ovarian neoplasms

Question 1

surface eptihelial tumors: epidemiology, where are they derived from? What are the two most common types? how are they graded?

Answer 1

most common ovarian tumor
derived from coelomic epithelium that lines the ovary. two most common subtypes of surface epithelial cells are serous and mucinous. both are usually cystic. may be benign, borderline, or malignant.

Question 2

Benign surface epithelial tumors: name, features, epidemiology

Answer 2

called cystadenomas. composed of single cyst with simple, flat lining. most commonly arises in premenopausal women (30-40).
may be serous or mucinous.
serous are most common ovarian neoplasm. may be bilateral, lined with fallopian-like epithelium, multilocular.

Question 3

maligant surface epithelial tumors: name, definition, path features, epidemiology

Answer 3

cystadenocarcinoma. composed of complex/multiple cysts with thick, shaggy lining. cells invade into CT of the cyst wall. may be mucinous or serous (psammoma bodies). most commonly in post menopausal women (60-70)

Question 4

what are borderline tumors?

Answer 4

features in between benign and malignant tumors. better prognosis than malignant tumors, but still carry metastatic potential.

Question 5

How do ovarian tumors present? How do you diagnose? how do you monitor progression? How do they spread?

Answer 5

present with adnexal mass, abdominal distention, bowel obstruction, or pleural effusion. they spread locally, esp. to the peritoneum (omental caking). diagnose surgically. monitor progession with CA-125 measurements.

Question 6

BRCA1 mutations and ovarian cysts

Answer 6

incr. risk of serous carcionoma of the ovary AND fallopian tube.

Question 7

What are the 2 uncommon types of surface tumors?

Answer 7

endometriod: usually malignant, but may be benign. may be associated with endometriosis. 15% will also have separate endometriod carcinoma in the endometrium.
or brenner: benign and contains urothelium. solid tumor that is pale yellow-tan and appears encapsulated. see coffee been nuclei on H&E

Question 8

germ cell tumors: epidemiology

Answer 8

2nd most common ovarian tumor, usually in women of reproductive age (think in 15-35). (remember 30-40: benign surface epithelial; 60-70: malignant surface epithelium).
tumor subtypes mimic tissues normally produced by germ cells.

Question 9

What kinds of germ cell tumors are there based on the tissues that germ cells can make?

Answer 9

fetal tissue --> cystic teratoma
fetal primitive tissue --> embrynal
yolk sac --> yolk sac tumor (endodermal sinus tumor)
germ cells --> dysgerminoma
placenta --> choriocarcinoma

Question 10

cystic teratoma: definition, epidemiology

Answer 10

cystic tumor composed of fetal tissue derived from 2-3 embryonic layers. most common germ cell tumor in females and is bilateral 10% of the time.

Question 11

cystic teratoma: bengin vs. malignant

Answer 11

usually benign. to be a benign teratoma (dermoid cyst), we must show that there is no immature tissue (most common tissue that would be immature is neural ectoderm- this would no longer be benign).
we must also show that none of the tissue in the teratoma has a cancer (ex. skin in the teratoma has squamous cell carcinoma). this is called a somatic malignancy. most common somatic malignancy: sqamous cell carcinoma

Question 12

struma ovarii

Answer 12

cystic teratoma composed primarily of thyroid tissue. hyperthyroidism + mass in ovary, you should consider struma ovarii

Question 13

dysgerminoma: definition and epidemiology, tumor markers

Answer 13

mass of egg-like cells: composed of large cells with clear cytompasm and central nuclei that resemble the oocytes
most common malignant germ cell tumor, most commonly seen in adolescents.
(equivalent to the seminoma in the testicles). tumor markers: LDH and hCG. responds to therapy.

Question 14

endodermal sinus tumor: tumor markers, epidemiology, characteristics

Answer 14

malignant tumor that mimics the yolk sac. most common germ cell tumor in kids. serum AFP is elevated. Schiller-duval bodies are seen on histology (glomeruloid like structures- blood vessel in the center, cells organizing around it).

Question 15

choriocarcinoma: histologic and clinical features, tumor markers

Answer 15

malignant prolifeation of placental like tissue. normally you have villi in the placenta, but these cells do NOT have villi. (cytotrophoblasts and syncitiotrophoblasts normally surround the villi, but in choriocarcinoma, the blasts are proliferating by themselves).
this is a small, hemorrhagic tumor with early hematogenous spread (these cells are designed to do that).
high beta-hCG
poor response to chemo.

Question 16

embryonal carcinoma: what is it, features

Answer 16

composed of large primitive cells. aggressive with early mets.

Question 17

What are sex cord stromal tumors?

Answer 17

tumors that resemble normal sex cord-stromal tissue of the ovary: granulosa cells, theca cells, fibrous tissue, rarely, sertoli/leydig cells.

Question 18

granulosa theca cell tumor: what is it, how does it present, any important path features

Answer 18

tumor of granulosa and theca cells. often makes estrogen (made by granulosa cells). present with signs of estrogen excess (precocious puberty in a kid, heavy menstrual bleeding in a middle adult, abdnormal uterine bleeding post-menopausal). histoly may show call-exner bodies, which resemble primordial follicles

Question 19

sertoli leydig tumor: what is it, how does it present, any important path features

Answer 19

mimics the sex cord stromal elements of the testicle. sertoli cells form tubules. leydig cells contian characteristic Reinke crytals. the may produce androgen (hirtsutism or virilization)

Question 20

fibroma: what is it, how does it present, any important path features?

Answer 20

benign tumor of fibroblasts. in a subset of patients, will present with Meig’s syndrome: pleural effusion and ascites. solid tumor with lots of white bands running through it.

Question 21

metastatic tumors to the ovary

Answer 21

1. kruckenberg tumor: bilateral ovarian tumor mets from mucinous carcinoma. primary site is classically a diffuse gastric carcinoma (other primary sites, like lobular breast carcinoma or colon cancer can spread to the ovaries, but diffuse stomach CA is the classic type).
   pseudomyxoma peritonei: abundant amount of mucin in the peritoneum (“jelly belly”). primary source is usually a mucinous carcinoma of the appendix.