ovarian pathology Flashcards
non-neoplastic cysts
follicular cysts
corpus luteum cyst
endometriosis
follicular cysts
very common reach up to 5cm forms when there is no LH surge and cyst doesn't rupture to release egg usually harmless resorb in 2-3 cycles smooth walled unicameral/simple cysts
corpus luteum cyst
if the opening from the released egg seals -> cyst
may spontaneously resolve or grow to 4cm
may hemorrhage or undergo torsion
endometriosis
repeated cycles may form chocolate cyst
ovarian torsion
sudden unilateral pain
occurs in young adult women typically with mass >5cm
must R/O ectopic by ultrasound
surgery
PCOD
aka stein-leventhal syndrome
most common endocrine issue in repro age women
8-10% of all women worldwide
PCOD symptoms
oligomenorrhea
hyperandrogenism (hirsutism etc)
polycystic ovareis
obesity, acanthrosis nigricans, DM, premature atherosclerosis
features of PCOD
anovulation MMR (amenorrhea) infertility acne, hirsuitism insulin resistance and obesity high cholesterol
stromal hyperthecosis
overlaps with PCOD
usually both ovaries enlarged with hormonally active ovarian stroma
most common in postmenopausal
virulization may be striking
infertility
failure to conceive after 1 year of sex
fecundity
likelihood of pregnancy over time
serous tumors
47%
cystadenoma
borderline tumors
adenocarcinomas (type I and II)
mucinous tumors
3%
cystadenoma
adenocarcinoma (only type I)
endometrioid tumors
20%
adenocarcinomas (type I and II)
sex-cord stromal tumors
granulosa tumors
fibrothecomas
sertoli-leydig tumors
germ cell tumors
teratoma
dysgerminoma
endodermal
sinus (yolk sac)
metastatic tumors
5%
ovarian CA overview
asymptomatic until late disease of older women (60s) BRCA 1&2 mutations lynch syndrome II (MSH 2 mutation) prognosis dependent on stage often b/l NO effective screening may arise from distal fallopian tube
serous cystadenoma
common benign lined by single layer of epi which is ciliated
serous borderline carcinoma
excrescences on cyst wall, more cytologic atypia, NO invasion
papillary
often seed peritonium
100% 5 yr survival
serous adenocarcinoma type I
low grade slow progression
serous adenocarcinoma type II
presents late
worse prognosis
psammoma bodies
pathogmonic for serous adenocarcinoma (not specific for either type)
mucinous tumors
least likely to be b/l (if it is R/O mets)
80% benign
KRAS mutation
rupture of mucinous tumors
pseudomyxoma peritonei -mucinous ascites w/mets on peritoneal surfaces
usually d/t appendix rupture
endometrioid tumros
mostly carcinomas
may arise in endometriosis
30% concurrent ovarian and endometrial endometrioid carcinomas
type I endometrioid tumors
PTEN and KRAS
type II endometrioid tumors
p53
CDH1
MI
high-grade serous immunoprofile
p53+ WT1+ Pax8+ High Ki67 2/3s are ER+
high-grade serous mutation
tp53
BRCA1,2
low-grade serous immunoprofile
WT1+
Pax8+
p53-
low Ki67
low-grade serous mutations
BRAF
KRAS
endometrioid carcinoma immunoprofile
ER+ Pax8+ Vimentin+ WT1- p53-
clear cell immunoprofile
HNF beta+
WT1-
ER-
clear cell mutations
KRAS
PTEN
PIK3CA
mucinous immunoprofile
CK20+ cdx+ CK7+ ER- WT1-
mucinous mutations
KRAS
peritoneal carcinomatosis
distinctive diffuse seeding of peritoneum
small shallow implants
cytology of ascites can aid Dx
what can be used to follow course of surface epi tumors?
CA-125
High albumin gradient
cirrhoiss alcoholic hepatitis heart failure/constrictive pericarditis massive hepatic mets budd-chiari syndrome portal v thrombosis idiopathic portal fibrosis
low albumin graident
peritoneal carcinomatosis peritoneal TB pancreatits serositis nephrotic syndrome
granulosa-thecal cell tumors
any age 2/3 in postmenopausal eomen hormonally active 75% produce E yellow inhibin + FOXL2 mutation callexner bodies can cause vaginal bleeding
fibromas
very common solid white hard fibrous tumor usually u/l bening associated with meig syndrome
meig syndrome
ascites
pleural effusion
ovarian fibroma
resolves with resection of fibroma
sertoli-leydig cell tumors
rare
all ages
50% produce androgens
germ cell tumors
teratomas dysgerinomas endodermal sinus (yolk sac) choriocarcinomas tend to be benign in adutls and malignant inkids
dermoids
benign cystic teratoma
2-3 germ cell lines
distinctive rokitanski nodule
1% develop CA (usually SCC)
immature malignant tertatoma
girls and adolescents
contain immature tissues (embryonal and fetal)
rapid growth and spread
monodermal (specialized teratomas)
single tissue predominates
carcinoids or struma ovarii most common
functional -> hyperthyrodism and carcinoid syndrome
dysgerminoma
ALL MALIGNANT ovarian counterpart to seminoma highly sensitive to radiation only 1/3 aggressive fried egg appearance on histo
endodermal sinus tumor
yolk sac very aggressive produces alpha fetoprotein and alpha 1 antitrypsin schiller-duval bodies kids/young adults chemo
choriocarcinoma
usually w/in another germ cell tumor psudoplacental tissue aggressive produce beta-HCG high levels no sensitive to methotrexate
krukenburg tumor
b/l mets of mucin producing signet CA cells, especially gastric origin
