Ovarian Pathology

Question 1

When do follicular cysts form?

Answer 1

When ovulation doesn’t occur properly and the follicle fials to rupture e.g. seen in PCOS

Question 2

Give some characteristics of follicular cysts

Answer 2

Can be several cm in size
Thin walled
Lined with granulosa cells
Tend to resolve after a few mon ths

Question 3

What is the term used for endometriosis of the ovaries?

Answer 3

Chocolate cysts

Question 4

What is endometriosis?

Answer 4

A condition characterised by endometrial glands and stroma found outwith the uterine body

Question 5

What are some of the complications of endometriosis

Answer 5

Pelvic inflammation
Cysts formation
Extreme pain
Infertility 
Ectopic pregnancy
Malignancy (less common)

Question 6

What is seen macroscopically in endometriosis?

Answer 6

Peritoneal spots/nodules
Fibrous adhesions
Chocolate cysts

Question 7

What is seen microscopically in endometriosis?

Answer 7

Endometrial gland and srtoma
Haemorrhage
Inflammation
Fibrosis

Question 8

What is the most common ovarian tumour?

Answer 8

Epithelial

Accounts for 65-70% of ovarian tumours

Question 9

What defines a benign epithelial ovarian tumour?

Answer 9

No cytological abnormalities
No proliferative activity
No stromal invasion

Question 10

When is an epithelial ovarian tumour considered borderline?

Answer 10

Has cytological abnormalities and proliferative activity but NO stromal invasion

Question 11

What classifies an epithelial tumour as malignant?

Answer 11

Proliferative activity
Cytological abnormalities
Stromal invasion

Question 12

Most cases of serous ovarian carcinomas are ____ in origin?

Answer 12

Tubal

Known as serous tubal intraepithelial carcinomas

Question 13

How is a primary diagnosis of ovarian tumour made?

Answer 13

Through ascitic fluid aspiration

Question 14

Define a Brenner tumour:

Answer 14

A tumour of transitional type epithelium which is usually benign
Borderline/malignant versions are extremely rare

Question 15

Germ cell tumours account for __% of all ovarian tumours?

Answer 15

15-20%

Question 16

What is the most commonly found germ cell tumour?

Answer 16

Teratoma

Question 17

Germ cell tumours commonly are malignant? True/False

Answer 17

False

They are cystic in nature and rarely become malignant

Question 18

What is the most common malignant germ cell type?

Answer 18

Dysgerminomas

Question 19

Dysgerminoma’s typically affect what group?

Answer 19

Children and young women (average age 22)

Question 20

List 3 examples of sex cord/stromal tumours

Answer 20

Fibroma/Thecoma
Granulosa Cell
Sertoli-Leydig

Question 21

Which sex-cord cell tumour are rare but can produce androgens?

Answer 21

Sertoli-Leydig

Question 22

What must you consider if you find small bilateral ovarian tumours?

Answer 22

Metastases from elsewhere

Question 23

Which sex-cord/stromal tumours are usually malignant and associated with oestrogenic manifestations?

Answer 23

Granulosa Cell

Question 24

Which sex-cord/stromal cell tumour is benign and associated with uterine bleeding?

Answer 24

Fibromas/Thecomas

can produce oestrogen, hence uterine bleeding

Question 25

Give some common sites of primary tumours which metastasize to the ovaries?

Answer 25

Stomach colon Breast Pancreas

Question 26

What are the three features of Meig's syndrome?

Answer 26

Pleural Effusion Benign Fibroma Ascites

Question 27

List some of the presenting symptoms of ovarian cancer:

Answer 27

``` Heartburn/indigestion Early satiety Weight loss/anorexia Bloating Pressure symptoms (esp. bladder) Change in bowel habit SOB Leg oedema (or generalised oedema) ```

Question 28

What % of ovarian tumours have a genetic basis?

Answer 28

5%

Question 29

List some risk factors for ovarian cancer:

Answer 29

Increased age >50 Nulliparity FHx +ve

Question 30

What 2 tumour markers can be used in the investigations of ovarian cancer:

Answer 30

``` CA 125 (raised in >80% of ovarian tumours) CEA ```

Question 31

Other than ovarian cancer, what other pathologies can have a raised CA 125

Answer 31

``` Endometriosis Peritonitis Pregnancy Pancreatitis Ascites ```

Question 32

What specific category of ovarian tumours is CEA likely to be raised in?

Answer 32

Mucinous tumours

Question 33

What is the main purpose for testing CEA

Answer 33

It excludes mets from a primary GI cancer

Question 34

What should you biopsy when concerned about ovarian cancer spreading?

Answer 34

The omentum This is always biopsied after an oophorectomy/hysterectomy

Question 35

What ovarian condition is characterised by bilateral hyperplasia of the ovarian stroma clusters of luteinising cells throughout the stroma, along with an increase in androgens e.g. testosterone?

Answer 35

Ovarian stromal hyperthecosis

Question 36

What is the appropriate management of ovarian stromal hyperthecosis in pre and post menopausal women

Answer 36

Pre menopausal - COCP | Post menopausal - Bilateral oophorectomy

Question 37

What would the hormone levels typically look like in a premature ovarian failure?

Answer 37

Raised FSH and LH Low oestradiol Potentially raised prolactin levels

Question 38

What drugs are first line treatment for ovarian cancer?

Answer 38

Platinum based drugs e.g. carboplatin, taxol and cisplatin

Question 39

What chemotherapy combination is used to treat germ cell tumours of the ovaries (and testes)?

Answer 39

BEP | Bleomycin Etoposide and platinum