Ovarian Pathology I Flashcards
follicular cyst
common - up to 5cm in size
no LH surge and cyst doesn’t rupture
often resorb after 2-3 menstrual cycle
smooth walled unicameral cyst
corpus luteum cyst
opening from released egg seals off - CL to cyst
may resolve
may hemorrhage - or undergo torsion
chocolate cyst
endometriosis in ovary
glands and strom present
benign ovarian cysts
follicular and corpus luteum
sudden unilateral pain
ovarian torsion
-blood supply compromised
tx of torsion
unwind vessel or remove ovary
ovarian torsion diagnosis
rule out ectopic pregnancy
ultrasound
poycystic ovary disease
most common endo problem in women of reproductive age
stein-leventhal syndrome
oligomenorrhea, hyperandrogen, hirsutism, balding, obesity, acanthosis nigricans, diabetes
PCOD
to visualize ovaries
ultrasound
to see PCOD
hypercholesterol, anovulation, MMR, amenorrhea, infertility, acne, insulin resistance, obesity
PCOD
leathery plaque like lesion
acanthosis nigricans
-with PCOD
failure to conceive after 1 year of sex
infertility
likelihood of pregnancy over time
fecindidity
over 35 yo with increased day 3 FSH
menopause
-ovarian failure
waited too long to get pregnant
less than 35yo with progesterone >3
recent ovulation
anovulatory infertility
PCOS - high androgen
endocrinopathy - prolactin, TSH, FSH
ovulatory infertility
if have high progesterone
hysterosalpingogram - to examine tubes
- blocked - PID or mechanical
- patent - endometriosis, adhesions, uterine mass, anoaly
majority of ovarian tumors
borderline serous tumors 47%
ovarian cancer
late at presentation
older women - increased if 1st degree relative has it
genetics of ovarian cancer
BRCA 1 and 2
lynch II syndrome
prognosis of ovarian cancer
depends more on stage
overal 50% 5 year mortality
often bilateral
ovarian cancer
screening ovarian cancer
no effective way
CA125
for following prognosis of ovarian cancer
NOT for diagnosis**
majority of ovarian cancer
serosal epithelium
layers of follicle in ovary
theca interna
granulosa
theca externa
granulosa cell tumor
malignant
sertoli-leydig cell tumor
malignant
dermoid cyst
teratoma
-benign
ovary serosa
invaginates into coelomic cavity - covered by serosal membrane during embryogenesis
serous cystadenoma of ovary
benign
-lined by single layer of epithelium
serous borderline carcinoma of ovary
atypia - but no invasion
serous adenocarcinoma of ovary
type 1 - low grade - slow progression
type 2 - aggressive - high grade - present late
-worse prognosis if peritoneum spread and mets
ciliated cells
benign serous cystadenoma of ovary
ascites
with serosal seeding of ovarian tumor
tx of borderline carcinoma of ovary
remove
prognosis excellent usually
surface of ovary covered by neoplasm
exophytic papillary serous carcinoma
protrudes to outside of ovary
surface of ovary smooth
cystic papillary serous carcinoma
psammoma body
pathogmonic of serous tumor of ovary
also seen in thyroid and kidney neoplasms
bilateral mucinous cancer of ovary
rule out mets
least likely to be B/L**
pseudomyxoma peritonei
mucinous ascites
if mucinous tumor breaks
endometroid tumors of ovary
type 1 - PTEN and KRAS
type 2 - p53, CDH1, and MI
same pathogenesis as uterus
goal of surgery for mucinous cystadenoma
avoid rupture - b/c seeding can occur
endometroid carcinoma of ovary
indistinguishable from endometroid adenocarcinoma of endometrium
15-20% coexist
associated with PTEN, KRAS, and beta-catenin mutations
KRAS and BRAF mutations
low grade serous carcinoma
p53, BRCA1 mutation
high grade serous carcinoma
p53 positive
BRCA1 positive
high Ki67**
WT1 positive
high grade serous carcinoma
Ki67 - proliferative
WT1 - serous
estrogen receptor
expressed 2/3 cases of high grade serous carcinoma
lower abdominal pain, GI complaints, ascites, pelvic pressure
symptoms for surface epithelial tumors of ovary
cytology of ascites
common means of establishing tissue diagnosis
surgery for surface epithelial tumors of ovary
main stay of treatment
all visible tumor removed
-followed by chemo
BRCA - BCP and salpingo-oophorectomy
malignant ascites
with ovarian serous carcinoma
mets of ovarian ca
liver, lung, bone, brain
peritoneal carcinomatosis
can be seen on CT
omental caking**
low albumin gradient
peritoneal carcinomatosis - seeding of tumor
high albumin gradient ascites
cirrhosis
heart failure
inhibin
biomarker for granulosa - theca cell tumor**
granulosa cells
call-exner bodies
granulosa thecal cell tumor
granulosa theca cell tumor
hormone active - 75% produce estrogen
yellow cut surface
all ages
intermediate malignancy
ascites, pleural effusion, ovarian fibroma
-resolves with resection
meig syndrome
fibroma
common and B9
solid white hard fibrous tumor
thecoma - with lipid droplets
fibrothecomas
sertoli-leydig cell tumor
rare
50% produce androgens
-causing virilization
teratoma in children
malignant
teratoma in adult
benign
dermoid cyst
benign cystic teratoma
contain 2 or 3 germ lines
hair and keratin - teeth**
teeth on X-ray
diagnostic for teratoma
rokitanski nodule
in dermoid cysts - teratomas
immature teratoma
malignant
mature teratoma
benign
monodermal teratoma
single tissue teratoma
carcinoids
struma ovarii - thyroid
functional - hyperthyroid and carcinomd syndrome
flushing
carcinoid
dysgerminoma
all malignant
sensitive to radiotherapy
1/3 aggressive
U/L confined to ovary - can be treated with salpingo-oophorectomy
endodermal sinus tumor
yolk sac
alpha-fetoprotein
allpha-1 antitrypsin
very aggressive - need chemo
in children and young adults
schiller duval bodies
endodermal sinus tumor
AFP and a-1 antitrypsin
endodermal sinus tumor
choriocarcinoma
within part of another germ cell tumor
aggressive
produce beta-hCG
beta hCG
choriocarcinoma
for diagnosis
krukenberg tumor
B/L mets of mucin producing signet ring cancer cells
gastric origin
signet ring
krukenberg tumor
