Ovarian Tumors Flashcards
1
Q
ow do cystic follicles occure?
A
they arise from unruptured graafian follicles that have ruptured and sealed
2
Q
What are cystic follicles filled with?
A
clear serous fluid
3
Q
What is the minimum size at which a tumor can be palpated?
A
2cm
4
Q
What size does the cystic follicle have to reach in order to cause pain?
A
2cm
5
Q
How do the outer theca cells look in a cystic follicle?
A
pale cytoplasm luteinized
6
Q
How do corpus luteal cyst look like?
A
lined by rim of bright yellow tissue= luteinized granules ells
7
Q
What is a consequence of corpus luteal cyst?
A
can rupture and cause a peritoneal reaction
8
Q
what is a DD for corpus luteal cyst?
A
Endometriosis
9
Q
What is Polycystic Ovary?
A
numerous cystic follicles and associated oligomenorrhea
10
Q
What are the features of polycystic ovary?
A
-Persistent anovulation Hirsutism Virillism
11
Q
Describe the size of the ovary in polycystic ovary?
A
The ovary is twice the size
12
Q
Describe the pathology of polycystic ovary?
A
Increased LH->stimulates theca lutein cells of follicles->produce more androgen->converted to estrone
13
Q
What is polycystic ovary linked to?
A
insulin resistance
14
Q
How do you treat polycystic ovary/ Stein-Leventhal Syndrome?
A
metforman glitazones clomiphene
15
Q
What is Stromal Hyperthecosis/Cortical Stromal hyperplasia?
A
proliferation of ovarian stroma with luteinization
16
Q
What age group is stromal hyperthecosis usually seen in?
A
post menopausal women
17
Q
Is Stromal Hyperthecosis/Cortical Stromal hyperplasia bilateral or unilateral?
A
bilateral
18
Q
Describe how Stromal Hyperthecosis/Cortical Stromal hyperplasia would look
A
white tan cut surface uniform enlargement of the ovary Micro: hypercellular storm and luteinization of stroll cells
19
Q
What is a similar condition to Stromal Hyperthecosis/Cortical Stromal hyperplasia?
A
theca lutein hyperplasia of pregnancy (proliferation of theca cells)
20
Q
Benign tumors are usually seen in what age women?
A
premenopausal
21
Q
malignant tumors are usually seen in what age women?
A
post menopausal
22
Q
List the types of surface epithelial cell tumors?
A
serous mucinous endometrioid clear cell brenner cystadenofibroma
23
Q
List the types of germ cell tumors?
A
Teratoma dysgerminoma endodermal sinus tumor choriocarcinoma
24
Q
list the types of sex cord tumors?
A
fibroma granulosa theca cell tumor sertoli-leydig tumor
25
What is surface epithelium derived from?
coelomic epithelium
26
what are germ cells derived from?
the yolk sac and are pluripotent (immature/stemcells)
27
Where do the sex cords come from?
ovarian tumor
28
What are the clinical symptoms of an ovarian tumor?
abdominal pain distention urinary and go symptoms vaginal bleeding fullness
29
What are the markers for ovarian epithelial tumors?
CA125 (serous and endometriod carcinomas) osteopontin
30
Why is CA125 not that reliable of a marker for ovarian epithelial tumors?
because it can be seen with irritation of the peritoneum (endometriosis, inflammation)
31
How to prevent ovarian cancer?
fallopian tubal ligation and Oral contraceptive therapy screening for BRCA mutations prophylactic saplingo-oophorectomy
32
Mullein ducts are formed from \_\_\_\_\_\_\_\_epthelium and become serous\_\_\_\_\_, endometrioid\_\_\_\_\_\_ and mutinous\_\_\_\_\_epithelilia
coelomic tubal like endometrial like cervical like
33
what are the two pathway that epilethial tumors arise?
Malignant with borderline (well differentiated KRAS or BRAF mutations) De novo (poorly differentiated p53mutations)
34
What is the most common malignant ovarian tumor?
serous epithelial tumors
35
What is the micro of serous epithelial tumors?
cystic tall columnar epithelial cells
36
Are serous epithelial tumors usually bilateral or unilateral?
bilateral
37
What are type I serous epithelial tumors associated with?
borderline tumors and endometriosis
38
what are the type 1 serous epithelial tumors
low grade serous endometrioid and mutinous tumors
39
where do type 2 serous epithelial tumors arise from?
fallopian tubes
40
what are the genes for low grade serous epithelial tumors?
serous borderline KRAS BRAF ERB2 and wild type P53
41
what are the genes for serous epithelial tumors serous epithelial tumors?
TP5 application of PIK3CA (No KRAS No BRAS)
42
What are the risk factors for serous epithelial tumors
BRCA1 BRCA2 weak: nulliparity, family hx
43
what decreases the risk for serous epithelial tumors?
OCP and tubal ligation
44
what is the gross pathology of serous epithelial tumors?
cystic can be lined by papillary projections (the more malignant the more complex the papillary projections and solid areas)
45
what is the micro for benign serous tumors?
cyst lined by columnar epithelium with cilia bland papillae
46
What is the micro for borderline serous tumors?
increased complexity of the storm papillae stratification of the epithelium mild nuclear atypic localized
47
what is a complication of borderline serous tumors?
can lead to intestinal obstruction
48
what is the micro? for low grade "micropaipillary" serous epithelial tumors/ carcinoma?
complex micro papillary growth spread to peritoneal surfaces and momentum ascites
49
what is the micro for high grade serous carcinoma?
even more complex growth pattern infiltrative pattern effacement of storm Cells: marked nuclear atypia, pleomorphism, multinucleate cells, Psammoma bodies (Ca2+) spread to peritoneal surfaces and momentum ascities
50
At what age do you seen mucinous tumors ?
mid adult life (rare before puberty and after menopause)
51
are mucinous tumors benign or malignant?
most ases benign/borderline
52
what is the risk factor for mucinous tumors
smoking
53
what is the gene mutation associated with mutinous tumors?
KRAS
54
What is the gross of mutinous tumors?
surface involvement rare usually unilateral larger cystic masses (THE LARGEST) fluid
55
what type of fluid is seen in mutinous tumors?
sticky gelatinous fluid rich in GLYCOPROTEINS
56
what is the micro of mutinous tumors?
bengin tall columnar cells apical mucin NO cilia a lot of gland like/papillary growth nuclear atypic stratification
57
Mullein Mutinous cyst adenoma can arise from?
endometriosis
58
mutinous tumors are precursors too \_\_?
most cystadenocarcinomas
59
describe the micro of cystadenocarcinomas?
areas of solid growth within cyst epithelial cella type and stratification LOSS of glands Necrosis
60
what does cystadenocarcinomas look like?
colonic cancer?
61
if cystadenocarcinomas spread beyond ovaries it is \_\_\_?
fatal
62
how often do cystadenocarcinomas spread beyond ovaries?
rare
63
what is Pseudomyxoma Peritonei?
Extensive mutinous ascities cystic epithelial implants on the peritoneal surfaces adhesions Mutinous tumor involving the ovaries
64
what can Pseudomyxoma Peritonea lead to?
intestinal obstruction nd death
65
how do you get Pseudomyxoma Peritonea?
APPENDICIEAL primary mutinous tumor mets to bilateral ovaries and peritoneum
66
Primary mucinous ovarian tumors are bilateral or unilateral?
unilateral if bilateral think mets
67
Describe Endometrioid carcinomas?
tubular glands resembling endometirum
68
Where can Endometrioid carcinomas arise from?
endometriosis ovarian surface epithelium
69
if Endometrioid carcinomas are associated with endometriosis does it improve or worsen the prognosis and by how long?
improves by a decade
70
are Endometrioid carcinomas usually bilateral or unilateral?
bilateral
71
what gene mutation is associated with Endometrioid carcinomas?
PTEN TUMOR suppressor gene KRAS and beta-catenin p53 (because poorly differentiated)
72
Describe the malignancy of clear cell carcinomas?
always benign and borderline
73
how prevalent are clear cell carcinomas?
very very rare
74
what is the micro of clear cell carcinomas?
large epithelial cells iwht abundant clear cytoplasm (looks like hypersecretory gestational endometrium)
75
what are clear cell adenomas associated with
endometriosis or endometrioid carcinoma of the ovary?
76
what is a cystadenofibroma?
benign increased proliferation of the fibrous stroma
77
what is brenner tumor?
adenofibroma
78
what type of epithelium is seen in a brenner tumor?
uroepithelium (urinary)
79
what age group do you usually see germ cell tumors?
women of reproductive age
80
what type of germ cell tumor is benign and which type is malignant?
benign (mature cells) malignant (immature cells)
81
what are benign/mature teratomas also called?
dermatoid cyst
82
What do teratomas consist of?
skin hard feet teeth different embryologic layers cheesy sebaceous material
83
Are teratomas usually malignant or benign?
Benign
84
what make be indicative of a malignant teratoma?
if it involves immature tissue (neuroectoderm) if it has somatic malignancy (skin of teratoma malignant)
85
If the skin of the teratoma is malignant it can lead to ?
\*\*squamous cell carcinoma hyperthyroidism (if there is thyroid tissue) melanoma
86
describe the micro of benign/mature teratomas?
cyst wall-squamous epithelium with underlying sebaceous glands hair shafts and other skin adnexal structures structures from other germ layers
87
where can teratomas been seen?
within the walls of a mutinous cyst adenoma
88
Mono dermal/specialized teratomas are usually bi lateral or unilateral?
unilateral
89
what is the most common type of Mono dermal/specialized teratomas?
#1\*\* carcinoid most common other type is strictly thyroid tissue (struma ovarii)
90
what can struma ovarii cause
hyper thyroidism
91
what is cacinoid
arises from intestinal epithelium in the teratoma
92
what can carcinoids produce/cause
5HT-carcincoid syndrome
93
what age group do you see immature/malignant teratomas?
prepubertal adolescents and young women
94
how do you treat malignant teratomas in ovary?
prophylactic chemotherapy
95
what is dysgerminoma?
equal to seminoma of the testies
96
are dysgerminoma usually malignant or benign?
malignant
97
what age groups are dysgerminoma usually seen?
kids to teens
98
what is the predisposing condition for dysgerminoma?
gonadal dysgenesis (pseduhermaphroditism)
99
what are the serum markers for dysgerminoma?
oct 3/4 and Nanogo+ C-kit+
100
what is the cure rate for dysgerminoma?
96% with SO if unilateral and confined to ovary very chemresponsive
101
what is the gross appearance of dysgerminoma?
small nodules to huge tumor yellow-white to gray pink soft and fleshy
102
what is the micro of dysgerminoma?
large vesicular cells with clear cytoplasm centrally placed regular nuclei
103
where can dysgerminoma be seen?
in walls of benign cystic teratoma or have a small cystic teratoma in it
104
Where are endodermal sinus tumors derived from?
yolk sac
105
how do you treat endodermal sinus tumors ?
chemo
106
what do you see in the micro of endodermal sinus tumors ?
-schiller-ducal body: looks like glomerulus with central blood vessels -hyaline droplets in tumor with AFP
107
what is the serum marker for endodermal sinus tumors ?
AFP
108
is choriocarcinoma malignant or benign?
malignant
109
where are choriocarcinomas from?
more often from placenta from ovary if prepubertal
110
what are serum markers of choriocarcinoma?
serum HCG is high
111
is choriocarcinoma from the ovary responsive to chemo?
no
112
is choriocarcinoma from the placenta responsive to chemo?
yes
113
granulosa-theca cell tumors seen in what age?
any age
114
what do granulosa-theca cell tumors produce?
estrogen
115
what is the serum marker for granulosa-theca cell tumors ?
inhibitin
116
what do you see in the micro of granulosa-theca cell tumors ?
yellow due to lipids hormonally active call-exner bodies
117
what are fibromas?\>
tumor of fibroblast that arise in ovarian stroma
118
what disease do you see a triad of fibromas right hydrothorax and ascites?
Miens syndrome
119
are fibromas benign or malignant?
benign
120
what type of tumor defeminizes women?
sertoil-leydig cell tumors
121
what are also known as chocolate cyst?
endometriomas filled with blood and endometrial glands/stroma (on the covary)
122
what are the risk factors for ovarian cancer?
increases in age incessant ovulations early menarche late menopause nulliparity family hx brace and braca2 but especially brace SMOKING
123
what are protective factors of ovarian cancer?
inhibit ovulation: cop, multiparty, breastfeeding surgical occlusion/excision: salpino-oophorectomy, tubal ligation hysterectomy
124
how to treat ovarian cancer
grade 1 1a/1b(confined to ovaries) surgery alone anything past that chemotherapy (paclitaxel and carboplatin)
125
what is PID?
actue infection of the upper genital tract
126
what are the causes of PID?
Neisseria gonorrhoeae Chlamydia trachomatis
127
what s the clinical px
Fever pelvic pain vaginal discharge cervical motion tenderness pelvic tenderness
128
PID can lead to \_\_\_\_\_\_\_?
tuboovarian abscess
129
what is tubooarian abscess?
inflammatory mass involving the fallopian tube ovary and the other adjacent pelvic organs
130
how to treat PID?
CEftriaxone Doxycycline Metronidazole Cefoxitin
131
cystic follicle with lutenized (pale cytoplasm) theca cells
132
corpus luteal cyst
133
Pcos
134
serous epithelial tumors
135
benign serous tumor with broad papillae
136
borderline serous tumor with more defined papillae
137
low grade micropapillary serous carcinoma
138
