Ovarian Path Flashcards
What do serous bordeline tumors look like microscopically
HIERARCHICAL BRANCHING
Psammoma bodies- Laminated/targetoid calcifications
Mature Cystic Teratoma
Germ cell tumor All three types of germ layers Commonest ovarian tumor Some have teeth!! Most asymptomatic
Anti-NMDA Encephalitis
Anti-N-methyl D-aspartate receptor (NMDAR) encephalitis affects young women
Presents with psychosis, memory deficits, seizures
Frequently associated with underlying neoplasm, most often teratoma
Immature Teratoma
Grading based on amount of immature neural tissue (more is worse)
Dysgerminoma
50% of malignant GCT
Female counterpart to seminoma
Excellent prognosis, even with widespread metastases
Sheets and nests of cells with large central nuclei and prominent nucleoli
Yolk Sac Tumor
Usually 10-30 years old or perimenopausal women
Produces alpha-fetoprotein
Schiller-Duval body
What the histologic feature to know about yolk sac tumors?
Schiller-Duval body- Glomeruloid structure with central blood vessel surrounded by neoplastic cells
Sex Cord Stromal Tumors
Granulosa cell tumor (adult and juvenile)
Thecoma-fibroma
Sertoli-Leydig cell
Adult Granulosa Cell Tumor
3% primary ovarian tumors
Associated with endometrial neoplasia
Serum inhibin is a great tumor marker
Late recurrance
Call-Exner bodies: resembles orimitive follicae; central space with secretions
What’s the path buzz word for Adult Granulosa Cell Tumors?
Call-Exner bodies: resembles orimitive follicae; central space with secretions
Fibroma/Thecoma
4% of all ovarian tumors
Almost all benign, but 1/5 have concurrent endometrial carcinoma
Hormone secreting in some cases can lead to abnormal bleeding as presenting symptom
Meig’s syndrome: Fibroma + Ascites + Hydrothorax
Sertoli-Leydig Cell Tumor
Recapitulates developing testis
Clinical outcome dependent on stage & grade
12% clinically malignant
Well differentiated: rarely metastasizes
Moderately/poorly diff: ~10% metastasize
General features of primary vs metastatic disease
Primary: Unilateral No surface growth Absence of nodularity Larger (>10 cm)
Metastatic Bilateral Surface and hilar involvement Nodular growth pattern Infiltrative growth with desmoplastic stroma Smaller (
Krukenberg Tumor
Metastatic gastric carcinoma
Signet ring morphology
Pseudomyxoma Peritoneii
Metastatic from appendix
“Jelly belly”- mucin throughout abdomen
Tubal Intraepithelial Carcinoma
Fimbriated end of fallopian tube
Putative precursor to most ovarian high grade serous carcinomas
p53
Ectopic Pregnancy
Implantation other than intrauterine 90% in fallopian tube 35-50% with prior PID Other tubal scarring Most common cause of hematosalpinx Rupture = Medical Emergency
Endometriosis
Extrauterine endometrial glands and stroma
Ovaries, uterine ligaments, pelvic peritoneum, bowel
6-10% women
Infertility, dysmenorrhea, pelvic pain
“chocolate cyst”
Polycystic Ovarian Disease
Young ♀ with infertility, oligomenorrhea, obesity (40%) and hirsutism (50%)
Pathophysiology:
Persistent anovulation due to asynchronous release of FSH and LH
Excess androgens with peripheral conversion to E2
Rx: Early intervention, metformin
Risk: unopposed E2 risk for Endometrial CA
Inherited Risk Factors for ovarian cancer
BRCA1: Ch 17q21 & BRCA2: 13q12-13 DNA repair genes Syndrome includes CA of breast and ovary Patients frequently survive breast CA, mortality from ovarian CA Typically high grade serous carcinoma
Presenting symptoms of ovarian cancer
Bloating Pelvic/Abdominal pain Early satiety Urinary symptoms Others: fatigue, dyspareunia, constipation, metrorrhagia
> 12 times/month or persistent symptoms new to patient visit doctor (gynecologist)
What are the major classifications of ovarian tumors?
Surface epithelial (stromal cell): 65-70%
Germ Cell: 15-20%
Sex cord-stroma: 5-10%
Metastasis to ovaries: 5%
What is the origin of most epithelial tumors believed to be?
fimbriated end of fallopian tube
Do low-grade serous carcinomas of the ovaries exist? What about low-grade serous carcinomas of the endometrium?
Ovaries: yes can exist
Endometrium: NO. By definition is high-grade
What percent of ovarian tumors are benign?
80%
Borderline tumors
Intermediate biologic phenotype
“Low Malignant Potential”
Often associated with long term survival
Low proliferative rate ∴ not responsive to radiotherapy or chemotherapy
Characteristics of malignant ovarian tumors
Heterogeneous Solid & cystic Hemorrhage & necrosis \+/- vaginal bleeding, ↑ abdominal girth High risk for dissemination
Serous Neoplasms
Hierarchical branching, cuboidal cells
Most frequent subtype (30% ovarian tumors)
Tubal-type epithelium: Ciliated columnar cells
Survival:
Benign (100%)
Borderline (80%)
Malignant (20%)
Histologic and gross findings of serous neoplasms (benign, borderline, malignant)
Epithelial tufting
One or multiple thin-walled cysts
Psammoma bodies: Laminated/targetoid calcifications (seen in benign and malignant settings)
Benign:
Broad papillae with fibrovascular cores
No cytologic atypia or mitoses
Borderline:
Intracystic velvety papillary excrescences
Complex papillae with epithelial tufting and HIERARCHICAL BRANCHING
No stromal invasion
+/- surface involvement; potential to spread
Malignant (carcinoma):
Solid, cystic, mixed
Friable with hemorrhage and necrosis
Cysts contain “straw-like” proteinaceous fluid
Increasingly complex architectural patterns
Stromal invasion present
Marked cytologic atypia
Pleomorphism (*)
Mitoses (^)
Glandular (bottom left) or solid (bottom right)
Treatment for malignant serous carcinoma of the ovary
Surgery + Chemo +/- Radiation
Mucinous Surface-Epithelial Tumors
Huge tumors, Intestinal vs Endocervical epithelium
Benign, borderline, malignant
Discrete dilated glands with simple shapes (no branching)
Types of Surface-Epithelial Tumors
Seers = Serous Make = Mucinous Everything = Endometrioid Clear = Clear cell
Cystadenoma
A type of Mucinous Surface-Epithelial Tumor
Simple glandular epithelium with small basal nuclei and abundant blue (mucinous) apical cytoplasm
Mucinous Borderline Tumors
Stratified epithelium with atypia and scattered mitoses
10 year survival: 80%
Mucinous Carcinoma
Rare compared to serous carcinomas
Unilateral in 80%
10 year survival = 35%
Stage is most important prognostic factor
2 types of invasion
Destructive (25% recur)
Expansile (
Endometrioid
Resembles uterine adenocarcinoma
Always exclude metastasis from uterine tumor
Same grading schema based on solid component
Similar genetic alterations as low-grade endometrial
Synchronous primary endometrial carcinoma in 15-30%
20% of all ovarian CA
40% bilateral
5 year survival for
Stage 1 = 75%
Clear cell Carcinoma
Very rare, but may be aggressive
Exclude metastases from other organs
Many growth patterns
Associated w endometriosis
Tubulocystic growth pattern
“Hobnail cells”: Nuclei bulging into cystic space without apparent cytoplasm (*)
What is clear cell carcinoma of the ovary associated with?
ENDOMETRIOSIS
What do mucinous tumors usually have?
GOBLET CELLS
What do endometrioid tumors usually resemble?
normal endometrial glands
What kinds of cells does clear cell carcinoma have?
Hobnail cells!
Call-Exner bodies
Granulosa Cell Tumor
