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Life Cycles Unit 1 > Ovarian Path > Flashcards

Ovarian Path Flashcards

1
Q

What do serous bordeline tumors look like microscopically

A

HIERARCHICAL BRANCHING

Psammoma bodies- Laminated/targetoid calcifications

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2
Q

Mature Cystic Teratoma

A 
Germ cell tumor
All three types of germ layers
Commonest ovarian tumor 
Some have teeth!!
Most asymptomatic
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3
Q

Anti-NMDA Encephalitis

A

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

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4
Q

Immature Teratoma

A

Grading based on amount of immature neural tissue (more is worse)

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5
Q

Dysgerminoma

A

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

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6
Q

Yolk Sac Tumor

A

Usually 10-30 years old or perimenopausal women

Produces alpha-fetoprotein

Schiller-Duval body

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7
Q

What the histologic feature to know about yolk sac tumors?

A

Schiller-Duval body- Glomeruloid structure with central blood vessel surrounded by neoplastic cells

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8
Q

Sex Cord Stromal Tumors

A

Granulosa cell tumor (adult and juvenile)
Thecoma-fibroma
Sertoli-Leydig cell

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9
Q

Adult Granulosa Cell Tumor

A

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

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10
Q

What’s the path buzz word for Adult Granulosa Cell Tumors?

A

Call-Exner bodies: resembles orimitive follicae; central space with secretions

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11
Q

Fibroma/Thecoma

A

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

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12
Q

Sertoli-Leydig Cell Tumor

A

Recapitulates developing testis

Clinical outcome dependent on stage & grade

12% clinically malignant

Well differentiated: rarely metastasizes

Moderately/poorly diff: ~10% metastasize

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13
Q

General features of primary vs metastatic disease

A 
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 (
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14
Q

Krukenberg Tumor

A

Metastatic gastric carcinoma

Signet ring morphology

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15
Q

Pseudomyxoma Peritoneii

A

Metastatic from appendix

“Jelly belly”- mucin throughout abdomen

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16
Q

Tubal Intraepithelial Carcinoma

A

Fimbriated end of fallopian tube

Putative precursor to most ovarian high grade serous carcinomas

p53

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17
Q

Ectopic Pregnancy

A 
Implantation other than intrauterine
90% in fallopian tube
35-50% with prior PID
Other tubal scarring
Most common cause of hematosalpinx
Rupture = Medical Emergency
18
Q

Endometriosis

A

Extrauterine endometrial glands and stroma
Ovaries, uterine ligaments, pelvic peritoneum, bowel
6-10% women
Infertility, dysmenorrhea, pelvic pain
“chocolate cyst”

19
Q

Polycystic Ovarian Disease

A

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

20
Q

Inherited Risk Factors for ovarian cancer

A 
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
21
Q

Presenting symptoms of ovarian cancer

A 
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)

22
Q

What are the major classifications of ovarian tumors?

A

Surface epithelial (stromal cell): 65-70%
Germ Cell: 15-20%
Sex cord-stroma: 5-10%
Metastasis to ovaries: 5%

23
Q

What is the origin of most epithelial tumors believed to be?

A

fimbriated end of fallopian tube

24
Q

Do low-grade serous carcinomas of the ovaries exist? What about low-grade serous carcinomas of the endometrium?

A

Ovaries: yes can exist
Endometrium: NO. By definition is high-grade

25
Q

What percent of ovarian tumors are benign?

A

80%

26
Q

Borderline tumors

A

Intermediate biologic phenotype
“Low Malignant Potential”
Often associated with long term survival
Low proliferative rate ∴ not responsive to radiotherapy or chemotherapy

27
Q

Characteristics of malignant ovarian tumors

A 
Heterogeneous
Solid & cystic
Hemorrhage & necrosis
\+/- vaginal bleeding, ↑ abdominal girth
High risk for dissemination
28
Q

Serous Neoplasms

A

Hierarchical branching, cuboidal cells

Most frequent subtype (30% ovarian tumors)

Tubal-type epithelium: Ciliated columnar cells

Survival:
Benign (100%)
Borderline (80%)
Malignant (20%)

29
Q

Histologic and gross findings of serous neoplasms (benign, borderline, malignant)

A

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)

30
Q

Treatment for malignant serous carcinoma of the ovary

A

Surgery + Chemo +/- Radiation

31
Q

Mucinous Surface-Epithelial Tumors

A

Huge tumors, Intestinal vs Endocervical epithelium

Benign, borderline, malignant

Discrete dilated glands with simple shapes (no branching)

32
Q

Types of Surface-Epithelial Tumors

A 
Seers = Serous
Make = Mucinous
Everything = Endometrioid
Clear = Clear cell
33
Q

Cystadenoma

A

A type of Mucinous Surface-Epithelial Tumor

Simple glandular epithelium with small basal nuclei and abundant blue (mucinous) apical cytoplasm

34
Q

Mucinous Borderline Tumors

A

Stratified epithelium with atypia and scattered mitoses

10 year survival: 80%

35
Q

Mucinous Carcinoma

A

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 (

36
Q

Endometrioid

A

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%

37
Q

Clear cell Carcinoma

A

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 (*)

38
Q

What is clear cell carcinoma of the ovary associated with?

A

ENDOMETRIOSIS

39
Q

What do mucinous tumors usually have?

A

GOBLET CELLS

40
Q

What do endometrioid tumors usually resemble?

A

normal endometrial glands

41
Q

What kinds of cells does clear cell carcinoma have?

A

Hobnail cells!

42
Q

Call-Exner bodies

A

Granulosa Cell Tumor

Life Cycles Unit 1 (17 decks)

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