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Reproductive > Ovarian Pathology B&B > Flashcards

Ovarian Pathology B&B Flashcards

1
Q

failure of what process causes a follicular ovarian cyst to develop?

A

failure of ovarian follicle to rupture and release its egg (of if follicle ruptures and reseals)

follicle is filled with estrogen and may stimulate endometrial growth —> pain + irregular bleeding

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2
Q

how do follicular ovarian cysts typically present?

A

young women with pain + irregular bleeding

caused by failure of ovarian follicle to rupture and release its egg - follicle is filled with estrogen and may stimulate endometrial growth

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3
Q

what type of ovarian cysts develop in PCOS?

A

multiple follicular cysts due to failure of follicle to rupture and release its egg

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4
Q

failure of what process causes a corpus luteal cyst?

A

failure of cyst to involute (degenerate) when there is no pregnancy

may continue to produce progesterone and delay menstruation

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5
Q

how do corpus luteal cysts typically present?

A

failure of cyst to involute (degenerate) when there is no pregnancy

may continue to produce progesterone and delay menstruation —> pain + missed period + adnexal mass

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6
Q

what is the cause of theca-lutein cysts?

A

high beta-hCG levels (can be caused by pregnancy with twins or molar pregnancy)

benign, usually bilateral + multiple cysts, regress after pregnancy

contain luteinized (hyperplastic) theca cells

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7
Q

What are the three types of tumors that can develop from the ovaries?

A
  1. germ cell tumors - derived from oocytes
  2. Sex cord stromal tumors - derived from theca/granulosa or fibroblasts
  3. Adenomas/carcinomas - derived from surface epithelium, most common ovarian tumor
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8
Q

from what embryonic tissue is the ovarian surface epithelium derived?

A

simple cuboidal derived from coelomic epithelium - epithelial lining of intraembryonic celom, a space which gives rise to the thoracic and abdominal cavities

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9
Q

what are the common clinical features among the various types of ovarian epithelial cell tumors?

A

“silent” disease that is detected late as an adnexal mass with vague abdominal symptoms (bloating, early satiety, pelvic/abdominal pain)

average age of patient is 63yo

acute symptoms may present in advanced disease due to mass affecting surrounding structures

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10
Q

contrast the histology of serous cystadenoma vs serous cystadenocarcinoma (epithelial tumors of the ovary)

A

most common type of benign and malignant ovarian tumor, respectively

cystadenoma: bilateral cysts filled with watery fluid, thin wall of single cells lining cyst

cystadenocarcinoma: complex cysts (not spherical) filled with watery fluid, growth of epithelia into folds, cells are similar to fallopian tube cells, psammoma bodies (small areas of calcification), often bilateral

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11
Q

Describe the key histological features of the most common type of malignant ovarian cancer

A

serous epithelial cystadenocarcinoma: complex cysts (not spherical) filled with watery fluid, growth of epithelia into folds

cells are similar to fallopian tube cells + presence of psammoma bodies (small areas of calcification)

commonly presents with ascites

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12
Q

describe the histology of ovarian mucinous cystadenomas and mucinous cystadenocarcinomas (epithelial tumors of the ovary)

A

both have similar histology - thin-walled cyst filled with mucous

often multiloculated - contain many small cavities filled with mucous

K-Ras mutations nearly always present

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13
Q

with what type of ovarian cancer is pseudomyxoma peritonei associated?

A

aka mucous in the abdomen, causing “mucinous ascites”

therefore, it makes sense this condition is associated with ovarian mucinous epithelial cystadenocarcinomas

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14
Q

How do endometrioid tumors of the ovary present?

A

ovarian epithelial tumors containing tubular glands that appear histologically similar to the endometrium - often occur in patients with endometriosis

Good prognosis, sensitive to chemotherapy and often identified early

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15
Q

what are Brenner Tumors made of?

A

rare type of epithelial ovarian tumor containing bladder (transitional) epithelial cells

Usually benign and found incidentally

Biopsy shows “coffee bean nuclei”

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16
Q

rare type of epithelial ovarian tumor containing bladder (transitional) epithelial cells

Biopsy shows “coffee bean nuclei”

A

Brenner Tumor - Usually benign and found incidentally

[B for Bladder]

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17
Q

explain why pregnancy, breast-feeding, and oral contraceptive pills lower the risk of epithelial cell ovarian tumors

A

all of these conditions prevent ovulation, and more ovulation is associated with more risk (damages the epithelium)

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18
Q

In what population are BRCA1 and BRCA2 gene mutations common?

A

Ashkenazi Jews (1:40 vs 1:400 general population)

recall BRCA1/2 mutations are associated with both breast and ovarian cancer

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19
Q

biomarker for epithelial ovarian cancer

A

CA-125 (cancer antigen 125)

not reliable for screening but helpful in evaluating adnexal masses or monitoring response to treatment

20
Q

what is the most common type of ovarian stromal tumor?

A

granulosa cell tumors: secrete estrogen (as granulosa cells do), usually unilateral, have malignant potential

present as large adnexal mass, cause symptoms related to estrogen secretion (endometrial hyperplasia, bleeding in post-menopausal women, breast tenderness)

associated with endometrial carcinoma (estrogen stimulates endometrium to grow)

21
Q

how do granulosa cell tumors of the ovary present?

A

secrete estrogen (as granulosa cells do), usually unilateral, have malignant potential

present as large adnexal mass, cause symptoms related to estrogen secretion - endometrial hyperplasia, bleeding in post-menopausal women, breast tenderness

associated with endometrial carcinoma (estrogen stimulates endometrium to grow)

22
Q

what are the 2 subtypes of granulosa cell tumors of the ovary?

A
  1. adult subtype (95%, 50-54yo): symptoms due to excess estrogen production (bleeding in post-menopausal women, endometrial hyperplasia)
  2. juvenile subtype: cause premature puberty (usually <8 yo)
23
Q

Pt is a 7yo F presenting to her pediatrician with sexual precocity (pre-mature puberty). What type of tumor must be excluded?

A

granulosa cell tumor (juvenile subtype): secrete estrogen (as granulosa cells do), usually unilateral, have malignant potential

premature puberty due to excess estrogen production

24
Q

what type of carcinoma are granulosa cell tumors of the ovary associated with and why does this make sense?

A

secrete estrogen (as granulosa cells do) —> endometrial hyperplasia

therefore, it makes sense that granulosa cell tumors are associated with endometrial carcinoma

25
Q

how do fibromas of the ovaries present?

A

benign, unilateral, solid white tumors with no hormone activity (derived from fibroblasts)

occur in post-menopausal women with Meigs syndrome (ovarian fibroma + ascites + pleural effusion) due to capillary leak from tumor factors

26
Q

benign, unilateral, solid white ovarian tumors with no hormone activity presenting in post-menopausal women

A

ovarian fibromas - present with Meigs syndrome (ovarian fibroma + ascites + pleural effusion) due to capillary leak from tumor factors

27
Q

Meigs syndrome

A

ovarian fibroma + ascites + pleural effusion

due to capillary leak from tumor factors

unusual case in which ascites/pleural effusion are NOT from metastasis of an aggressive malignancy

28
Q

thecomas of the ovary may produce which hormone?

A

thecomas: usually co-exist with fibromas (“fibrothecoma”) and may produce estrogen —> endometrial hyperplasia + bleeding

29
Q

female with androgen-related symptoms + pelvic mass = what kind of ovarian tumor?

A

Sertoli-Leydig cell tumor - more often in males but may occur in the ovary

produce androgens —> breast atrophy, amenorrhea, sterility (anovulation), hirsutism

30
Q

which type of ovarian tumors typically occur in younger women?

A

ovarian germ cell tumors

have many characteristics of placenta/fetal tissue - can generate AFP or beta-hCG

[you can remember that the features of the tumors are of young tissue, just like their patients]

31
Q

what is the most common type of ovarian germ cell tumor?

A

teratomas: derived from cells of all three germ layers (monodermal forms are rare)

benign form = dermoid cyst
malignant form = immature teratoma

32
Q

dermoid cyst

A

aka mature cystic teratoma: benign teratoma (ovarian germ cell tumor containing cells of all 3 germ layers)

“dermoid” because it is skin-like, containing hair/ squamous cells/ sebaceous (oily) material, walls may contain tooth-like calcifications

usually unilateral + asymptomatic but removed surgically to avoid complications (torsion, rupture, squamous cell carcinoma transformation)

33
Q

what type of malignant transformation is most common in dermoid cysts?

A

dermoid cyst: skin-like benign teratoma

usually unilateral & asymptomatic but removed surgically to avoid complications - ovarian torsion, rupture, squamous cell carcinoma transformation

34
Q

struma ovarii

A

rare monodermal type of teratoma containing mostly thyroid tissue - sometimes cause hypothyroidism

classic case is woman with hyperthyroidism + ovarian mass

35
Q

woman presents with hyperthyroidism + an ovarian mass

A

struma ovarii: rare monodermal type of teratoma containing mostly thyroid tissue - sometimes cause hypothyroidism

36
Q

immature teratomas (malignant teratomas) most commonly contain what type of cells?

A

solid mass with immature fetal tissue of all 3 germ layers, but neural tissue is most represented

37
Q

what is the most common malignant germ cell tumor of the ovary?

A

dysgerminoma: usually unilateral, may produce enzymes/hormones such as lactate dehydrogenase (LDH), placental alkaline phosphatase, beta-hCG which can be used as tumor markers to monitor treatment

highly responsive to treatment

38
Q

how do dysgerminomas appear histologically?

A

most common malignant germ cell tumor of the ovary, may produce enzymes/hormones (LDH, beta-hCG)

histology shows undifferentiated germ cells - look like nests of large cells with clear cytoplasm and central nuclei (”fried egg”)

39
Q

yolk sac tumors, aka endodermal sinus tumors, secrete _____

A

rare malignant germ cell ovarian tumor derived from extra-embryonic yolk sac cells

secrete alpha fetoprotein (AFP), which is normally derived from yolk sac cells

40
Q

how do yolk sac (endodermal sinus) tumors presents?

A

rare malignant germ cell ovarian tumor derived from extra-embryonic yolk sac cells which secrete alpha fetoprotein (AFP)

large, solid mass that causes necrosis and hemorrhage —> abdominal pain

[can also occur in male testes]

41
Q

Pt is a 31yo F presenting with abdominal pain and abnormal bleeding. Ultrasound reveals a large, solid mass. A subsequent biopsy is taken which shows evidence of necrosis and hemorrhage, and the tissue is positive for alpha fetoprotein (AFP). What is the diagnosis?

A

yolk sac (endodermal sinus) tumor: rare malignant germ cell ovarian tumor derived from extra-embryonic yolk sac cells

42
Q

what is the classic pathological finding of yolk sac (endodermal sinus) tumor?

A

Schiller-Duval bodies: blood vessel surrounded by cancer cells (“glomerular like”), diagnostic of yolk sac tumors

43
Q

choriocarcinoma

A

rare malignant tumor of placental cells, contain syncytiotrophoblasts and cytotrophoblasts

secretes hCG —> mimics effects of LH, FSH, and TSH

[recall hCG, TSH, LH, and FSH share a common alpha subunit]

aggressive hematogenous spread, often already in lungs/liver/bone at diagnosis

44
Q

rare malignant tumor of placental cells, contain syncytiotrophoblasts and cytotrophoblasts and secretes hCG

A

choriocarcinoma - aggressive hematogenous spread, often already in lungs/liver/bone at diagnosis

45
Q

Woman presents to the ED complaining of sudden onset of lower abdominal/pelvic pain. On PE, there is abdominal tenderness the women states she feels nauseous. Pelvic exam is significant for a palpable mass greater than 5cm. What is the most immediate concern?

A

ovarian torsion due to a cyst or tumor (palpable mass) - surgical emergency because this can cause the ovarian blood supply to be cut off

46
Q

what is the key pathological finding of granulosa cell ovarian tumors?

A

Call-Exner bodies, aka “coffee-bean” nuclei

47
Q

Krukenberg tumor

A

gastric cancer that metastasizes to the ovary - bilateral

Reproductive (29 decks)

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