Ovarian Tumors

Question 1

Polycystic Ovary

Answer 1

• Multiple Follicular cysts in ovary w/Subcapsular cysts
• “Stein-Leventhal syndrome”
• Lab: Excessive secretion of estrogen, testosterone, androgen
  
  • _{^{<strong><u>High LH </u>(Theca cells)<u>,</u> <u>LOW FSH</u> (Granulosa cell degeneration=Cysts)</strong>}}
• Obesity:
• High insulin _{^{(type 2)}} w/Low FSH & High LH
• High conversion of estrogen=_{^{<em><strong>High estrogen (<u>endometrial carcinoma)</u></strong></em>}}
• “Hirsutism”-_{^{Increased androgen by Theca cells}}
• Symptoms:
• Growth is normal _{^{(short stature=Sertoli-Leydig tumor)}}
• Oligomenorrhea _{^{<strong>(infrequent)</strong>}}
• Infertility
• Endometrial hyperplasia = Cancer

Question 2

Epithelial Tumor (Serous)

Answer 2

• Serous Cystademnoma:
  
  • _{^{No atypical cells <strong>(not cancer)</strong> & No invasion}}
  • _{^{Single CYSTIC tumor lined by<em><strong>ciliated columnar</strong></em>}}
• Serous Borderline tumor:
  
  • _{^{<em><strong>Atypical</strong></em> cells, mitosis present, BUT <em><strong>NO invasion</strong></em>}}
• Serous Cystadenocarcinoma (solid tumor):
• Papillary process w/psammomma body _{^{(laminar calcification)}}
  
  • _{^{Multiple complex cyts w/shaggy <strong>BILATERAL</strong>}}
  • _{^{<strong><em><u>Spread to omentum-</u>Invasion ASCITES</em></strong>}}
  • _{^{<strong><em>Papillae w/atypical cubodial cells-<u>DO NOT PRODUCE ANYTHING</u></em></strong>}}
• X-ray-“calcification”-Psammoma body
• Genetics-BCRA 1 (Breast & Ovary/Fallopian)

Question 3

Epithelial Tumor (mucinous)

Answer 3

• Cysteadenomas- Cysts lined by single layer of BENIGN mucinous columnar epithelium
  
  • _{^{<strong>Ex. Cervival epithelium or Coelemic epithelium</strong>}}
• Cystadenocarcinoma-Large/multiple tumors
  
  • _{^{Not common}}
  • _{^{Cysts contain mucinous geltinous fluid}}
• Histo: Thick w/shaggy lining
• Complications:
• Tumor can rupture & spread mucins in peritoneal cavity - Pseudomyxoma peritonei _{^{(assoc w/pancreas cancer)}}
  
  • _{^{Invasion=<strong>Ascites w/GI fibrosis</strong>}}
  • _{^{<u><strong>Histo: </strong></u>Signet cells in “Mucocele”}}

Question 4

Transitiional cell tumor

Answer 4

• Brenner tumor (Ovarian surface tumor)
• Histo: Stromal/Epi pattern
  
  • Origin is urothelium tissue _{^{<strong>(Transitional)</strong>}}
  • All present late w/poor prognosis-Spread locally peritoneum (“Omental caking”)
• CA-125 serum marker for reaccurance ^{_{<strong>(0 no cancer)</strong>}}

Question 5

Germ cell tumor (teratoma)

Answer 5

• Pt 20-40
• Contains all 3 germ layers _{^{(hair, teeth, GI, thyroid)}}
• Cystic: Benign
  
  • Mature dermoid cyst of ovary
• Histo: Squamos epithelium (skin)
  
  • _{^{Can progress to malignant-<strong><u>Squamous cell carcinoma-SOMATIC malignancy</u></strong>}}
  • _{^{Follicular carcinoma <u><strong>(thyroid)-"</strong></u><strong>Stroma ovarii-Hyperthyroidism”</strong>}}
  • _^Melanoma
• Solid: Malignant
  
  • Immature tissue (neuroectoderm)

Question 6

Germ cell tumor (Dysgerminoma)

Answer 6

• Malignant & presents unilateral
• Occurs with gonadal dysgenesis-
  
  • _{^{Loss of germ cells in developing gonads}}
  • _{^{Common in <u>Turner's Syndrome</u>}}
• Morphology: Grey-white homogenous
• “knobby” uniform cells
• Histo: Fibrosis w/hypoplasia of glands
  
  • _{^{Large cells w/clear cytoplasm & central nuclei <strong>(nest of cells)</strong>}}
• Lab: HIGH LDH
• Radiosensitive tumor w/80% cure rate
• Male version is Seminoma-Testis

Question 7

Germ cell tumor (Endodermal Sinus)

Answer 7

• Malignant tumor mimics yolk sac
• Most common in children
• Serum: Alpha feto protein elevated
• Histo: Schiller-Duval Bodies _{^{(glomular-like/Bowman’s)}}

Question 8

Germ cell Tumor (Choriocarcinoma)

Answer 8

• Very agressive malignant tumor w/increase in b-hCG
  
  • _{^{<strong>Age-before 20 & after 40</strong>}}
  • _{^{<strong>Increase in b-hCG is to <u>synctiotrohoblast</u></strong>}}
• Morphology: throphoblast & Synctiotrophoblast _{^{(<u>NO villi)</u>}}
• High RIsk-Complete mole (50%), After abortion (25%)
• Diagnose: Preform curettage B-hCG lvl down, B-hCG lvls rise treat w/drug = continue to rise _{^{Choriocarcinoma}}
• Metastasis (blood)-Lung, Vagina, Brain, Liver, Kidney
  
  • _{^{Due to trophoblast composition=Spreads to blood}}

Types

• Uterus = Gestational choriocarcinoma _{^{(molar, Abortions, pregers)}}
  
  • _{^{Responds well to chemo}}
• _Germ-line _{^{(testis/ovaries)}} _does NOT respond to chemo

Question 9

Sex-Cord stromal tumor (Granulosa-Theca)

Answer 9

• Theca->Androgen (LH)->Granulosa->Estrogen (FSH)
• Post-menopause woman w/unilateral presentation
  
  • _{^{Symptoms-Abnormal bleeding}}
• Children present w/percocious puberty
• Estrogen excess-Endometrial hyperplasia leads to endometrial carcinoma
• Replace of ovary by solid mass
• Histo: Call-exner body (H&E) small esoinophilic fluid filled spaces between granulosal cells

Question 10

Sex-cord stromal tumor (Sertoli-Leydig)

Answer 10

• “Arrhenoblastoma/Androblastoma”
• All ages & unilateral over production of androgen
• Sertoli = FSH & Leydig = LH
• Symptoms:
• Masculinizing (short, amenorrhea _^(Absence), acne, deepening of voice, & temporal balding)
• Histo: Pink sertoli-leydig cells (reinke crystals)
• D/D polycystic ovary-Excess secretion of estrogen, testosterone, & androgen

Question 11

Sex-cord stromal tumor (Ovarian fibroma)

Answer 11

• Benign tumor of fibroblast
• May contain collagen fibers
• Meigs Syndrome:
• Assoc w/pleural effusions, ascitis, ovarian tumor
• Effusion commonly on right & can be seen in X-ray
• Histo: Solid tumor w/white bands

Question 12

Sex-cord stromal tumor (metastasic)

Answer 12

• In older pt
• Primary source: breast, lung , GI
  
  • Presents as LARGE bilateral mass
• Krukenberg (GI) - bilateral deposit of adenocarcinoma to ovary
  
  • Gastric (diffuse), colon or Breast _{^{(lobular caricinoma)}}
• Histo: Signet cells (mucin)
  
  • Travel through seeding of body cavity

Question 13

Placental Disorder (Complete Hydatidiform mole)

Answer 13

• Abnormal form of pregers where NON-viable egg implants in uterus
• Pt.=Asian countries mother over 40 & under 20
• Morphology: “Cluster of grapes” @ 2nd tri _{^{(in both)}}
• Complete:
• Empty ovum + 2 sperm _{^{<strong>(46 chromosome)</strong>}}
• Fetal tissue absent
• NO blood vessels in villi
• ALL villi are hydrophobic _{^{(swollen edematous villi)}}
• Trophoblast prolif severe ^{<u>_{<strong>(high B-Hcg-syncytiotrophoblast)</strong>}</u>}
• Absence of P57 = Risk for choriocarcinoma (Cause=Paternal tissue)

Question 14

Placental Disorder (Partial Hydatidiform mole)

Answer 14

• Normal ovum + 2 sperm (69 chromosomes)
• Fetal tissue PRESENT (even whole fetus)
• SOME villi are vesicular & Normal
• Blood vessels present in NORMAL villi (RBC)
• Beta-hCG silight elevated _{^{(more in complete)}}
• Mild trophoblasitc proliferation
• LOW risk of choriocarcinoma

Question 15

Placental Disorder (Mole)-Treatment

Answer 15

• Signs/Symptoms:
• Uterus too large for term
• Vaginal bleeding
• Morning sickness more frequent
• Passage of vesicle
• Monitor Beta-hCG lvls for accurate removal & monitor choriocarcinoma ^(complete)
• Curettage preformed-Beta hCG lvls should go down
• Invasive mole
• Increase Beta-hCG lvls after surgery
• Treat w/drug to down reg beta hCG=Decline