Ovarian cancers

Question 1

Surface of ovary is rarely involved, unilateral, larger cystic masses that are multiloculated, filled with sticky, gelatinous fluid rich in glycoproteins

Answer 1

mucinous carcinoma

Question 2

Characterized by a lining of tall, columnar epithelial cells with apical mucin that lack cilia, but most have gastric/intestinal type differentiation

Answer 2

mucinous tumors

Question 3

Solid and cystic areas of growth, tubular glands resembling endometrium

Answer 3

endometrioid

Question 4

Large epithelial cells with abundant clear cytoplasm , look like hypersecretory gestational endometrium
but arranged in sheets or tubules, cystic areas are lined by neoplastic cells

Answer 4

clear cell carcinoma (probably arises from endometrioid carcinoma)

Question 5

pronounced proliferation of fibrous stroma underlying columnar lining, small, multilocular and possess simple papillary processes

Answer 5

benign cystadenofibroma

Question 6

Stroma marked by nests of cells resembling urinary bladder, plump fibroblasts resembling theca cells and brenner’s tumors

Answer 6

Brenner’s tumors. transition cell carcinoma

Question 7

always lined by skin like structures and characteristically possesses unilocular cysts. when are they found?

Answer 7

benign (mature) teratomas, usually during a woman’s reproductive years

Question 8

Occasionally absorbed into wall of a mucinous cystadenoma

Answer 8

dermatoid cyst

Question 9

1% undergo malignant transformation, most commonly transform into squamous cell carcinoma

Answer 9

dermatoid cyst

Question 10

what is the karyotypes of almost all benign ovarian teratomas? what do they indicate?

Answer 10

46, XX: Indicating most arise from ovum after first meiotic division

Question 11

stuma ovarri: what is it, and is it bilateral

Answer 11

stuma ovarri
Almost always unilateral

Struma ovarri are composed entirely of mature thyroid tissue: May be functional and cause hyperthyroidism

Question 12

“carcinoid” tumor

Answer 12

Carcinoid is a teratoma composed of Intestinal tissue. Can produce enough 5-HT (serotonin) to cause carcinoid syndrome. Must be distinguished from metastatic intestinal carcinoid which is always bilateral

Question 13

Rare tumors found chiefly in prepubertal adolescents and young women with a mean age ~18 yrs/old d.

Morphology: Smooth external surfaces but bulky. All features of germ layer tissues found. What is the big risk with these? How responsive to chemo is it?

Answer 13

Malignant teratoma (immature): 
Important risk of extraovarian spread 
Grow rapidly, frequently penetrate capsule and spread locally or distantly. Chemo is generally curative for stage 1

Question 14

Dysgerminoma: malignancy potential, overall survival, when they mostly appear

Answer 14

Dysgerminoma is the ovarian counterpart of testicular seminoma. All are malignant, but only 1/3 are aggressive. Overall survival exceeds 80% kill.

75% occur in 2nd or 3rd decades

Question 15

This tumor makes up 50% of malignant germ cell tumors

Answer 15

Dysgerminoma

Question 16

Function of the dysgeminoma and associations with gonadal dysgenesis.

Answer 16

most have no endocrine functions. Association with gonadal dysgenesis disorders include pseudohermaphroditism. Few produce chorionic gonadotropin

Question 17

what tumor markers do dysgerminomas express?

Answer 17

Express OCT3, OCT4, Nannog. 1/3 have KIT tyrosine mutations

Question 18

90-90% are unilateral tumors. These are barely visible masses or may fill the entire abdomen. Solid yellow-white to grey-pink appearance with large vesicular cells. Clear cytoplasm and well defined cell boundaries, demonstrating a centrally placed regular nuclei.

Answer 18

Dysgerminoma

Question 19

Clear cytoplasm, well defined cell boundaries and centrally placed regular nuclei. Sheets or cords separated by fibrous stroma

Infiltrated by mature lymphocytes and occasionally granulomas

Answer 19

dysgerminoma

Question 20

a central blood vessel enveloped by tumor cells within a space also lined by tumor cells

Answer 20

Schiller-Duval body found in yolk sac tumors

Question 21

Metastasize hematogenously (move to: lungs, liver, bone, others). Elaborate high levels of chorionic gonadotropin. What’s the tissue these are derived from and behavior?

Answer 21

Choriocarcinoma: commonly of placental origin and very aggressive.

Question 22

Yellow coloration. Cuboidal to polygonal cells. Grow in anastomosing cords, sheets, or strands. Small distinctive glandlike structures filled with acidophilic material recall immature follicles.

Answer 22

Granulosa Cell tumors: the glandlike structures are called cell exner bodies

Question 23

What is elevated in granulosa cell tumors and what is genetic pathway upregulated in them?

Answer 23

Inhibin: elevated tissue levels associated with granulosa tumors

FOXL2 gene mutation ~97% of granulosa cell tumors: Encodes transcription factor for granulosa development

Question 24

Unilateral ~90% of time
Usually solid
Spherical/slightly lobulated/encapsulated. Covered by glistening, intact ovarian serosa. Composed of well differentiated fibroblasts with interspaced collagenous stroma. Most come to attention as pelvic mass, sometimes pain. What are my associations?

Answer 24

Two associations

Ascites: ~40% of the time: hydrothorax: uncommon, but usually on right side.

Question 25

Ovarian tumor+ascites+hydrothorax =

Answer 25

Ovarian tumor (fibroid tumor)+ascites+hydrothorax = Meigs syndrome