Ovarian pathology

Question 1

Ovarian cancer types

Answer 1

Epithelial cell tumours (most common)
- Serous carcinoma (most common malignant)
- Endometrioid
- Clear cell
- Mucinous

Germ cell tumours

Sex cord-gonadal stromal
tumours

Question 2

Ovarian teratomas
- Description

Answer 2

Benign ovarian tumour that arises from germ cell layers.
- Gives rise to different tissues within the ovary

Question 3

Ovarian germ cell tumours are associated with the rise in which two biomarkers?

Answer 3

Alpha-fetoprotein

hCG

Question 4

Ovarian sex cord-gonadal stroma tumours examples

Answer 4

Sex cord
- granulosa cell tumour

Gonadal stromal
- thecoma, fibroma

Mixed
- sertoli-leydig cell tumour

Question 5

Granulosa cell tumour
- Description
- Malignancy
- Epidemiology

Answer 5

Sex cord ovarian tumour
- arises from the granulosa cells
- produces estradiol from androgens
- produces progesterone after ovulation

Mainly benign, 20% malignant

Primarily affects women 50-55
- Juvenile granulosa cell tumour presents in pre-pubertal girls

Question 6

Ovarian gondal stroma tumours

Answer 6

Benign sex cord tumours
- Arising from the theca of follicle (thecoma) or fibroblasts (fibroma)

Thecoma
- Oestrogen producing, presents with abnormal uterine bleeding and increased risk for endometrial cancer

Fibroma
- Typically presents in peri/menopausal women.
- Forms a firm, white ovarian mass

Question 7

Sertoli-Leydig cell tumour
- Description
- Epidemiology

Answer 7

Testosterone-secreting ovarian tumour
- Rare cause of ovarian cancer
- Typically affects young women
- Leydig cells secrete androgens

Question 8

Ovarian cancer risk of malignancy index (RMI)
- description
- features
- significant value

Answer 8

Tool used to assess the risk of ovarian malignancy, involving 3 parameters multiplied together:

• Ultrasound findings, max 3 points
• Menopausal state (pre=1 , post=3)
• CA-125 levels (>35 is significant)

Score >200 is high risk of malignancy.

Question 9

Ovarian cancer presentation

Answer 9

Pelvic/ abdominal mass

Pelvic pain

Urinary incontinence/ urgency

Intermenstrual/ post-menstrual bleeding

Ascites

Weight loss, anorexia

Androgen producing tumours: hirsuitism, amenorrhoea.

Question 10

First line investigations for ovarian tumour

Answer 10

Pelvic, transvaginal ultrasound

CA-125 levels

Alpha-fetoprotein and hCG if <40, showing complex mass.

Question 11

Ovarian cancer treatment

Answer 11

MDT for gynae-oncology

For localised disease
- Hysterectomy and bilateral salpingo-ophrectomy
- Radical hysterectomy with lymphadenectomy if lymphatic spread is indicated.

Higher stage disease
- Chemotherapy and radiotherapy

Question 12

Risk factors for ovarian cancer

Answer 12

Increased number of follicles released
- Early menarche, later menopause

BRCA1, BRCA2 mutations
- FMHx of breast, endometrial and ovarian cancer

Smoking

Lynch syndrome (HNPCC), family history of colorectal cancer

Nulliparous

HRT

Diabetes

Endometriosis

Question 13

Protective factors against ovarian cancer

Answer 13

Multiparous

Breastfeeding

COCP

Salphinectomy