelium can therefore be incorporated into the stroma of the ovary and then undergoes metaplasia
epithelial ovarian tumours are classed as benign, borderline and malignant, how is each defined?
benign - no cytological abnormalities - scant or absent proliferative activity - no stromal invasion borderline - cytological abnormalities present - proliferative - no stromal invasion malignant - stromal invasion
(however one tumour can be mixed and have areas which are benign, borderline or malignant)
serous carcinoma is divided into low and high grade which are distinct entities with different precursors, what are these?
high grade
- origin in fallopian tube (Not ovarian)
- AKA serous tubal intraepithelial carcinoma (STIC)
low grade
- serous borderline tumour
high grade serous carcinoma is common in BRCA mutation, how can this be prevented?
tubal in origin so need to remove fallopian tubes as well as ovaries
- however there is still a risk of peritoneal growth of the tumour if some of the fallopian tube cells have dropped into the peritoneum
what are endometrioid and clear cell ovarian carcinomas associated with?
endometriosis of the ovary
lynch syndrome
graded the same as uterine tumours
most are low grade and early stage at presentation
normal findings in peritoneal fluid?
not much
might have some mesothelial cells that have fallen off from the lining
might have some inflammatory cells and a little blood from procedure
anything else (e.g malignant cells can help diagnose)
what is a brenner tumour?
tumour of transitional type epithelium
usually benign
borderline and malignant variants are rare
most common germ cell tumour?
mature cystic teratoma (“dermoid cyst”)
- shouldnt really be called dermoid cyst as its not a cyst
features of dermoid cyst?
cystic containing sebum and hair
ectoderm, mesoderm and endoderm
skin, resp epithelium, gut and fat are common
can rarely become malignanct
why can germ cell tumours become any tissue?
germ cells are pleuripotent
what other germ cell tumours can occur in the ovary?
immatre teratoma dysgerminoma (equivalent to seminoma in testes) yolk sac tumour choriocarcinoma mixed germ cell tumour
most common malignant germ cell tumour?
dysgerminoma
examples of sex cord/stromal tumours?
fibroma/thecoma
granulosa cell tumour
sertoli-leydig cell tumours
features of fibroma?
benign
homogenous (potato like)
may produce oestrogen causing uterine bleeding
features of granulosa cell tumour?
all are potentially malignant
may be associated with oestrogenic manifestations
features of sertoli-leydig cell tumours?
rare
may produce androgens
commonest origins of ovarian metastases?
stomach
colon
breast
pancreas
what pathology can occur in fallopian tubes?
inflammation (salpingitis) cysts and tumours serous tubal intra-epithelial carcinoma endometriosis ectopic pregnancy
