Ovarian Pathology

Question 1

what are the main pathological groups that effect the ovaries?

Answer 1

Cysts

Endometriosis

Tumours

Question 2

name the different types of epithelial ovarian tumours

Answer 2

• Serous #
• Mucinous
• Endometrioid
• Clear cell
• Brenner

all subdivided into benign (no abnormal cells)

Borderline (abnormal cells but no stromal invasion)

and Malignant (stromal invasion)

Question 3

what are the twon different types of serous carcinoma and their precursor lesions?

Answer 3

•High grade serous carcinoma

–Serous tubal intraepithelial carcinoma (STIC)

–Most cases are essentially tubal in origin

–

•Low grade serous carcinoma

–Serous borderline tumour

Question 4

what two epithelial cancers are associated with endomtriosis?

Answer 4

Endometroid and clear cell

Question 5

name sex cord/ stromal tumours and what hormones they may produce

Answer 5

•Granulosa cell tumour

–All are potentially malignant

–May be associated with oestrogenic manifestations

–

•Sertoli-Leydig cell tumours

–Rare, may produce androgens

Question 6

where do the most common metastases originate?

Answer 6

–Stomach

–Colon

–Breast

–Pancreas

Question 7

describe the staging of ovarian cancer

Answer 7

1A tumour limited to one ovaries 2A Extension or implants on uterus/fallopian tube

1B tumour limited to both ovaries 2B Extension to other pelvic intraperitoneal

1C Cancer involving ovarian surface/

rupture/surgical spill/tumour in washings

3A Retroperitoneal lymph node

Metastasis or microscopic extrapelvic peritoneal involvement

3B Macroscopic peritoneal metastasis beyond pelvis up to 2cm in dimension

3C Macroscopic peritoneal metastasis >2cm in dimension

4 Distant metastasis

Question 8

how does ovarian cancer present?

Answer 8

• Heartburn/indigestion
• Early satiety
• Weight loss/anorexia.
• Bloating
• ‘Pressure’ symptoms (esp bladder)
• Change of bowel habit
• SOB/ Pleural effusion
• Leg oedema or DVT

N.B May not be a pelvic mass

Question 9

what are risk factors for ovarian cancer?

Answer 9

• Increasing age
• Nulliparity
• Family history

BRC1 BRC2 Lynch Syndrome

Question 10

what investigations for ovarian carcinoma?

Answer 10

SSS- nature of cyst

CT- staging

CA125- tumour marker but not very specicfic

CEA- exclude GI mets

Question 11

why would you test CEA?

Answer 11

to exclude GI mets