Ovarian cancer pathology 2 Flashcards
What do serous ovarian carcinomas show histological patterns reminiscent of ?
Tubal epthielium
What do endometrioid and clear cell ovarian tumours show histological patterns reminisent of ?
Endometrium epithelium
What are the associations of endometrioid and clear cell carcinomas ?
- Strong association with endometriosis of the ovary
- Endometriod carcinomas graded the same as uterine tumours.
- Most endometrioid carcinomas are low grade and early stage - Association with Lynch syndrome
What is a brenner tumour ?
A tumour of transitional type epithelium, usually benign, borderline and malignant variants are rare
Transitional epithelium is a layer of cells that forms the mucosal lining of your ureters, a portion of your urethra, and your urinary bladder.
What is the most common type of germ cell tumour and what is it comprised of ?
Mature cystic teratomas - comprised of all 3 embryonic germ cell layers:
- Most commonly ectodermal - skin, hair, teeth etc
- But also endodermal e.g. intestinal and resp epithelium
- and mesodermal e.g. muscle, fat
What are mature cystic termatomas likely to become malignant ?
Rarely become malignant
What type of ovarian tumour is shown?
Mature cystic termatoma
what is the most common malignant germ cell tumour and who does it almost exclusively affected?
- Dysgerminoma
- It is the most common malignant primitive germ cell tumour accounting for 1-2% of all malignant ovarian tumours
- Affects almost exclusively children and young women, average age 22
What are the different Sex Cord/Stromal Tumours which can affect the ovaries ?
- Fibroma/Thecoma
- Granulosa cell tumour
- Sertoli-Leydig cell tumours
What are the key features of granulosa cell tumours ?
- Occur esp in postmenopausal women
- Are all potentially malignant
- May secrete oestrogen - which as a result may cause uterine bleeding due to causing uterine hyperplasia and potentially carcinoma
What are the key points about ovarian fibromas/thecomas?
- Benign
- May produce oestrogen causing uterine bleeding and potentially assoiciated with endometrial neoplasia through same process as in granulosa cell tumours
What are the key points about Sertoli/Leydigs cell tumours ?
- They are rare
- May secrete androgens leading to virilisation in female
What are the commonest origins of metastases to the ovaries ?
- Stomach
- Colon
- Breast
- Pancreas
Needs to be considered in all cases, particularly when tumours are small and bilateral
What is the staging of ovarian cancers ?
FIGO staging:
Stage 1:
- 1A tumour limited to one ovaries
- 1B tumour limited to both ovaries
- 1C Cancer involving ovarian surface/rupture/surgical spill/tumour in washings
Stage 2:
- 2A Extension or implants on uterus/fallopian tube
- 2B Extension to other pelvic intraperitoneal
Stage 3:
- 3A Retroperitoneal lymph node
- Metastasis or microscopic extrapelvic peritoneal involvement
- 3B Macroscopic peritoneal metastasis beyond pelvis up to 2cm in dimension
- 3C Macroscopic peritoneal metastasis >2cm in dimension
Stage 4:
- Distant metastasis
What are some of the pathologies whcih can affect the fallopian tubes ?
- Inflammation - Salpingitis due to infection
- Cysts and tumours
- Serous tubal intraepithelial carcinoma
- Endometriosis
- Ectopic pregnancy
What are the key points about ectopic pregnancy?
i.e. what is it, where does it most commonly occur and what are its key presenting features ?
- It is Implantation of a conceptus outside the endometrial cavity
- Commonest site is the ampulla of Fallopian tube
- May occur in ovary or peritoneum
- Often ruptures
- May cause fatal haemorrhage
- Consider diagnosis in any female of reproductive age with amenorrhoea and acute hypotension or an acute abdomen.
Appreciate this
>90% epithelial cell tumours of ovary such as:
- serous - most common
- mucinous
- endometrioid
- clear cell
- undifferentiated
<10% germ cell, granulosa cell
