Ovarian Cancer

Question 1

3 main features of ovarian pathology?

Answer 1

pain (very severe acute pain in torsion especially)
swelling
endocrine effects (e.g hirsutism etc)

Question 2

main pathological groups of ovarian pathology?

Answer 2

cysts
endometriosis
tumours

Question 3

ovarian cysts may arise from what elements of the ovary?

Answer 3

any

• follicular (polycystic ovaries)
• luteal (cystic corpus luteum)
• endometriotic
• epithelial (neoplastic - benign or malignant)
• mesothelial

Question 4

which ovarian cysts usually self resolve?

Answer 4

follicular

luteal

Question 5

describe a follicular cyst?

Answer 5

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

Question 6

what is endometriosis and what may it cause?

Answer 6

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

Question 7

sites of endometriosis?

Answer 7

ovary (chocolate cyst)
pouch of douglas
peritoneal surfaces (including uterus)
cervix, vulva, vagina
bladder, bowel etc

Question 8

potential pathogenesis of endometriosis?

Answer 8

regurgitation (of glands and stroma)
metaplasia (mesothelium in pelvis undergoes metaplasia to form glands)
vascular/lymphatic dissemnination

Question 9

macroscopic features of endometriosis?

Answer 9

peritoneal spots or nodules
fibrous adhesions (on surface of ovary)
chocolate cysts

Question 10

microscopic features of endometriosis?

Answer 10

endometrial glands and cuff of stroma around them

haemorrhage, inflammation, fibrosis

Question 11

complications of endometriosis?

Answer 11

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)

Question 12

most important ovarian tumour to be aware of?

Answer 12

epithelial (most likely to be malignant)

Question 13

classifications of ovarian tumours?

Answer 13

epithelial
germ cell
sex-cord/stromal
metastatic
miscellaneous

Question 14

types of epithelial ovarian tumours?

Answer 14

serous
mucinous
endometrioid
clear cell
brenner
undifferentiated

Question 15

how do epithelial tumours occur in ovary when there is no epithalium?

Answer 15

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

Question 16

epithelial ovarian tumours are classed as benign, borderline and malignant, how is each defined?

Answer 16

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)

Question 17

serous carcinoma is divided into low and high grade which are distinct entities with different precursors, what are these?

Answer 17

high grade

• origin in fallopian tube (Not ovarian)
• AKA serous tubal intraepithelial carcinoma (STIC)

low grade
- serous borderline tumour

Question 18

high grade serous carcinoma is common in BRCA mutation, how can this be prevented?

Answer 18

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

Question 19

what are endometrioid and clear cell ovarian carcinomas associated with?

Answer 19

endometriosis of the ovary
lynch syndrome
graded the same as uterine tumours
most are low grade and early stage at presentation

Question 20

normal findings in peritoneal fluid?

Answer 20

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)

Question 21

what is a brenner tumour?

Answer 21

tumour of transitional type epithelium
usually benign
borderline and malignant variants are rare

Question 22

most common germ cell tumour?

Answer 22

mature cystic teratoma (“dermoid cyst”)

- shouldnt really be called dermoid cyst as its not a cyst

Question 23

features of dermoid cyst?

Answer 23

cystic containing sebum and hair
ectoderm, mesoderm and endoderm
skin, resp epithelium, gut and fat are common
can rarely become malignanct

Question 24

why can germ cell tumours become any tissue?

Answer 24

germ cells are pleuripotent

Question 25

what other germ cell tumours can occur in the ovary?

Answer 25

immatre teratoma
dysgerminoma (equivalent to seminoma in testes)
yolk sac tumour
choriocarcinoma
mixed germ cell tumour

Question 26

most common malignant germ cell tumour?

Answer 26

dysgerminoma

Question 27

examples of sex cord/stromal tumours?

Answer 27

fibroma/thecoma
granulosa cell tumour
sertoli-leydig cell tumours

Question 28

features of fibroma?

Answer 28

benign
homogenous (potato like)
may produce oestrogen causing uterine bleeding

Question 29

features of granulosa cell tumour?

Answer 29

all are potentially malignant

may be associated with oestrogenic manifestations

Question 30

features of sertoli-leydig cell tumours?

Answer 30

rare

may produce androgens

Question 31

commonest origins of ovarian metastases?

Answer 31

stomach
colon
breast
pancreas

Question 32

what pathology can occur in fallopian tubes?

Answer 32

inflammation (salpingitis)
cysts and tumours
serous tubal intra-epithelial carcinoma
endometriosis
ectopic pregnancy