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DT4-Exam 1 > Ovarian Disease-Leah : ) > Flashcards

Ovarian Disease-Leah : ) Flashcards

1
Q

Lesions of the ovary (three types)

A
  • cysts
  • tumors
  • inflammation (rare)
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2
Q

Two types of benign (functional) cysts:

Which hormone is each assc with?

A
  • cystic follicles/follicular cyst: estrogen

- luteal cysts: progesterone

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3
Q

Cells lining a cystic follicle?

What fills the follicle?

A
  • thin granulosa lining (produces estrogen)

- follicle looks “empty” or “fluid filled” - no cells in the cyst!

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4
Q

Where do cystic follicles originate (2 possibilities)?

A
  • graffian follicle that failed to rupture
  • graffian follicle that ruptured/ immediately closed

(rupture is normal –> its what releases an egg in ovulation)

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5
Q

What is a follicular cyst?

A

A follicular CYST is just a large cystic follicle.

Same process– just called a “cyst” if bigger than 2cm (called a FOLLICLE if small)

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6
Q

What does a luteal cyst look like on histo? What are they filled with?

A
  • lined with luteinized cells (prog. production)

- full of fibrin (not empty like cystic follicles)

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7
Q

Rupture of a luteal cyst causes ?

A

peritoneal reaction–may be mistaken or appendicitis!

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8
Q

Stein-Levanthall syndrome:
What common disease is this?
Presentation?
Presumed cause/treatment?

A

-PCOS/D
-obese woman with ^^ adrogenicity; infertile
-now thought to be caused by insulin resistance
(insulin mediators can cause ovulation to resume)

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9
Q

Most common cause of ovarian cancer death?

A

-late detection (common sense)

just know these are hard to detect and often found when its too late– no screening tools in place.

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10
Q

Clinical symptoms of ovarian tumors (3)

A
  • 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.)

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11
Q

Why is nulliparity a risk for ovarian cancer?

A

-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

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12
Q

What three groups (tissue types) are ovarian cancers classified under?

A

-epithelial
-germ cells
-stromal/support cells
(based on the cells from which the tumor originates)

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13
Q

Which of the ovarian cancers is most common?

What age group gets these?

A
  • 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

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14
Q

Three common epithelial derived ovarian cancers? One other?

One other random tumor of the ovarian epi?

A
  • serous (#1)
  • mucinous
  • endometriod: clear cell v. cystadenofibroma

Also: Brenner’s Tumor exists

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15
Q

Are epithelial tumors bilateral or unilateral?

A

Most can be bilateral, but rarely see this in the mucinous type!!

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16
Q

What increases the likelihood than an epithelial tumor will be malignant?

A

-^^ SOLID material

solid is bad, cystic is good

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17
Q

How are serous and mucinous tumors subdivided (3)?

What are these subdivisions characterized by?

A
  • benign- well differentiated
  • borderline- increased complexity + nuclear atypia
  • malignant- STROMAL INVASION

( review of classification: ovarian tumor –> epi. derived –> serous v. mucinous –> benign v. malignant)

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18
Q

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.

A
  • 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.
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19
Q

Occasionally tumor cells are derived via endometriosis. What tumors are caused by this process?

A

The more rare ones –clear cell/adenofibroma

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20
Q 
Serous Tumor/ Serous cystadenoma:
From what tissue is the tumor derived? 
Commonly benign or malignant--which population gets malignant tumors?
Gross appearance (2)? 
Bilateral?
A
  • # 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
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21
Q

Histo appearance of serous tumor?

A

-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

22
Q

Gross differenence between benign and borderline serous tumors?

A

Papillae are more numerous and can originate on ovarian surface in borderline

23
Q

Mucinous tumors:
how do they differ grossly from serous tumors?
at what age do they tend to present?

A

-multi-lobulation/ larger, not bilateral
(looks like a big fat honeycomb)
-tumor of middle age

24
Q

Mucinous tumor histo appearance :

A
  • Tall columnar cells with MUCIN, no cilia
  • Benign: Resembles CERVIX
  • Malignant/ Boarderline: Resembles INTESTINE (glandular epi)
25
Q

What is Pseudomyxomatous Peritonei?

A
  • Ovarian tumor causing “mucinous ascites”
  • Can cause intestinal obstruction and death
  • *Note: these tumors more commonly occur in APPENDIX

(looks like a tumor just taking over the whole abdomen in the pictures)

26
Q 
Two types of endometroid ovarian tumors?
Which is benign and which is malignant?
Which is more common?
What is the source? 
**What should we check for clinically?
A
  • Benign: Cystadenofibroma
  • Malignant: Clear cell adnenocarcinoma (more common)
  • *Comes from “endometriosis” in younger women

**Up to 30% patients will have underlying endometrial carcinoma of uterus–CHECK THE UTERUS!!!

(Dr. Brown says that although clear cell is supposedly more common, she sees cystadenofibroma in practice.)

27
Q

Histo for endometrioid tumors?

A

tubular glands + stroma that resemble endometrial tissue

28
Q

Brenner Tumor of the ovary:
histo?
malignant?

A

-transition/ urothelial cells!
(like bladder cancer of the ovary)
-usually benign

29
Q

What happens when malignant EPITHELIAL ovarian tumors spread beyond the ovary?

Tumor marker for EPITHELIAL ovarian cancer?

A
  • peritoneal seeding/ massive ascites filled with malignant cells (will look like 3D “balls” of cells)
  • CA-125
30
Q

What reduces risk of EPITHELIAL ovarian cancer? (3)

A
  • tubal ligation
  • birth control
  • BRCA screenings
31
Q

Germ Cell Tumors of Ovary:

  • Which is the most common type? malignant?
  • What others exist (5)? malignant?
A

1: Benign/mature teratoma (Adults)

#2: Malignant tumors in young adults/ kids:
- Immature teratoma
- Monodermal teratoma (struma ovarii– thyroid tissue)
- Dysgerminoma
- Sinus/yolk sac
- Choriocarcinoma

32
Q

Benign Teratoma: aka?
Most common germ cell layer involved?
Age group and assc epidermal tumor?

A
  • Dermoid cyst
  • Can be any germ layer but usually ectoderm
  • Young women; mucinous cystadenoma assc.
33
Q

Benign teratoma:
gross appearance
histo appearance

A
  • Unilocular, contain hair and cheesy sebaceous material + sometimes teeth/ calcification.
  • can be any mature tissue but usually mature squamous epi w/ underlying adnexal structures
34
Q

Karyotype for benign teratoma?

From what cell are they derived?

A
  • derived from ovum after first meiotic division

- 46 X,X

35
Q

Immature/ malignant teratoma:
from what tissue?
treatment?

A
  • Tissue resembles that found in fetus/ embryo (as opposed to mature in benign teratoma)
  • responds to chemo
36
Q

Gross appearance of immature/ malignant teratoma?

Histo grading scale?

A
  • Solid w/ areas of necrosis + hemorrhage

- Grade (I-III) based on amount of immature neuroectoderm

37
Q

What is struma ovarii?

Benign or malignant?

A
  • monodermal teratoma made of thryoid tissue; may be functional
  • usually benign
38
Q 
Dysgerminoma:
male counterpart? 
prevalence ?
age group? 
With what congenital abnormality is this tumor associated? 
prognosis?

one sign?

A
  • Seminoma in males
  • Rare; accounts for HALF OF MALIGNANT GERM CELL TUMORS!!!
  • Young people/ kids!
  • Assocated w gonadal dysgenisis
  • Bad actor but radiosensitive

-May secrete HCG, unlike chorio which always secretes HCG

39
Q

Dygerminoma

gross + histo appearance?

A
  • large and round

- fibrous stroma filled with lymphocyes + large cells w clear cytoplasm

40
Q

Endodermal Sinus (Yolk Sac) Tumor:

  • who gets it?
  • what does it secrete?
  • whats the outcome?
A
  • young women
  • secretes AFP/ a1 antitrypsin
  • bad prognosis
41
Q

Classic histo finding for yolk sac tumors in males AND females:

A

Schiller-Duval body: looks like a glomerulus

42
Q 
Choriocarcinoma:
USUALLY where do these arise?
What do they secrete?
Tx? 
Outcome?
A
  • More commonly of placental origin, may be seen as part of mixed tumor in male testis.
  • Secrete HCG
  • In contrast to placenta, CHEMO DOESN’T WORK IN OVARY FOR CHORIO.
  • They are AGRESSIVE and they will met.
43
Q

Cells that make up choriocarcinomas?

A

-trophoblasts (syncytio/ cyto)

44
Q

Where does the ovarian stroma come from?

What cells does it contain?

A
  • sex cords of primitive gonads

- sex cords contain granulosa/ thecal cells in women and leydig/sertoli cells in males.

45
Q

Theca/ granulosa tumors:
who gets these?
what do they secrete?

A
  • older women
  • secrete estrogen/ inhibin
  • malignant– rare
46
Q

Theca/ granulosa tumors:
gross appearance?
classic histo findings?

A

Large yellow tumors due to ^^ lipids for hormone synthesis

Histo:

  • Granulosa component = CALL-EXNER BODIES (resemble immature follicles)
  • Theca component= cells w/ coffee bean nuclei
47
Q

Fibroma – Thecoma:
How common?
Benign vs maligant?
Describe the two cell components:

A
  • very common
  • benign but thecoma is hormonally active

Histo: “Glistening white mass”

  • fibroblasts (fibromas)
  • spindle cells with lipid drops (thecoma)– can be pure or mixture of both
48
Q

What is Meigs Syndrome?

A

Fibroma-thecoma causing:

  • pelvic pain
  • ascites
  • right sided hydrothorax
49
Q

Fibroma with increased nuclear/cytoplasmic ratio + mitoses would actually be?

A

fibrosarcoma– malignant.

50
Q

Androblastoma?

  • What is it?
  • What does it cause?
  • Malignant?
A
  • Sertoli/ Leydig cell tumor
  • Masculinization or defeminization (loss of hips, facial hair etc)
  • usually benign
51
Q

Kruckenberg tumor:

what is it?

A

-signet ring tumor that mets from stomach to ovary

DT4-Exam 1 (17 decks)

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