Ovarian Neoplasms

Question 1

2 Most Common Epithelial Tumors

Answer 1

Serous and mucinous cystadenomas/cystadenocarcinomas

Question 2

Cystadenoma and Cystadenocarcinoma Appearance/Demographic Differences

Answer 2

Benign are single cyst with simple flat lining in pre-menopausal (30-40)
Malignant are complex with thick shaggy lining in postmenopausal

Question 3

BRCA1 Mutation (risk/tx)

Answer 3

Increased risk for serous carcinoma of ovary and fallopian tube, so may need prophylactic sapingo-oophorectomy

Question 4

Brenner Tumor

Answer 4

Epithelial tumor with bladder-like epithelium (urothelium) usually benign

Question 5

Endometrioid Tumor (what it is/malignancy, possible precursor, important association)

Answer 5

Epithelial tumor of endometrial-like glands that are usually malignant
Can arise from endometriosis
15% associated with an independent endometrial carcinoma

Question 6

Epithelial Tumors Presentation/Prognosis/Marker

Answer 6

Usually present late with vague abdominal symptoms from local spread, so poor prognosis
CA-125 is good marker for tx and recurrence, not screening

Question 7

4 Germ Cell Tissue Types and Their (5) Respective Tumors

Answer 7

Fetal Tissue - Cystic teratoma and embryonal carcinoma
Oocytes - dysgerminoma
Yolk sac - endodermal sinus tumor
Placental tissue - choriocarcinoma

Question 8

Cystic Teratoma 2 Indications of Malignant Potential

Answer 8

Immature tissue, usually neural ectoderm

Somatic malignancy of another cell type in the teratoma, usually squamos cell carcinoma of the skin

Question 9

Struma ovarii

Answer 9

Teratoma composed of mostly thyroid tissue that can lead to hyperthyroidism

Question 10

Dysgerminoma (Histo, male equiv, response, serum marker)

Answer 10

Large cells w/ clear cytoplasm and central nuclei (resemble oocytes)
Seminoma
Good px, responds well to radiotherapy
Serum LDH may be elevated

Question 11

Endodermal Sinus Tumor (what it is, demographic, serum marker, histo)

Answer 11

Yolk sac malignancy, most common germ cell tumor in children
elevated AFP
Schiller-Duval bodies - glomeruloid structures

Question 12

Choriocarcinoma (what it is/histo, spread, serum marker, response)

Answer 12

Malignant tumor of trophoblasts and syncytiotrophoblasts that mimics placenta but VILLI absent
Early hematogenous spread so can be small primary and lotsa mets
High hCG, can lead to thecal cysts in ovary
Poor response to chemo

Question 13

Embryonal Carcinoma

Answer 13

Malignant tumor with large primitive cells and aggressive, early mets

Question 14

Granulosa-Theca Cell Tumor

Answer 14

Produces more E, so get signs of E by age
Precocious puberty
Menorrhagia or metrorrhagia
Postmenopausal bleeding/endometrial hyperplasia

Question 15

Sertoli-Leydig Cell Tumor (product/effect, histo)

Answer 15

Produce androgens so can get hirsutism or virilization

Characteristic Reinke crystals

Question 16

Fibroma (what it is, important association)

Answer 16

Benign tumor of fibroblasts

Meigs syndrome - Fibroma, pleural effusions, ascites, resolves with removal of tumor

Question 17

Krukenberg Tumor (what it is/cause and how to distinguish from ddx)

Answer 17

Metastatic mucinous tumor, usually gastric carcinoma (diffuse type) but can be colon or breast
Bilateral, unlike primary mucinous carcinoma of the ovary which is unilateral

Question 18

Pseudomyxoma peritonei

Answer 18

Massive amounts of mucus in peritoneum, usually from mucinous tumor of appendix with mets to ovary