Ovarian Disease-Leah : ) Flashcards
Lesions of the ovary (three types)
- cysts
- tumors
- inflammation (rare)
Two types of benign (functional) cysts:
Which hormone is each assc with?
- cystic follicles/follicular cyst: estrogen
- luteal cysts: progesterone
Cells lining a cystic follicle?
What fills the follicle?
- thin granulosa lining (produces estrogen)
- follicle looks “empty” or “fluid filled” - no cells in the cyst!
Where do cystic follicles originate (2 possibilities)?
- graffian follicle that failed to rupture
- graffian follicle that ruptured/ immediately closed
(rupture is normal –> its what releases an egg in ovulation)
What is a follicular cyst?
A follicular CYST is just a large cystic follicle.
Same process– just called a “cyst” if bigger than 2cm (called a FOLLICLE if small)
What does a luteal cyst look like on histo? What are they filled with?
- lined with luteinized cells (prog. production)
- full of fibrin (not empty like cystic follicles)
Rupture of a luteal cyst causes ?
peritoneal reaction–may be mistaken or appendicitis!
Stein-Levanthall syndrome:
What common disease is this?
Presentation?
Presumed cause/treatment?
-PCOS/D
-obese woman with ^^ adrogenicity; infertile
-now thought to be caused by insulin resistance
(insulin mediators can cause ovulation to resume)
Most common cause of ovarian cancer death?
-late detection (common sense)
just know these are hard to detect and often found when its too late– no screening tools in place.
Clinical symptoms of ovarian tumors (3)
- abdomen enlarged
- GI irritation
- pressure/ urinary frequency
(these are all symptoms of having a MASS– there are also tumor specific symptoms when hormones are released.)
Why is nulliparity a risk for ovarian cancer?
-more ovulatory cycles
(pregnancy allows breaks)
-this means more opportunity for follicles to rupture/ mesothelium to enter the ovary and cause dysplasia
-also means ^^ estrogen exposure over lifetime
What three groups (tissue types) are ovarian cancers classified under?
-epithelial
-germ cells
-stromal/support cells
(based on the cells from which the tumor originates)
Which of the ovarian cancers is most common?
What age group gets these?
- Epithelial type –> serous tumor
- Less than half of epi. ovarian
- Epi cancers represent NINETY PERCENT of ovarian malignancies (despite fact that most Epi cancers are benign)
Anyone age 20+ gets these
Three common epithelial derived ovarian cancers? One other?
One other random tumor of the ovarian epi?
- serous (#1)
- mucinous
- endometriod: clear cell v. cystadenofibroma
Also: Brenner’s Tumor exists
Are epithelial tumors bilateral or unilateral?
Most can be bilateral, but rarely see this in the mucinous type!!
What increases the likelihood than an epithelial tumor will be malignant?
-^^ SOLID material
solid is bad, cystic is good
How are serous and mucinous tumors subdivided (3)?
What are these subdivisions characterized by?
- benign- well differentiated
- borderline- increased complexity + nuclear atypia
- malignant- STROMAL INVASION
( review of classification: ovarian tumor –> epi. derived –> serous v. mucinous –> benign v. malignant)
What is the embryonic origin of serous, mucinous, or endometrioid tissue in ovarian cancer?
What is the embryonic origin of mesothelium? How is this relevant to ovarian function?
**She loves this little tidbit, so I would know it.
- Coelomic epithelium–> mullerian ducts (serous/ mucinous/ endometrioid tissue repro system) + mesothelium
- Mesothelium of these tissue types is incorporated into the ovary during “repair” (forms an inlcusion cyst), which happens after each time a woman ovulates/ ruptures a follicle.
Occasionally tumor cells are derived via endometriosis. What tumors are caused by this process?
The more rare ones –clear cell/adenofibroma
Serous Tumor/ Serous cystadenoma: From what tissue is the tumor derived? Commonly benign or malignant--which population gets malignant tumors? Gross appearance (2)? Bilateral?
- # 1 EPITHELIAL tumor of ovary
- 75% benign –> borderline
- 25% malignant in hereditary cases/ very old patients
Grossly:
- Smooth cyst full of clear/ yellow fluid
- May have papillary projections under outer layer
- 20% bilateral
Histo appearance of serous tumor?
-Cyst wall/papilla lined by ciliated columnar epi (normal fallopian tube histo)
- Benign = well differentiated
- Malignant = PSAMMOMA BODIES poorly differentiated/ invasive into stroma
**Apart from PSAMMOMA bodies the above are general rules for benign vs. malignant tumors
Gross differenence between benign and borderline serous tumors?
Papillae are more numerous and can originate on ovarian surface in borderline
Mucinous tumors:
how do they differ grossly from serous tumors?
at what age do they tend to present?
-multi-lobulation/ larger, not bilateral
(looks like a big fat honeycomb)
-tumor of middle age
Mucinous tumor histo appearance :
- Tall columnar cells with MUCIN, no cilia
- Benign: Resembles CERVIX
- Malignant/ Boarderline: Resembles INTESTINE (glandular epi)
