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Obgyne > Ovarian Tumer > Flashcards

Ovarian Tumer Flashcards

1
Q

D/D of Ovarian Mass

A

Functional :
1. Follicular cyst
2. Corpus luteal cyst
3. Thea luteal cyst
Inflammatory :
1. Tubo-ovarian abscess
2. Oophoritis.
Neoplastic
1. Benign
2. Malignant
Other:
1. Endometriotic cyst
2. Enlarged ovary in PCOS
3. Para-ovarian cyst

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2
Q

Ultrasound features of ovarian masses
Benign
Malignant
——
Internal structure:
Margins:
Echogenicity :
Content :
Vascularization :
Pouch of Douglas :

A

سلايد ٧

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3
Q

What’s the type of benign ovarian tumer ?

A

• Epithelial : 60%
1. Serous cystadenoma
2. Mucinous cystadenoma
3. Brenner
• Germ cell :
1. Mature cystic teratoma (Dermoid cyst)
2. Stuma ovaraii
• Sex cord- stromal :
1. Fibroma
2. Thecoma

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4
Q

Serous cystadenoma

A
  1. composed of cells resembling the fallopian tube lining.
  2. Unilocular, may have septations , with Papillary components
  3. Unilateral, 10-20% are bilateral
  4. CharacterisCc psammoma
    bodies
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5
Q

Mucinous cystadenoma

A
  1. Composed of cells resembling the endocervical lining
  2. Multiloculated , unilateral 5-10% bilateral.
  3. Can get extremely large 7-10kg
  4. Round mass with smooth
    capsule.
  5. Contain clear, viscid fluid
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6
Q

Most common tumors of the reproductive age group (50% of all)

A

Benign Germ cell Ovarian Tumors

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7
Q

DERMOID CYST (mature cyst teratoma)

A

• Most common ovarian tumor in young age
• Peak incidence 20 years
• 90% of germ cell tumors
• 10% are bilateral
> 15 % present with acute torsion Its contents may be the derivatives of 3 embryonic cell layers:
1. Ectoderm: skin, hair, teeth & nervous tissue
2. Mesoderm: cartilage, bone, and muscles
3. Endoderm: thyroid, stomach, & intestinal tissue

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8
Q

STUMA OVARII

A

consists only of the active thyroid tissue

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9
Q

Treatment of Benign Germ cell tumors

A

• Cystectomy. to preserve ovarian function. Careful evaluation of the opposite adnexa should be
performed, as dermoid cysts can occur bilaterally in 10–15% of cases.
• Oophorectomy: If an ovarian cystectomy cannot be done, then an oophorectomy is performed, but conservative management should always be accepted before an oophorectomy is done.
• Follow-up is on an annual basis.

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10
Q

Benign sex cord-stromal Ovarian Tumors

A

• These are solid tumors
• Composed of stromal cells
• Present in post-menopausal women

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11
Q

OVARIAN FIBROMA

A

Meig’s syndrome consists of pleural effusion, ascites & ovarian fibroma

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12
Q

THECOMA (theca cell)

A

((secrets estrogen)) cause :
1. post-menopausal bleeding
2. associated with ca endometrium

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13
Q

What is the type of Malignant Ovarian Tumors

A

Epithelial 90% :
1. Serous cystadenocarcinoma
2. Mucinous cystadenocarcinoma
3. Endometrioid ca
4. Clear cell carcinoma
5. Undifferentiated.

Germ cell 5% :
1. Malignant teratoma
2. Dysgerminoma
3. Endodermal sinus tumor
4. Choriocarcinoma
5. Gonadoblastoma

Sex cord- stromal 3-5%:
1. Granulosa cell
2. Theca cell
3. Sertoli-leydig cell
4. Gyandroblastoma

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14
Q

Mucinous cystadenocarcinoma

A

Pseudomyxoma peritoneii’ a thick, jelly-like ascites with mucinous tumor deposits throughout the abdominal cavity.

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15
Q

Borderline ovarian tumors (BOTs)

A
  1. Variant of epithelial ovarian cancers
  2. Tumors of low malignant potential
  3. Well-differentiated with nuclear pleomorphism and cellular atypia but doesn’t invade the basement membrane
  4. Behaves much less aggressively and prognosis is very
    favorable
  5. 10% of malignant ovarian tumors.
  6. Presents at a younger age, at approximately 48 years
  7. Staging by using the FIGO
  8. > 75% of presentaCons are at stage1
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16
Q

Malignant germ cell tumors (5%)

A
  1. Unilateral (except for dysgerminoma).
  2. Young age
  3. Lymphatic spread
  4. Rapid growth
  5. Most are stage I and confined to the ovary at the time of diagnosis.
  6. increased incidence with dysgenetic gonads.
17
Q

Patient with pain in the right side and there is a mass on ovary and she is down syndrome. What type of the tumor maybe she has?

A

Malignant germ cell tumors.

18
Q

Malignant germ cell tumours
• Tumour markers

A

• Dysgerminoma ➙ LDH, Placental alk
phosphatase
• Endodermal sinus tumor ➙ alpha-
fetoprotein
• Choriocarcinoma ➙ (bHCG)

19
Q

Treatment of Malignant germ cell tumors

A
  1. A unilateral salpingo-oophorectomy and surgical staging (peritoneal and diaphragmatic biopsies, peritoneal cytology, pelvic and paraAortic
    lymphadenectomy, and omentectomy)
  2. postoperative chemotherapy (Vinblastine, Bleomycin, and cisplatin).
    ((( ALL pt ))).
  3. Follow-up (( every three months )).
20
Q

Malignant Sex cord-Stromal Ovarian Tumors. What’s the type and what’s the characteristic?

A
  1. Granulosa cell tumer
    • Low-grade malignancy
    • Reproductive age (5% prepubertal)
    • Produce estrogens Asso with : endometrial carcinoma 5% endometrial hyperplasia 25-50%
  2. Sertoli-Leydig Tumour :

• Low-grade malignancy
• 75% <40 years
• Produce androgens : Asso with 70-85% - clinical virilization

21
Q

Sex-cord stromal tumors (5%)
What’s the hormonal produce ?

A

• Granulosa cell tumor ➨ Estrogen
• Sertoli cell tumor ➨ Estrogen
• Leydig cell tumor ➨ Antrogens

22
Q

Sex-cord stromal tumors
How are you gonna treat it?

A

Surgical removal

23
Q

Secondary or Metastatic Ovarian Tumours:

A
  1. ovaries may get enlarger than primary malignancy
  2. H/P shows the primary picture
  3. From the Genital tract
  4. From extragenital tract organs
    Krukenberg tumor:
    • secondary ovarian tumor from metastatic spread of gastric carcinoma • Uniform enlargement
    • Bilateral involvement Characteristic mucin-secreting signet-ring cell appearance.
24
Q

Ovarian Cancer Risk Factors

A
  1. 50 years of age or older
  2. Familial factors:
    A • Family history of breast, ovarian, or colon cancer 3x baseline risk.
    B • Personal history of breast or colon cancer
    C • Familial cancer syndrome (10%) :
    - BRCA (breast cancer) gene mutation
    - hereditary non-polyposis colon cancer.

[[ Other potential risk factors ]]

• Early menarche (younger than 12 years of age)
• Late menopause (older than 52 years of age)
• Nulliparity
• First pregnancy at older than 30 years of age
• Infertility , endometriosis
• (fertility Rx does not increase risk)
• Hormone replacement therapy

25
Q

BRCA1

A

chromosome 17

26
Q

BRCA2

A

chromosome 13

27
Q

A tumor suppressor gene

A

produces a protein for
DNA repair» predispose to the development of breast and ovarian cancer

28
Q

Hereditary nonpolyposis colorectal cancer

A

• Also known as “Lynch syndrome”
• 12% risk of developing ovarian cancers.
• A hereditary cancer syndrome caused by a mutation in mismatch repair genes. Individuals have a signifcantly higher risk of developing colorectal, gastric, ovarian, and endometrial cancer.

29
Q

Protective factors

A

Surgical interven :
• Bilateral salpingo-oophorectomy.
• Hysterectomy.
• Tubal ligation.

Hormonal factors :
• Oral contraceptives.
• breast-feeding.
• Parity.

30
Q

Presentation S&S

A

• Can be asymptomatic
• Incidentally found on routine pelvic examination or imaging
• Early symptoms are nonspecifc
• Changes in urination (e.g., frequency or urgency)
• Bloating/abdominal distention
• Early satiety
• Nonspecifc pelvic pain
• Abnormal bleeding
• Postmenopausal bleeding
• Rectal bleeding
• Adnexal mass
• Para neoplastic syndromes

31
Q

Clinical examination

A

Pelvic/abdominal mass (fxed/mobile); ascites; omental mass; pleural effusion ; supraclavicular lymph nodes.

32
Q

Tumour markers:

A

• CA125
• Carcinoembryonic antigen(CEA): raised in colorectal cancers, normal in ovarian CA
• AFP, hCG, LDH, inhibin, and oestradiol

33
Q

What’s the investigation of the ovarian cancer?

A
  1. Haematological tests: FBC, U&E, LFTs.
  2. Tumour markers:
    • CA125
    • Carcinoembryonic antigen (CEA): raised in colorectal cancers, normal in ovarian CA
    • AFP, hCG, LDH, inhibin, and oestradiol
  3. Image :
    • Abdominal/pelvic USS: the presence of pelvic mass and ascites
    • CXR: pleural ecusion or lung metastases
    • CT abdomen/pelvis: the extent of metastasis
    • MRI abdomen/pelvis : to assess the origin & the extent of metastasis
34
Q

Surgical staging of primary ovarian cancer:

A

mid-line sub umbilical suprapubic exploratory laparotomy:

  1. Exploration of the pelvic and peritoneal cavity
  2. Aspiration of (ascites) or
    perform peritoneal washings for Cytology.
  3. infracolic omentectomy.
  4. Pelvic and paraAortic lymph node sampling
  5. Resection of any visible enlarged nodules or masses.

Obgyne (26 decks)

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