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RGU Exam 2 > Ovarian Pathology > Flashcards

Ovarian Pathology Flashcards

1
Q

Turner’s syndrome

A
  • 45, X
  • Short stature
  • Coarctation of the aorta
  • Streak ovaries
  • Infertility
  • Amenorrhea
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2
Q

Ovarian torsion

A
  • Causes enlargement of ovary
  • Can mimic cystic disease and or tumors
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3
Q

Nonneoplastic and functional cysts

A
  • Follicle cysts
  • Luteal cysts
  • Polycystic ovaries
  • Stromal hyperthecosis
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4
Q

Follicular cysts

A
  • Cystic follicles are so common to almost by physiologic
  • Originate in unruptured graafian follicels or in follicles that have ruptured and immediately sealed
  • Cysts usually multiple, occasionally larger than 2cm
  • Filled w/ serous fluid
  • Outer thecal cells can be conspicuous, may have large cytoplasm
  • Granulosa cells can be identified
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5
Q

Luteal cysts

A
  • Normally present in ovary
  • Lined by a rim of bright yellow luteal tissue containing luteinized granulosa cells
  • May rupture and cause a peritoneal reaction
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6
Q

Polycystic ovary disease

A
  • Affects 3-6% of reproductive age women
  • Etiology not completely understood
  • Central pathologic abnormality is numerous follicle cysts
  • Often assoc. w/ oligomenorrhea
  • Ovaries may be twice normal size
  • Multiple subcortical cysts
  • Thickened superficial cortex
  • Hyperplasia of theca interna: increased production of androgens
  • Cysts lined by theca interna cells lead to increased luteinizing hormone
  • Increased estrogen due to conversion of androgens
  • Enzymes involved in androgen biosynthesis are poorly regulated resulting in excessive androgen production
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7
Q

Polycystic ovary disease presentation

A
  • Anovulation
  • Obesity
  • Hirsutism
  • Virulism
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8
Q

Stromal hyperthecosis

A
  • Seen in postmenopausal women
  • May blend w/ PCOD in younger women
  • Uniform enlargement of the ovary up to 7cm
  • Tan, white appearance
  • Usually B/L
  • Hypercellular stroma
  • Luteinized stroma cells
  • Clinical effects similar to PCOD but virulization may be more striking
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9
Q

Ovarian tumors

A
  • Approx. 80% of tumors are genign mostly occuring in younger women b/w 20-45
  • Malignant tumors more common in older women b/w 40-65
  • Under age 45: 1/15 are malignant
  • Oveer age 50: 1/3 are malignant
  • Estimated risk of developing ovarian cancer if woman has BRCA-1 or 2 is 20-60% by age 70
  • Mutations in p53 found in 50% of ovarian cancers
  • Most ovarian cancers are serous cystadenocarcinomas
  • 30% of ovarian adenocarcinomas express Her2/neu oncogene and carries a poor prognosis
  • OCP use is assoc. w/ a decreased overall incidence of ovarian tumors
  • Most ovarian tumors originate from the surface epithelium
  • Ovulation traumatizes the surface epithelium due to expulsion of oocytes
  • OCP prevent ovulation and decreases injury to surface epithelium
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10
Q

Epithelial cell origin (surface epithelial-stromal cell tumors) ovarian tumor frequency, malignancy, age affected, types

A
  • Overall frequencey: 65-70%
  • Proportion malignant: 90%
  • Age affected: 20+
  • Types:

*serous tumor

*mucinous tumor

*endometrioid tumor

*clear cell tumor

*brenner tumor

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11
Q

Germ cell origin ovarian tumor frequency, malignancy, age affected, types

A
  • Overall frequency: 15-20%
  • Proportion malignant: 3-5%
  • Age affected: 0-25+
  • Types:

*teratoma

*dysgerminoma

*endodermal sinus tumor

*choriocarcinoma

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12
Q

Sex cord-stroma origin ovarian tumor frequency, malignancy, age affected, types

A
  • Overall frequency: 5-10%
  • Proportion malignant: 2-3%
  • Age affected: all ages
  • Types:

*fibroma

*granulosa-theca cell tumor

*sertoli-Leydig cell tumor

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13
Q

Metastasis to ovaries tumor frequency, malignancy, age affected, types

A
  • Overall frequency: 5%
  • Proportion malignant: 5%
  • Age affected: variable
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14
Q

Ovarian neoplasms-surface epithelial tumors types

A
  • Mucinous tumors
  • Serous tumors
  • Brenner tumors
  • Endometriod tumors
  • Clear cell carcinoma

Pneumonic: My Sister Began Experiencing Cancer

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15
Q

Surface epithelial tumors characteristics

A
  • No significant serum screening tools available
  • CA-125 is present in the serum of more than 80% of pts w/ serous and endometrioid carcinomas but can be elevated in any peritoneal irritation
  • Fallopian tube ligation and oral contraceptives are assoc. w/ a significant reduction in relative risk
  • 2/3 of ovarian tumors
  • Divided into benign, borderline, malignant
  • 90% of all maligant ovarian tumors
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16
Q

Surface epithelial tumors- Serous tumors characteristics

A
  • Cystic spaces w/ papillary formations filled w/ clear fluid
  • Have benign, borderline and malignant types

*classification of tumor is important to therapy

  • 25-30% of all ovarian tumors, most in adults
  • Serous adenocarcinomas are the most common malignant ovarian tumor
  • Benign and borderline tumors are most common b/w age 20-45
  • Serous carcinomas occur later in life
  • 30-50% are B/L
  • Tumors may spread to the peritoneum resulting in ascites
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17
Q

Surface epithelium tumors- Serous tumors risk factors

A
  • Risk factors are hard to define: higher incidence in women w/ low parity
  • Genetic risk factors: mutations in BRCA1 and 2 increase susceptibility to ovarian cancer, especially high grade types
  • Low grade tumors arising fromm borderline tumors have KRAS and BRAF oncogene mutations
  • High grade tumors have a high freq. of mutations in p53
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18
Q

Surface epithelial tumors- Serous tumors morphology

A
  • Benign tumors: smooth glistening cyst wall w/ no epithelial thickening or w/ small papillary projections, lined by columnar cells w/ cilia
  • Borderline tumors: increased number of papillary projections w/ complex stromal papillae, stratification of the epithelium and mild nuclear atypia w/o destructive infiltrative growth into the stroma
  • Malignant tumors: may be high or low grade, larger amts of solid or papillary masses, irregularity of tumor, nodularity of capsule, marked nuclear atypia, pleomorphism, mitotic figures, multinucleation, may have psammoma bodies
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19
Q

Serous tumors survival rates

A
  • 5yr survival rate for borderline tumors confined within the ovarian mass is 100%
  • 5yr survival rate for malignant tumors confined to the ovarian mass is 70%
  • 5yr survival rate for borderline tumors involving the peritoneum is 90%
  • 5yr survival rate for malignant tumors involving the peritoneum is 25%
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20
Q

Surface epithelial tumors- Serous tumors gross appearance

A
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21
Q

Serous cystadenoma histology

A
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22
Q

Borderline serous tumor histology

A
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23
Q

Serious borderline tumor gross appearance

A
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24
Q

High grade serous carcinoma histology

A
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25
Q

Surface epithelial tumors- Mucinous tumors

A
  • 15-25% of ovarian tumors
  • B/L in 10-20%
  • Usually seen in middle adult life, rare before puberty or after menopause
  • 80% are borderline or benign
  • Grow larger than serous tumors
  • Mostly multiloculated cysts containing mucinous material
  • Pseudomyxoma peritonei: implant on peritoneal structures
  • Have diff. risk factors than mucinous tumors
  • Smoking
  • Can produce large cystic masses
  • Can be multiloculated filled w/ gelatinous fluid rish in glycoproteins
  • Mucinous cystadenomas are lined by tall columnar epithelium w/ apical mucin and absence of cilia
  • Borderline tumors may have cells w/ more papillary growth and nuclear atypia and nuclear stratifiication
  • Cystadenocarcinomas have solid growth patterns w/ obvious nuclear atypia and stratification, need to look for stroma invasion
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26
Q

Surface epithelial tumors- Mucinous tumors survival rate

A
  • 10yr survival for noninvasive cancers is 95% and 90% for invasive
  • Mucinous cancers that have spread beyond the ovary are usually fatal
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27
Q

Mucinous cystadenoma gross appearance

A
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28
Q

Surface epithelial tumors- Mucinous tumors mutations

A
  • Mutation of KRAS proto-oncogene is often seen in benign, borderline or malignant tumors
29
Q

Pseudomyxoma peritonei

A
  • Extensive mucinous ascites
  • Cystic epithelial implants on the peritoneal surfaces
  • Freq. involvement of the ovaries
  • In most cases the source is extraovarian most likely the appendix
  • Can result in intestinal obstruction and death
30
Q

Pseudomyxoma peritonei gross appearance

A
31
Q

Surface epithelial tumors- Endometriod tumors

A
  • 5-10% of ovarian tumors
  • Benign endometriod adenofibromas and borderline endometriod tumors are uncommon
  • Endometriod carcinomas account for approx. 20% of all ovarian tumors
  • Large cystic mass w/ solid areas
  • Resemble endometrial adenocarcinoma, 15-30% of cases are also assoc. w/ endometrial carcinoma
  • May be assoc. w/ endometriosis
  • Most are small well differentiated w/ a good prognosis
32
Q

Surface epithelial tumors- Endometriod tumors risk mutations

A
  • PTEN tumor suppressor gene mutation
  • KRAS and beta-catenin oncogenes
  • p53 mutations common in poorly differentiated tumors
33
Q

Surface epithelial tumors- Clear cell carcinoma

A
  • 40-50yr old
  • May occur in assoc. w/ endometriosis or endometriod carcinoma of the ovary and resembles clear cell carcinoma of the endometrium
  • Now thought to be a variant of endometriod adenocarcinoma
  • Cystic or solid appearance
  • Solid tumors the clear cells are arranged in sheets or tubules
  • In cystic cells the neoplastic cells line the spaces
  • Large tumor cells w/ clear cytoplasm w/ a hobnail cytoplasm
  • Tumors tend to be aggressive and often spread beyond ovary
34
Q

Surface epithelial tumors- Clear cell carcinoma survival rate

A
  • 5yr survival rate is 65% in confined to ovaries
35
Q

Cystadenofibroma

A
  • Tumors w/ a pronounced proliferation of fibrous stroma under the columnar lining epithelium
  • Benign tumors
  • Small and multilocular w/ simple papillary processes
  • May have mucinous, serous, endometrioid and transitional epithelium
  • Borderline lesions are uncommon
36
Q

Surface epithelial tumors- Brenner tumor

A
  • 1-2% of all ovarian tumors
  • Classified as adenofibromas in which the epithelial component consists of nests of transitional-type epithelial cells
  • U/L, firm, white solid
  • Solid and cystic nests of cells resembling transitional cells w/ grooved nuclei
  • Mucinous glands may be present
  • Vary in size from small to large lesions
  • Most tumors are benign
  • Borderline and malignant tumors have been reported
37
Q

Surface epithelial tumors- Brenner tumors gross appearance

A
38
Q

Germ cell tumors

A
  • Teratomas
  • Dysgerminomas
  • Endometrial sinus (yok sac) tumors
  • Ovarian choriocarcinoma

Pneumonic: The Doctor Examined Ovaries

39
Q

Germ cell tumor flow chart

A
40
Q

Teratomas

A
  • Mature: benign
  • Immature: malignant
  • Monodermal or highly specialized
41
Q

Mature teratomas

A
  • Cystic often referred to as a dermoid cyst
  • Derived from totipotential cells
  • Seen in young women of reproductive years
  • B/L in 10-20%
  • Cyst wall is wrinkled and gray
  • Tissue resembles that seen in an adult
  • Hair, squamous cells
  • Bone, cartilage
  • Thyroid tissue
  • 1% will undergo malignant transformation in one of the elements: squamous cell carcinoma, thyroid cancer, melanoma
42
Q

Teratoma causes

A
  • Arise from ovum after first meiotic division
  • 46XX
43
Q

Monodermal teratomas

A
  • Struma ovarii: comosed of thyroid tissue, often assoc. w/ hyperthyroidism
  • Carcinoid: arise from the intestinal epithelium and may produce carcinoid syndrome
  • Strumal carcinoid: both elements present
44
Q

Struma ovarii histology

A
45
Q

Strumal ovarii w/ carcinoid histology

A
46
Q

Immature malignant teratomas

A
  • Tissue resembles tissue seen in embryo not an adult
  • Mostly in prepubertal adolescents and young women
  • Bulky w/ smooth external surface
  • Solid w/ necrosis and hemorrhage
  • Various amts of immature tissue present such as har, bone, cartilage, glands, nerves
  • Prognosis related to grade and stage
47
Q

Immature teratoma histology

A
48
Q

Dysgerminoma

A
  • Ovarian counterpart to the seminoma of the testes
  • Solidk soft, fleshy yellow white
  • Composed of large vesicular cells w/ a clear cytoplasm
  • Well defined cell borders
  • Lymphocytic infiltrate
  • Centrally located nucleus
  • 2% of ovarian tumors
  • 50% of malignant germ cell tumors
  • Most occur in second and third decade of life
  • Most have no endocrine function
  • Some may have elevated lvls of chorionic gonadotropin

- Express OCT-3, OCT-4, NANOG transcription factors

- Also express the receptor tyrosine kinase KIT

  • Usually U/L
  • All malignant, only 1/3 are aggressive
  • Overall survival is good
49
Q

Dysgerminoma gross appearance

A
50
Q

Dysgerminoma histology

A
51
Q

Endometrial sinus tumor

A
  • AKA yolk sac tumor
  • Rare tumor but 2nd most common malignant tumor of germ cell origin
  • Similar to the yolk sac it has high lvls of alpha fetoprotein and alpha one antitrypsin
  • Schiller Duval body: glomerulus like structure w/ a central blood vessel enveloped by germ cells within a space lined by germ cells
  • Intracellular and extracellular droplets some of which stain for alpha fetoprotein
  • Children and young women
  • Presents w/ abdominal pain and rapidly growing pelvic mass
  • Overall an aggressive lesion
52
Q

Yok sac tumor histology

A
53
Q

Yok sac tumor- alpha fetoprotein stain

A
54
Q

Choriocarcinoma

A
  • More commonly of placental origin
  • An example of extraembryonic differentiation of malignant germ cells
  • Usually exists in combination with other germ cell tumors
  • Pure choriocarcinomas are rare
  • Very aggressive w/ early metastasis to lungs, liver and bone
  • Soft yellow fleshy and necrotic
55
Q

Sex cord-stromal tumors

A
  • Granulosa cell tumor
  • Fibroma, thecoma and fibrothecomas
  • Sertoli-Leydig cell tumors

Pneumonic: She Felt Grim

56
Q

Granulosa-theca cell tumors

A
  • Varying proportions of granulosa and theca cell differentiation
  • Composed either entirely of granulosa cells or a combination of both
  • Accounts for 5% of ovarian tumors
  • 2/3 occur in postmenopausal women
  • U/L, yellow
  • Vary from small foci to large solid or cystic masses
  • May grow in cords, sheets or strands
  • Call-Exner bodies: small glandlike structures
  • Thecoma component: clusters or sheets of cuboidal or polygonal cells
  • Produce large amts of estrogen: can be assoc. w/ endometrial hyperplasia, endometrial carcinoma and fibrocystic changes in the breast
  • Granulosa cell forms are all potentially malignant
  • Estimates of clinical malignancy varies from 5-25%
  • Inhibin: higher lvls in tissue and serum may serve as useful marker
57
Q

Granulosa-theca cell tumors mutations

A
  • Most have mutations of FOXL2 which encodes a transcription factor
58
Q

Juvenil granulosa cell tumor histology

A
59
Q

Granulosa cell tumor histology

A
60
Q

Fibroma-thecoma

A
  • Usually U/L, soid, lobulated hard, gray white
  • Covered by intact serosa
  • Meig’s syndrome: ovarian tumors, hydrothorax and ascites
  • Assoc. w/ basal cell nevus syndrome
  • Thecomas may secrete estrogen
  • Fibromas are essentially nonhormonal

- Fibroma: composed of fibroblasts

  • Thecoma: plump spindle cells w/ lipid droplets
  • Acct for 4% of all ovarian tumors
  • Most tumors are a combo of both types
61
Q

Fibroma gross appearance

A
62
Q

Thecoma fibroma histology

A
63
Q

Sertoli-leydig cell tumors

A
  • Recapitulate cells of the testes
  • Usually produce masculinization or defemination
  • Some have estrogenic effects
  • Peak incidence in 2nd and 3rd decade of life but can occur in women of all ages
  • U/L
  • Solid, gray to golden brown
  • Tubules composed of Sertoli or Leydig cells
64
Q

Sertoli Leydig cell tumor histology

A
65
Q

Sex cord tumor with annular tubules

A
  • Assoc. in 1/3 of cases w/ Peutz-Jeghers syndrome
  • Has features similar to granulosa cell tumors and a growth pattern similar to Sertoli cells
  • Complex annular tubules containing eosinophilic hyaline bodies
  • May be benign or malignant
66
Q

Sex cord tumor with annular tubules histology

A
67
Q

Metastatic tumors

A
  • Common primary sites are ovary, uterus, fallopian tubes
  • May have spread from GI tract
  • Krukenburg tumor: metastasis from adenocarcinoma w/ characteristic signet ring cells
68
Q

Krukenburg tumor gross appearance

A
69
Q

Krukenburg tumor histology

A

RGU Exam 2 (21 decks)

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