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MSII Pathology > Ovarian disorders > Flashcards

Ovarian disorders Flashcards

1
Q

what is the most common ovarian mass?

A

follicular cyst

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2
Q

what is a follicular cyst?

  • what happens if it ruptures?
  • does it regress?
  • best screening test?
  • what if it’s symptomatic?
A

non-neoplastic cyst (accumulation of fluid in a follicle, or previously ruptured follicle)

  • rupture produces sterile peritonitis with pain
  • most regress spontaneously
  • US is best screening test
  • surgical removal if symptomatic
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3
Q

what is the most common ovarian mass in pregnancy?

A

corpus luteum cyst

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4
Q

what is a corpus luteum cyst?

  • does it regress?
  • what if it’s symptomatic?
A

non-neoplastic cyst (accumulation of fluid in CL during pregnancy; may be confused with amniotic sact)

  • most regress spontaneously
  • surgical removal if symptomatic
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5
Q

what is oophoritis?

A

may be a complication of mumps or PID

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6
Q

epidemiology of stromal hyperthecosis?

A

occurs primarily in obese postmenopausal women, causing bilateral ovarian enlargement

  • hypercellular ovarian stroma (vacuolated/luteinized stromal hilar cells are present to make excess androgens)
  • may cause hirutism or virilization
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7
Q

clinical findings of stromal hyperthecosis?

A
  • hirutism or virilization
  • association with acanthosis nigricans and insulin resistance (metabolic syndrome)
  • HTN
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8
Q

treatment of stromal hyperthecosis

A

oophorectomy

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9
Q

epidemiology and pathogenesis of ovarian tumors

A

more likely benign in women <45 yo

  • risk increases with age
  • median age of presentation is 61 yo, and approx. 60% present with advanced disease
  • peaks in late 70s
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10
Q

risk factors for ovarian tumors

A
  1. nulliparity (increased number of ovulatory cycles increases risk for surface-derived ovarian tumors)
  2. genetic factors (mutations of BRCA1/2 suppressor genes, Lynch syndrome, Turner’s syndrome (increased risk for dysgerminoma), Peutz-Jeghers syndrome (increased incidence of sex cord tumors with annular tubules))
  3. history of breast cancer
  4. postmenopausal estrogen therapy, obesity (increased estrogen)
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11
Q

what decreases risk of surface-derived ovarian cancers?

A

OCPs/pregnancy (decreased number of ovulatory cycles)

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12
Q

surface-derived ovarian tumors

  • percentage
  • derivation
A

most common group (65-70% of ovarian tumors)

  • derive from coelomic epithelium
  • account for greatest number of malignant ovarian tumors, which commonly seed omentum
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13
Q

germ cell ovarian tumors

  • how many are malignant?
  • common benign and malignant types
A

account for 15-20% of ovarian tumors

  • cancers similar to testicular cancer
  • small number of tumors are malignant
  • teratoma and dysgerminoma are most common benign and malignant, respectively
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14
Q

serous cystadenocarcinoma

A

most common ovarian cancer (surface-derived, serous tumor)

  • benign, with psammoma bodies (dystrophically calcified tumor cells)
  • most common malignant tumor that is bilateral
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15
Q

what do malignant surface-derived cancers commonly seed?

A

abdominal cavity

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16
Q

sex cord stromal tumors

  • percentage
  • derivation
  • benign or malignatn?
A

3-5% of ovarian tumors

  • derive from stromal cells
  • may be hormone producing
  • majority of tumors are benign
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17
Q

metastisized ovarian tumors?

A

5% of ovarian tumors

-common primary cancers metastasize to ovaries (breast, stomach)

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18
Q

clinical findings of ovarian tumors (6)

A
  1. abdominal enlargement due to fluid (most common sign)
    - malignant ascites most often due to seeding (induration of rectal pouch on digital rectal exam, and intestinal obstruction with colicky pain)
  2. palpable ovarian mass in postmenopausal women (should NOT be palpable; cancer until proven otherwise)
  3. malignant pleural effusion (common site for ovarian cancer metastasis)
  4. cystic teratomas undergo torsion leading to infarction (radiographs show calcification from bone/teeth)
  5. signs of hyperestrinism from estrogen-secreting tumors (bleeding from endometrial hyperplasia/cancer, 100% superficial squamous cells in cervical Pap smear)
  6. Hirsutism or virilization from androgen-secreting tumors
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19
Q

ovarian tumor markers

A

increased serum cancer antigen 125

-only increased in surface-derived malignant tumors

20
Q

treatment for ovarian cancer

A

surgery, chemotherapy, sometimes radiation

21
Q

ovarian tumor prognosis

A

better if <65 yo

-overall 1 and 5 year relative survival rates are 75% and 45%

22
Q

4 types of surface derived (serosal epithelium) tumors and if benign/malignant

A
  1. serous tumors (benign cystaderoma to malignant adenocarcinoma)
  2. mucinous tumors (benign cystaderoma to malignant adenocarcinoma)
  3. endometrioid (malignant)
  4. Brenner tumor (benign)
23
Q

3 types of germ cell tumors and if benign/malignant

A
  1. cystic teratoma (benign)
  2. dysgerminoma (malignant)
  3. yolk sac tumor (malignant)
24
Q

4 types of sex-cord stromal tumors and if benign/malignant

A
  1. thecoma-fibroma (benign)
  2. granulosa-theca cell tumor (malignant)
  3. Sertoli-Leydig cell (malignant)
  4. gonadoblastoma
25
Q

what is a Krukenberg tumor?

A

a tumor metastatic to ovary

  • may affect both ovaries
  • contains signet-ring cells from hematogenous spread of a gastric cancer
26
Q

serous tumors characteristics

-most common type?

A

surface derived tumors

  • most common group of primary benign and malignant tumors
  • most common group of tumors that can be bilateral
  • cysts are lined by ciliated cells (similar to fallopian tube)
  • serous cystadenoma(carcinoma) is most common benign
27
Q

mucinous tumors characteristics

A

surface derived tumors

  • cysts lined by mucus-secreting cells (similar to endocervix)
  • large, multiloculated tumors
  • seeding produces pseudomyxoma peritonei
  • mucinous cystadenoma (benign) may be associated with Brenner tumors
  • -mucinous cystadenocarcinoma
28
Q

Brenner tumor characteristics

A

surface derived tumors

  • usually benign
  • contain Walthard rests (transitional-like epithelium)
29
Q

endometrioid tumor

A

surface derived tumors

  • malignant tumors associated with endometrial carcinoma (15-30% of cases)
  • tumor resembles endometrial carcinoma
  • commonly bilateral
30
Q

cystic teratoma characteristic

A

most common benign germ cell tumor; less than 1% become malignant (usually squamous cancer)

  • ectodermal differentiation (hair, sebaceous glands, teeth) most prominent
  • most found in nipple-like structure in cyst wall (Rokitansky tubercle)
  • immature malignant types contain mature and immature components (muscle, neuroepithelium)
  • struma ovarii type has functioning thyroid tissue
31
Q

dysgerminoma characteristics

A

most common malignant germ cell tumor; characteristic increase in serum LDH

  • same histologic picture as seminoma of testis
  • associated with streak gonads of Turner syndrome
32
Q

yolk sac tumor characteristics

A

germ cell tumor

  • malignant
  • most common ovarian cancer in girls < 4 yo
  • contains Schiller-Duval bodies (resemble yolk sac)
  • increased a-FP
33
Q

thecoma-fibroma characteristics

A

sex-cord stromal tumor

  • benign and associated with Meigs’ syndrome (ascites, right-sided pleural effusion)
  • -regression of effusions follows removal of tumor
  • commonly calcify
34
Q

granulosa-theca cell tumor characteristics

A

sex-cord stromal tumor

  • low-grade malignant tumor
  • feminizing (estrogen-secreting) tumor that contains Call-Exner bodies
35
Q

Sertoli-Leydig cell tumor characteristics

A

sex-cord stromal tumor

  • benign masculinizing (androgen-producing) tumor
  • pure Leydig cell tumors contain cells with crystals of Reinke
36
Q

gonadoblastoma characteristics

A

sex-cord stromal tumor

  • malignant tumor with mixture of germ cell tumor (dysgerminoma) and sex-cord stromal tumor
  • associated with abnormal sexual development in 80% of cases
  • commonly calcify
37
Q

causes of vaginal bleeding in adolescent (common to rare)

A
  1. anovulation
  2. pregnancy
  3. exogenous hormone use
  4. coagulopathy
38
Q

causes of vaginal bleeding in reproductive age (common to rare)

A
  1. pregnancy
  2. anovulation
  3. exogenous hormone use
  4. uterine leiomyomas
  5. cervical and endometrial polyps
  6. thyroid dysfunction
39
Q

causes of vaginal bleeding in perimenopausal (common to rare)

A
  1. anovulation
  2. uterine leiomyomas
  3. cervical and endometrial polyps
  4. thyroid dysfunction
40
Q

causes of vaginal bleeding in postmenopausal (common to rare)

A
  1. endometrial lesions (including cancer)
  2. exogenous hormone use
  3. atrophic vaginitis
  4. other tumor (vulvar, vaginal, cervical)
41
Q

what are the markers CA-125, alpha-FP, beta-hCG, and inhibin usually associated with?

A

CA-125: serous cystadenoma (usually benign)
aFP: yolk sac tumor (malignant)
BhCG: choriocarcinoma (malignant)
inhibin: granulosa cell tumor

42
Q

what mutations are usually seen in low-grade serous carcinomas?

A

mutually exclusive genetic abnormalities affecting MAPK pathway in 80% of cases

  • HER2 amplification
  • KRAS mutations
  • BRAF mutations
43
Q

differences between type I and II serous ovarian cancers

  • progression
  • grade
  • Ras, BRCA, and TP53 status
  • Xm
  • platinum effect
A

I

  • progress from LMP
  • usually low grade
  • Ras pathway frequently mutated
  • BRCA wild type
  • generally TP53 wild type
  • Xmally stable
  • frequently platinum insensitive

II

  • de novo invasive tumors
  • high grade
  • Ras wild type
  • BRCA dysfunction
  • TP53 mutant
  • widespread DNA copy number change
  • usually platinum sensitive
44
Q

what is the T/N/M staging method for tumors?

A

T: size or direct extent of the primary tumor
-Tx: tumor cannot be evaluated
-Tis: carcinoma in situ
-T0: no signs of tumor
-T1, T2, T3, T4: size and/or extension of the primary tumor
N: degree of spread to regional lymph nodes
-Nx: lymph nodes cannot be evaluated
-N0: tumor cells absent from regional lymph nodes
-N1: regional lymph node metastasis present; (at some sites: tumor spread to closest or small number of regional lymph nodes)
-N2: tumor spread to an extent between N1 and N3 (N2 is not used at all sites)
-N3: tumor spread to more distant or numerous regional lymph nodes (N3 is not used at all sites)
M: presence of distant metastasis
-M0: no distant metastasis
-M1: metastasis to distant organs (beyond regional lymph nodes)[3]

45
Q

between the grades and the stages (if only 1 ovary affected), what’s the risk for ovarian cancer?

A

low risk: grade 1, stage 1A

intermediate: grade 1,, stage 1BC; grade 2, stage 1A
high: grade 2, stage 1BC; grade 3, stage 1ABC

46
Q

when is adjuvant chemotherapy most effective?

A

improves survival in high risk early stage ovarian cancer

MSII Pathology (11 decks)

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