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DMST 315 OBGYN 3 > Ovarian Pathology: Masses > Flashcards

Ovarian Pathology: Masses Flashcards

1
Q

What is the 4th leading cause of death due to cancer in women?

A

Ovarian cancer

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2
Q

What is ovarian cancer known as?

A

Silent Killer

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3
Q

75% of ovarian cancer presents with what?

A

Advanced diseases

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4
Q

What is the peak age ovarian cancer presents with?

A

60-70 years

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5
Q

There is a increased risk of ovarian cancer in what demographic?

A

Nulliparous women

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6
Q

Non specific symptoms of ovarian cancer are what? 5

A
  1. Abdominal discomfort, bloating
  2. Vague abdominal- pelvic pain
  3. Constipation
  4. Urinary frequency
  5. Ascites
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7
Q

What are risk factors for ovarian CA? 9

A
  1. Over 90% of sporadic ovarian cancer occurs in women >50
  2. Nulluparity
  3. Low parity
  4. Delayed childbearing
  5. Early onset of menses
  6. Late menopause
  7. HRT over 10 years
  8. Family Hx of breast or ovarian cancer
  9. Direct relationship to number of years of ovulation and epithelial ovarian cancer
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8
Q

What is the percentage of ovarian tumors that are benign?

A

80%

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9
Q

What are the most common types of ovarian tumors? 2

A
  1. Serous cystadenoma’s
  2. Cystic (mature) teratomas
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10
Q

What are 3 types of neoplastic tumors?

A
  1. Epithelial tumors
  2. Germ cell tumors
  3. Connective tissue tumors
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11
Q

Label the image

A
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12
Q

What are 7 kinds of epithelial tumors?

A
  1. Serous cystadenoma
  2. Serous cystadenocarcinoma
  3. Mutinous cystadenoma
  4. Mutinous cystadenocarcinoma
  5. Endometriosis
  6. Clear cell carcinoma
  7. Brenner’s tumor
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13
Q

What is the most common epithelial ovarian tumor?

A

Serous cystadenoma

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14
Q

What kind of tumor is a serous cystadenoma?

A

Simple cystic tumor

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15
Q

Which demographic of people are affected by serous cystadenoma?

A

Menstruating age group

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16
Q

What are some characteristics of serous cystadenoma? 3

A
  1. Thin walls
  2. Variable size
  3. May have multiple septations
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17
Q

What does the serous mean in serous cystadenoma?

A

Serum producing, thin fluid

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18
Q

What does this image represent?

A

Serous cystadenoma

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19
Q

Serous cystadenocarcinoma’s may have what internally?

A

Cystic with regular texture and walls

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20
Q

What does serous cystadenocarcinomas contain? (fluid)

A

Ascites

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21
Q

What is the size of serous cystadenocarcinomas?

A

Large >10cm

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22
Q

What does the colour flow look like with serous cystadenocarcinoma? What does the septations look like?

A

Thick septations with colour doppler flow seen within

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23
Q

What are some things we must look for in terms of serous cystadenocarcinoma? (things outside of the pelvis)

A

Para-aortic lymph nodes

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24
Q

Serous cystadenocarcinomas predominately affect which age group?

A

Predominately premenopausal age group

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25
Q

Which is the most common malignant ovarian tumor?

A

Serous cystadenocarcinoma

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26
Q

What kind of tumour is this?

A

Serous cystadenocarcinoma

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27
Q

Are mutinous cystadenoma benign of malignant? What is it comprised of mostly?

A
  1. Benign
  2. Comprised mostly of mucin producing cells similar to those found in intestinal linings
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28
Q

What does Mucinoous cystadenomas look like? How large are they?

A
  1. Unilateral cystic mass with low level echoes (mucin) or complex looking
  2. Very large, 15-30 cm
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29
Q

What happens to mutinous cystadenomas in terms of size?

A

May rupture due to size

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30
Q

What kind of tumour is this?

A

Mucinous cystdenoma

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31
Q

What kind of mass is this?

A

Mucinous cystadenoma

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32
Q

How common are Mucinous cystadenocarcinoma? And is it malignant or benign?

A

Rare compared to its benign counterparts, and it is malignant

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33
Q

Mucinous cystadenocarcinomas are complex and associated with what?

A

Ascites

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34
Q

In terms of rupture, what are the risks with Mucinous cystadenocarcinoma

A

Risk of pseudomyxoma peritonei

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35
Q

Endometriosis carcinomas are usually benign or malignant?

A

Malignant

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36
Q

Which demographic people are associated with endometriosis carcinoma?

A

Menausal age group >60 years

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37
Q

What are characteristics of endometriosis carcinomas? 2

A
  1. Large 10-15 cm
  2. Complex or solid looking
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38
Q

What is endometrial carcinomas associated with?

A

Endometrial cancer and endometriosis

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39
Q

What are clear cell carcinomas also called? What kind of origin do they have?

A

Mesonephroid, with Müllerian duct origin

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40
Q

Clear cell carcinomas are benign or malignant?

A

Malignant

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41
Q

Clear cell carcinomas are a variant of what kind of Carcinoma?

A

Endometriosis carcinoma

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42
Q

Brenner tumors are also called what?

A

Transitional Cell tumors

43
Q

How common are brenner tumors?

A

Rare

44
Q

What is the appearance of brenner tumors? 3

A
  1. Solid
  2. Varies in size
  3. Unilateral
45
Q

What are four kinds of germ cell tumors?

A
  1. Cystic teratoma (Desmond, dermoid)
  2. Solid teratoma
  3. Dysgerminoma
  4. Endodermal sinus tumor (Yolk sac tumor)
46
Q

What is another name for cystic teratoma?

A

Mature teratoma or dermoid

47
Q

How common are cystic teratoma?

A

Common in >25% of all ovarian neoplasms

48
Q

Cystic teratomas are malignant or benign?

A

Usually benign, 2% may become malignant

49
Q

What is the appearance of cystic teratomas? 2

A
  1. Variance appearance, predominantly complex with fat/ fluid levels, calcifications (teeth or hair)
  2. Tip of iceberg appearance
50
Q

Which demographic of individuals are affected by cystic teratomas?

A

All ages, usually present in 20-40 y/o

51
Q

Cystic teratomas may undergo what?

A

Torsion

52
Q

What are these images representing?

A

Cystic teratomas

53
Q

What is a benacerraf dermoid? What do they look like?

A
  1. Dermoid plug or rokitansky nodule
  2. Very hyperechoic, discrete rounded protuberance with dermoid mass
54
Q

What is another name for solid teratoma?

A

Also called immature Teratoma

55
Q

Which demographic of individuals are affected by solid teratomas?

A

Young children and young women

56
Q

Are solid teratomas benign or malignant?

A

Benign to highly malignant

57
Q

What are the most common malignant tumor in women under 30?

A

Solid teratoma

58
Q

What does solid teratomas look like?

A

Solid mass, may have complex internal echoes

59
Q

How common are dysgerminomas?

A

Rare

60
Q

Who is most affected by dysgerminomas?

A

Young women

61
Q

Are dysgerminomas benign or malignant? How radiosensitive are they? What kind of mass are they?

A
  1. Malignant and highly radiosensitive
  2. Solid masses
62
Q

What is the male counterpart of dysgerminomas? And what is it associated with?

A
  1. Male counterpart is seminoma
  2. Associated with choriocaricinomas form increase in hCG
63
Q

Choriocarcinoma is the malignant form of what?

A

Persistent trophoblastic disease

64
Q

What are endodermal sinus tumors also called?

A

Yolk sac tumor

65
Q

Who is most affected by endodermal yolk sac tumors?

A

Young women

66
Q

What is the characteristics of a endodermal sinus tumor in terms of malignancy, growth, and composition?

A
  1. Malignant
  2. Rapid growth
  3. Solid
67
Q

What is the prognosis of endodermal sinus tumors?

A

Poor prognosis and high recurrence rate

68
Q

What enzyme causes endodermal sinus tumors?

A

Increase in AFP

69
Q

What are sex cord - stromal tumors?

A

Connective cell tumors

70
Q

What are three kinds of sex cord stromal tumors?

A
  1. Granulosa cell tumor
  2. Sertoli- leydig cell
  3. Fibrous and fibrosarcoma
71
Q

What are Granulosa cell tumors characteristics in terms of composition, malignancy, and enzymes produced?

A
  1. Solid
  2. Usually benign
  3. Estrogen producing
72
Q

Granulosa cell tumors are precocious in which demographic?

A

Puberty in children

73
Q

What is Granulosa cell tumors associated with? What can it increase the risk of?

A

Endometrial hyperplasia and can cause increased risk of endometrial cancer

74
Q

What is a sertoli-leydig cell tumor? What is it similar to? 2

A
  1. Solid and unilateral
  2. Similar to Granulosa cell tumors
75
Q

Sertoli-leydig cell tumors may do what?

A

Degenerate, exhibit necrosis

76
Q

What are sertoli leydig cell tumors also called?

A

Androblastoma

77
Q

Which demographic of individuals are affected by sertoli leydig cell tumors?

A

Adolescence/ young women

78
Q

What does sertoli-leydig cell tumors produce?

A

Androgens which cause masculinization

79
Q

Are sertoli leydig cell tumors benign?

A

Usually but 10-20% become malignant, higher malignancy than Granulosa cell tumors

80
Q

What are fibroma’s also called?

A

Adenofibroma

81
Q

What is the malignant form of fibroma called?

A

Fibrosarcoma

82
Q

What demographic of individuals are affected by fibromas?

A

Postmenopausal

83
Q

What are the appearances of fibromas? 2

A
  1. Unilateral
  2. Solid, similar appearance to a fibroid
84
Q

What are the primary carcinoma of a different organ with metastatic spread to the ovary called?

A

Secondary ovarian tumors

85
Q

How common are secondary ovarian tumors?

A

Common

86
Q

What does secondary ovarian tumors usually arrive from?

A

GI or breast

87
Q

What are krukenbergs tumors?

A

Bilateral metastatic ovarian tumors that produce mucin

88
Q

How big are secondary ovarian tumors?

A

Large complex masses

89
Q

How strongly is breast cancer and ovarian cancer associated with each other?

A

Strongly

90
Q

Women who have had breast cancer have how much of a risk of developing a primary ovarian cancer?

A

2X higher risk

91
Q

Women with ovarian cancer have a _________ risk of developing risk of developing breast cancer?

A

3-4x higher risk

92
Q

Mutation of which genes may cause increase rise of breast and ovarian cancer?

A

BRCA 1 and BRCA 2

93
Q

What two enzymes have a lower chance of affecting breast and ovarian cancer?

A

MSH2 and MLH1 (colon cancer)

94
Q

What is an antibody used to detect ovarian cancer?

A

Ca125

95
Q

Why is Ca 125 so helpful?

A

Helpful for detecting recurrence and the most sensitive are non mucinous tumors

96
Q

What is the acronym for ovarian masses?

A

CHEETAH

Cystadenoma
Hemorrhagic cyst
Ectopic
Endometrioma
Teratoma
Abscess
Hydrosalpinx

97
Q

What does sonographer’s evaluate in terms of pathology? 5

A
  1. Size
  2. Echogenicity
  3. Consistency
  4. Contour of the mass
  5. Vasculature
98
Q

If any pelvic abnormality is seen what must be done?

A

Endovaginal

99
Q

When looking beyond the pelvis for pathology where should we look? 4

A
  1. Kidneys for obstruction
  2. Liver for metastatic disease
  3. Lymphadenopathy
  4. Free fluid/ ascites
100
Q

Simple cysts below what size are usually benign?

A

<5cm

101
Q

What are some features of worrisome malignancy? 6

A
  1. > 5cm
  2. Thick separations, irregular boarders
  3. Solid elements
  4. Abnormal tumor vascularity
  5. Ascites, lymphadenopathy
  6. Extension to adjacent organs
102
Q

What are some treatment options for ovarian masses? 4

A
  1. Surgery
  2. Radiation therapy
  3. Chemotherapy
  4. Possible laparotomy
103
Q

Young women with stage 1 cancer, may remove how much of their ovaries?

A

Only the affected ovary to help preserve fertility

DMST 315 OBGYN 3 (21 decks)

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