Ovarian Pathology: Masses Flashcards
What is the 4th leading cause of death due to cancer in women?
Ovarian cancer
What is ovarian cancer known as?
Silent Killer
75% of ovarian cancer presents with what?
Advanced diseases
What is the peak age ovarian cancer presents with?
60-70 years
There is a increased risk of ovarian cancer in what demographic?
Nulliparous women
Non specific symptoms of ovarian cancer are what? 5
- Abdominal discomfort, bloating
- Vague abdominal- pelvic pain
- Constipation
- Urinary frequency
- Ascites
What are risk factors for ovarian CA? 9
- Over 90% of sporadic ovarian cancer occurs in women >50
- Nulluparity
- Low parity
- Delayed childbearing
- Early onset of menses
- Late menopause
- HRT over 10 years
- Family Hx of breast or ovarian cancer
- Direct relationship to number of years of ovulation and epithelial ovarian cancer
What is the percentage of ovarian tumors that are benign?
80%
What are the most common types of ovarian tumors? 2
- Serous cystadenoma’s
- Cystic (mature) teratomas
What are 3 types of neoplastic tumors?
- Epithelial tumors
- Germ cell tumors
- Connective tissue tumors
Label the image
What are 7 kinds of epithelial tumors?
- Serous cystadenoma
- Serous cystadenocarcinoma
- Mutinous cystadenoma
- Mutinous cystadenocarcinoma
- Endometriosis
- Clear cell carcinoma
- Brenner’s tumor
What is the most common epithelial ovarian tumor?
Serous cystadenoma
What kind of tumor is a serous cystadenoma?
Simple cystic tumor
Which demographic of people are affected by serous cystadenoma?
Menstruating age group
What are some characteristics of serous cystadenoma? 3
- Thin walls
- Variable size
- May have multiple septations
What does the serous mean in serous cystadenoma?
Serum producing, thin fluid
What does this image represent?
Serous cystadenoma
Serous cystadenocarcinoma’s may have what internally?
Cystic with regular texture and walls
What does serous cystadenocarcinomas contain? (fluid)
Ascites
What is the size of serous cystadenocarcinomas?
Large >10cm
What does the colour flow look like with serous cystadenocarcinoma? What does the septations look like?
Thick septations with colour doppler flow seen within
What are some things we must look for in terms of serous cystadenocarcinoma? (things outside of the pelvis)
Para-aortic lymph nodes
Serous cystadenocarcinomas predominately affect which age group?
Predominately premenopausal age group
Which is the most common malignant ovarian tumor?
Serous cystadenocarcinoma
What kind of tumour is this?
Serous cystadenocarcinoma
Are mutinous cystadenoma benign of malignant? What is it comprised of mostly?
- Benign
- Comprised mostly of mucin producing cells similar to those found in intestinal linings
What does Mucinoous cystadenomas look like? How large are they?
- Unilateral cystic mass with low level echoes (mucin) or complex looking
- Very large, 15-30 cm
What happens to mutinous cystadenomas in terms of size?
May rupture due to size
What kind of tumour is this?
Mucinous cystdenoma
What kind of mass is this?
Mucinous cystadenoma
How common are Mucinous cystadenocarcinoma? And is it malignant or benign?
Rare compared to its benign counterparts, and it is malignant
Mucinous cystadenocarcinomas are complex and associated with what?
Ascites
In terms of rupture, what are the risks with Mucinous cystadenocarcinoma
Risk of pseudomyxoma peritonei
Endometriosis carcinomas are usually benign or malignant?
Malignant
Which demographic people are associated with endometriosis carcinoma?
Menausal age group >60 years
What are characteristics of endometriosis carcinomas? 2
- Large 10-15 cm
- Complex or solid looking
What is endometrial carcinomas associated with?
Endometrial cancer and endometriosis
What are clear cell carcinomas also called? What kind of origin do they have?
Mesonephroid, with Müllerian duct origin
Clear cell carcinomas are benign or malignant?
Malignant
Clear cell carcinomas are a variant of what kind of Carcinoma?
Endometriosis carcinoma
Brenner tumors are also called what?
Transitional Cell tumors
How common are brenner tumors?
Rare
What is the appearance of brenner tumors? 3
- Solid
- Varies in size
- Unilateral
What are four kinds of germ cell tumors?
- Cystic teratoma (Desmond, dermoid)
- Solid teratoma
- Dysgerminoma
- Endodermal sinus tumor (Yolk sac tumor)
What is another name for cystic teratoma?
Mature teratoma or dermoid
How common are cystic teratoma?
Common in >25% of all ovarian neoplasms
Cystic teratomas are malignant or benign?
Usually benign, 2% may become malignant
What is the appearance of cystic teratomas? 2
- Variance appearance, predominantly complex with fat/ fluid levels, calcifications (teeth or hair)
- Tip of iceberg appearance
Which demographic of individuals are affected by cystic teratomas?
All ages, usually present in 20-40 y/o
Cystic teratomas may undergo what?
Torsion
What are these images representing?
Cystic teratomas
What is a benacerraf dermoid? What do they look like?
- Dermoid plug or rokitansky nodule
- Very hyperechoic, discrete rounded protuberance with dermoid mass
What is another name for solid teratoma?
Also called immature Teratoma
Which demographic of individuals are affected by solid teratomas?
Young children and young women
Are solid teratomas benign or malignant?
Benign to highly malignant
What are the most common malignant tumor in women under 30?
Solid teratoma
What does solid teratomas look like?
Solid mass, may have complex internal echoes
How common are dysgerminomas?
Rare
Who is most affected by dysgerminomas?
Young women
Are dysgerminomas benign or malignant? How radiosensitive are they? What kind of mass are they?
- Malignant and highly radiosensitive
- Solid masses
What is the male counterpart of dysgerminomas? And what is it associated with?
- Male counterpart is seminoma
- Associated with choriocaricinomas form increase in hCG
Choriocarcinoma is the malignant form of what?
Persistent trophoblastic disease
What are endodermal sinus tumors also called?
Yolk sac tumor
Who is most affected by endodermal yolk sac tumors?
Young women
What is the characteristics of a endodermal sinus tumor in terms of malignancy, growth, and composition?
- Malignant
- Rapid growth
- Solid
What is the prognosis of endodermal sinus tumors?
Poor prognosis and high recurrence rate
What enzyme causes endodermal sinus tumors?
Increase in AFP
What are sex cord - stromal tumors?
Connective cell tumors
What are three kinds of sex cord stromal tumors?
- Granulosa cell tumor
- Sertoli- leydig cell
- Fibrous and fibrosarcoma
What are Granulosa cell tumors characteristics in terms of composition, malignancy, and enzymes produced?
- Solid
- Usually benign
- Estrogen producing
Granulosa cell tumors are precocious in which demographic?
Puberty in children
What is Granulosa cell tumors associated with? What can it increase the risk of?
Endometrial hyperplasia and can cause increased risk of endometrial cancer
What is a sertoli-leydig cell tumor? What is it similar to? 2
- Solid and unilateral
- Similar to Granulosa cell tumors
Sertoli-leydig cell tumors may do what?
Degenerate, exhibit necrosis
What are sertoli leydig cell tumors also called?
Androblastoma
Which demographic of individuals are affected by sertoli leydig cell tumors?
Adolescence/ young women
What does sertoli-leydig cell tumors produce?
Androgens which cause masculinization
Are sertoli leydig cell tumors benign?
Usually but 10-20% become malignant, higher malignancy than Granulosa cell tumors
What are fibroma’s also called?
Adenofibroma
What is the malignant form of fibroma called?
Fibrosarcoma
What demographic of individuals are affected by fibromas?
Postmenopausal
What are the appearances of fibromas? 2
- Unilateral
- Solid, similar appearance to a fibroid
What are the primary carcinoma of a different organ with metastatic spread to the ovary called?
Secondary ovarian tumors
How common are secondary ovarian tumors?
Common
What does secondary ovarian tumors usually arrive from?
GI or breast
What are krukenbergs tumors?
Bilateral metastatic ovarian tumors that produce mucin
How big are secondary ovarian tumors?
Large complex masses
How strongly is breast cancer and ovarian cancer associated with each other?
Strongly
Women who have had breast cancer have how much of a risk of developing a primary ovarian cancer?
2X higher risk
Women with ovarian cancer have a _________ risk of developing risk of developing breast cancer?
3-4x higher risk
Mutation of which genes may cause increase rise of breast and ovarian cancer?
BRCA 1 and BRCA 2
What two enzymes have a lower chance of affecting breast and ovarian cancer?
MSH2 and MLH1 (colon cancer)
What is an antibody used to detect ovarian cancer?
Ca125
Why is Ca 125 so helpful?
Helpful for detecting recurrence and the most sensitive are non mucinous tumors
What is the acronym for ovarian masses?
CHEETAH
Cystadenoma
Hemorrhagic cyst
Ectopic
Endometrioma
Teratoma
Abscess
Hydrosalpinx
What does sonographer’s evaluate in terms of pathology? 5
- Size
- Echogenicity
- Consistency
- Contour of the mass
- Vasculature
If any pelvic abnormality is seen what must be done?
Endovaginal
When looking beyond the pelvis for pathology where should we look? 4
- Kidneys for obstruction
- Liver for metastatic disease
- Lymphadenopathy
- Free fluid/ ascites
Simple cysts below what size are usually benign?
<5cm
What are some features of worrisome malignancy? 6
- > 5cm
- Thick separations, irregular boarders
- Solid elements
- Abnormal tumor vascularity
- Ascites, lymphadenopathy
- Extension to adjacent organs
What are some treatment options for ovarian masses? 4
- Surgery
- Radiation therapy
- Chemotherapy
- Possible laparotomy
Young women with stage 1 cancer, may remove how much of their ovaries?
Only the affected ovary to help preserve fertility
