Ovarian Cysts and Tumors of Epithelial Origin

Question 1

Example of Non-neoplastic Ovarian Disease?

Answer 1

Polycystic Ovarian Disease (stein leventhal syndrome)

Question 2

Types of Non Neoplastic Cysts?

Answer 2

Follicle Cysts

Corpus Luteum Cysts

Theca Lutein Cysts

Surface Epithelium Inclusion Cysts

Chocolate Cysts

Polycystic Ovaries

Question 3

What is the Classic triad in PCOS?

Answer 3

Amenorrhea

Hirsutism

Obesity

Question 4

Cause of development of Polycystic Ovaries?

Answer 4

polycystic ovaries d/2 persisten anovulation

Question 5

Diagnostic Criterion for PCOS?

Answer 5

At least 2 of the following 3 features:

• Oligo-ovulation or anovulation (manifested as oligio- or a- menorrhea)
• Hyperandrogenism (clinical or biochemical)
• Polycystic Ovaries (defined on ultrasonography)

Question 6

What are the predisposing factors of PCOS?

Answer 6

• Mostly unk. Etiology
• Functional deficit in P450c17 (17 hydroxylase)
• Familal disorder

Question 7

Key features of PCOS?

Answer 7

• Insulin resistance
• Androgen Excess
• Abnormal Gonadotropin dynamics

Question 8

Pathogenesis of PCOS?

Answer 8

A proposed mechanism for anovulation and elevated androgen levels suggests that, under the increased stimulatory effect of luteinizing hormone (LH) secreted by the anterior pituitary, stimulation of the ovarian theca cells is increased. Hyperinsulinemia also can lead to theca cell hyperplasia with the same results. These cells, in turn, increase the production of androgens (eg, testosterone, androstenedione). Because of a decreased level of follicle-stimulating hormone (FSH) relative to LH, the ovarian granulosa cells cannot aromatize the androgens to estrogens, which leads to decreased estrogen levels and consequent anovulation. Growth hormone (GH) and insulin-like growth factor–1 (IGF-1) may also augment the effect on ovarian function

Question 9

what are the morphologic signs of anovulation?

Answer 9

Multiple, small, and subcapsular follicular cysts (unruptured follicles)

thick and smooth ovarian surfaces (no ovulation–no rupture–no scar)

no corpora lutea and corpora albicanata

Question 10

Other morphological signs of PCOS?

Answer 10

Hyperplastic and fibrotic stroma

Hyperplastic theca interna

Question 11

PCOS Complications?

Answer 11

• Infertility
• Increased risk of DM
• Increased risk of CVD (cardio or cerebro)
• Increased risk of developing endometrial hyperplasia–>endometrial carcinoma

Question 12

Common age for developing Ovarian tumors?

Answer 12

any age, mainly reproductive.

Question 13

Prognosis of Ovarian tumors?

Answer 13

poor

Question 14

Are ovarian tumors unilateral or bilateral?

Answer 14

unilateral>bilateral

(except serous cystadenoCA)

Question 15

How to screen for ovarian tumors?

Answer 15

pelvic sonography/CT/MRI/PET

BRCA screening

Osteopontin, serum CA-125 glycoprotein

Question 16

Risk factors for Ovarian Cancers?

Answer 16

Family history

Age

Obesity

Question 17

Risk REDUCERS for ovarian cancer

Answer 17

• pregnancy and lactation
• “the pill”- oral contraceptives
• tubal ligation
• ovariectomy in high risk
• low fat diet

Question 18

Origin of Ovarian Tumors?

Answer 18

Mullerian ducts are formed from coelomic epithelium and evolve into serous (tubal), endometrial and mucinous (Cervix) epithelium.

Question 19

What are the symptoms of ovarian neoplasia?

Answer 19

bloating or pressure in the belly

pain in the abdomen or pelvis

felling full too quickly during meals

urinating more frequently

Question 20

Simplified clinical staging of Ovarian Cancer?

Answer 20

Question 21

Methods of Tx for Ovarian Cancer?

Answer 21

Chemotherapy

Surgery

Anti-angiogenesis therapy

Question 22

What are the most common ovarian tumors?

Answer 22

Surface epithelial (mullerian) tumors

Question 23

What are examples of surface epithelial tumors?

Answer 23

Benign: Minimal Epithelial proliferation
Borderline: Moderate to high epithelial proliferation
Malignant: Epithelial proliferation with stromal invasion

Question 24

Oncogenesis of Serous and Mucinous Ovarian CA

Answer 24

Question 25

Serous Cystadenoma gross morphology?

Answer 25

uni-/paucilocular cyst, smooth lining, with occasional epithelial folds

Question 26

Serous cystadenoma histology?

Answer 26

one layer of columnar cells

Question 27

Serous CystadenoCA Gross morphology?

Answer 27

Bilateral solid or cystic uni-/paucilocular

Papillae on external and internal surfaces

Question 28

Diagnostic feature of serous cystadenoCA?

Answer 28

Psammoma Bodies

Question 29

Mucinous Cystadenoma

Answer 29

Question 30

Mucinous CystadenoCA

Answer 30

Question 31

Mucinous CystadenoCA histology

Answer 31

Question 32

Jelly Belly Syndrome?

Answer 32

Pseudomyxoma Peritonei

Question 33

How does jelly belly syndrome present?

Answer 33

• Jelly like mucus within peritoneal cavity
• Cystic implants on peritoneal leaflets

Question 34

Origin of Jelly Belly Syndrome?

Answer 34

mucinous tumors either from appendix or ovary

Question 35

Oncogenesis of Clear Cell and Endometrioid Ovarian CA

Answer 35

Question 36

Endrometrioid CA

Answer 36

Concomitatnt endometrial carcinoma may be seen in 15-30% of women.

Question 37

Clear Cell CA

Answer 37

Question 38

Brenner Tumor

Answer 38

Question 39

REVIEW OF LECTURE

Answer 39