Ovarian Pathology B&B Flashcards
failure of what process causes a follicular ovarian cyst to develop?
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
how do follicular ovarian cysts typically present?
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
what type of ovarian cysts develop in PCOS?
multiple follicular cysts due to failure of follicle to rupture and release its egg
failure of what process causes a corpus luteal cyst?
failure of cyst to involute (degenerate) when there is no pregnancy
may continue to produce progesterone and delay menstruation
how do corpus luteal cysts typically present?
failure of cyst to involute (degenerate) when there is no pregnancy
may continue to produce progesterone and delay menstruation —> pain + missed period + adnexal mass
what is the cause of theca-lutein cysts?
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
What are the three types of tumors that can develop from the ovaries?
- germ cell tumors - derived from oocytes
- Sex cord stromal tumors - derived from theca/granulosa or fibroblasts
- Adenomas/carcinomas - derived from surface epithelium, most common ovarian tumor
from what embryonic tissue is the ovarian surface epithelium derived?
simple cuboidal derived from coelomic epithelium - epithelial lining of intraembryonic celom, a space which gives rise to the thoracic and abdominal cavities
what are the common clinical features among the various types of ovarian epithelial cell tumors?
“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
contrast the histology of serous cystadenoma vs serous cystadenocarcinoma (epithelial tumors of the ovary)
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
Describe the key histological features of the most common type of malignant ovarian cancer
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
describe the histology of ovarian mucinous cystadenomas and mucinous cystadenocarcinomas (epithelial tumors of the ovary)
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
with what type of ovarian cancer is pseudomyxoma peritonei associated?
aka mucous in the abdomen, causing “mucinous ascites”
therefore, it makes sense this condition is associated with ovarian mucinous epithelial cystadenocarcinomas
How do endometrioid tumors of the ovary present?
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
what are Brenner Tumors made of?
rare type of epithelial ovarian tumor containing bladder (transitional) epithelial cells
Usually benign and found incidentally
Biopsy shows “coffee bean nuclei”
rare type of epithelial ovarian tumor containing bladder (transitional) epithelial cells
Biopsy shows “coffee bean nuclei”
Brenner Tumor - Usually benign and found incidentally
[B for Bladder]
explain why pregnancy, breast-feeding, and oral contraceptive pills lower the risk of epithelial cell ovarian tumors
all of these conditions prevent ovulation, and more ovulation is associated with more risk (damages the epithelium)
In what population are BRCA1 and BRCA2 gene mutations common?
Ashkenazi Jews (1:40 vs 1:400 general population)
recall BRCA1/2 mutations are associated with both breast and ovarian cancer
biomarker for epithelial ovarian cancer
CA-125 (cancer antigen 125)
not reliable for screening but helpful in evaluating adnexal masses or monitoring response to treatment
what is the most common type of ovarian stromal tumor?
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)
how do granulosa cell tumors of the ovary present?
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)
what are the 2 subtypes of granulosa cell tumors of the ovary?
- adult subtype (95%, 50-54yo): symptoms due to excess estrogen production (bleeding in post-menopausal women, endometrial hyperplasia)
- juvenile subtype: cause premature puberty (usually <8 yo)
Pt is a 7yo F presenting to her pediatrician with sexual precocity (pre-mature puberty). What type of tumor must be excluded?
granulosa cell tumor (juvenile subtype): secrete estrogen (as granulosa cells do), usually unilateral, have malignant potential
premature puberty due to excess estrogen production
what type of carcinoma are granulosa cell tumors of the ovary associated with and why does this make sense?
secrete estrogen (as granulosa cells do) —> endometrial hyperplasia
therefore, it makes sense that granulosa cell tumors are associated with endometrial carcinoma
how do fibromas of the ovaries present?
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
benign, unilateral, solid white ovarian tumors with no hormone activity presenting in post-menopausal women
ovarian fibromas - present with Meigs syndrome (ovarian fibroma + ascites + pleural effusion) due to capillary leak from tumor factors
Meigs syndrome
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
thecomas of the ovary may produce which hormone?
thecomas: usually co-exist with fibromas (“fibrothecoma”) and may produce estrogen —> endometrial hyperplasia + bleeding
female with androgen-related symptoms + pelvic mass = what kind of ovarian tumor?
Sertoli-Leydig cell tumor - more often in males but may occur in the ovary
produce androgens —> breast atrophy, amenorrhea, sterility (anovulation), hirsutism
which type of ovarian tumors typically occur in younger women?
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]
what is the most common type of ovarian germ cell tumor?
teratomas: derived from cells of all three germ layers (monodermal forms are rare)
benign form = dermoid cyst
malignant form = immature teratoma
dermoid cyst
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)
what type of malignant transformation is most common in dermoid cysts?
dermoid cyst: skin-like benign teratoma
usually unilateral & asymptomatic but removed surgically to avoid complications - ovarian torsion, rupture, squamous cell carcinoma transformation
struma ovarii
rare monodermal type of teratoma containing mostly thyroid tissue - sometimes cause hypothyroidism
classic case is woman with hyperthyroidism + ovarian mass
woman presents with hyperthyroidism + an ovarian mass
struma ovarii: rare monodermal type of teratoma containing mostly thyroid tissue - sometimes cause hypothyroidism
immature teratomas (malignant teratomas) most commonly contain what type of cells?
solid mass with immature fetal tissue of all 3 germ layers, but neural tissue is most represented
what is the most common malignant germ cell tumor of the ovary?
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
how do dysgerminomas appear histologically?
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”)
yolk sac tumors, aka endodermal sinus tumors, secrete _____
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
how do yolk sac (endodermal sinus) tumors presents?
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]
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?
yolk sac (endodermal sinus) tumor: rare malignant germ cell ovarian tumor derived from extra-embryonic yolk sac cells
what is the classic pathological finding of yolk sac (endodermal sinus) tumor?
Schiller-Duval bodies: blood vessel surrounded by cancer cells (“glomerular like”), diagnostic of yolk sac tumors
choriocarcinoma
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
rare malignant tumor of placental cells, contain syncytiotrophoblasts and cytotrophoblasts and secretes hCG
choriocarcinoma - aggressive hematogenous spread, often already in lungs/liver/bone at diagnosis
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?
ovarian torsion due to a cyst or tumor (palpable mass) - surgical emergency because this can cause the ovarian blood supply to be cut off
what is the key pathological finding of granulosa cell ovarian tumors?
Call-Exner bodies, aka “coffee-bean” nuclei
Krukenberg tumor
gastric cancer that metastasizes to the ovary - bilateral
