Ovarian Neoplasms

Question 1

How does an ovarian neoplasm present?

Answer 1

adnexal mass, abdominal distension, bowel obstruction, pleural effusion. DX: surgically. Monitor progression by measuring CA-125 levels.

Question 2

What are the Benign ovarian neoplasms?

Answer 2

Serous cystadenoma, mucinous cystadenoma, endometrioma, mature cystic teratoma (dermoid cyst), Brenner tumor, Fibromas, Thecoma

Question 3

Serous cystadenoma

Answer 3

Most common ovarian neoplasm. Thin walled, uni or multilocular. Lined with fallopian-like epithelium. Often bilateral

Question 4

Mucinous cystadenoma

Answer 4

Multiloculated, large. Lined by mucus secreting epithelium.

Question 5

Endometrioma

Answer 5

Mass arising from growth of ectopic endometrial tissue. Complex mass on ultrasound. Presents with pelvic pain, dysmenorrhea, dysparenuia

Question 6

Mature Cystic Teratoma (dermoid cyst)

Answer 6

Germ cell tumor, most common ovarian tumor in women (20-30 years old). Can contain elements from all 3 germ layers; teeth, hair, sebum are common components. Can present with pain secondary to ovarian enlargement or torsion. Can also contain functional thyroid tissue and present as hyperthyroidism (struma ovarii)

Question 7

Brenner tumor

Answer 7

looks like bladder. solid tumor that is pale yellow-tan in color and apears encapsulated. “coffee bean” nuclei on H&E

Question 8

Fibromas

Answer 8

Bundles of spindle shaped fibroblasts. Meigs syndome - triad of ovarian fibroma, ascites, and hydrothorax. Pulling sensation in groin

Question 9

Thecoma

Answer 9

Like granulosa cell tumors, may produce estrogen. Usually present as abnormal uterine bleeding in a postmenopausal woman.

Question 10

What are the malignant ovarian neoplasms?

Answer 10

Immature teratoma, granulosa cell tumor, serous cystadenocarcinoma, mucinous cystadenocarcinoma, dysgerminoma, choriocarcinoma, yolk sac (endodermal sinus) tumor, krukenberg tumor

Question 11

Immature Teratoma

Answer 11

Aggressive, contains fetal tissue, neuroectoderm. Immature teratoma is most typically represented by immature/embryonic like neural tissue. Mature teratoma are more likely to contain thyroid tissue.

Question 12

Granulosa cell tumor

Answer 12

Most common sex cord stromal tumor. Predomionanty women in their 50s. Often produce estrogen and/or progesterone and present with abnormal uterine bleeding, sexual precocity (in pre-adolescents), breast tenderness. Histology shows Call-Exner Bodies (resemble primordial follicles).

Question 13

Serous Cystadenocarcinoma

Answer 13

Most common ovarian neoplasm, frequently bilateral. Psammoma bodeis

Question 14

Mucinous Cystadenocarcinoma

Answer 14

Pseudomyxoma Peritonei-intraperitoneal accumulation of mucinous material from ovarian or appendiceal tumor.

Question 15

Dysgerminoma

Answer 15

Most common in adolescents. Equivalent to male seminoma but more rare. 1% of all ovarian tumors; 30% of germ cell tumors. Sheets of uniform ‘fried egg’ cells. hCG, LDH = tumor markers.

Question 16

Choriocarcinoma

Answer 16

Rare; can develop during or after pregnancy in mother or baby. malignancy of trophoblastic tissue (cytotrophoblasts, syncytiotrophoblasts); NO chorionic villi present. Increase frequency of theca-lutein cysts. Presents with abnormal B-hCG, shortness of breath, hemoptysis. Hematogenous spread to lungs. Very responsive to chemotherapy.

Question 17

Yolk Sac (endodermal Sinus) tumor

Answer 17

Aggressive, in ovaries or testes (boys) and sacrococcygeal area in young children. Most common tumor in male infants. Yellow, friable (hemorrhagic), solid mass. 50% have Schiller-Duval bodies (resemble glomeruli). AFP tumor marker

Question 18

Krukenberg tumor

Answer 18

GI malignancy that metastasizes to the ovaries, causing a mucin-secreting signet cell adenocardinoma.