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Pathology/ICM-GYN Module > Ovarian Tumors > Flashcards

Ovarian Tumors Flashcards

1
Q

ow do cystic follicles occure?

A

they arise from unruptured graafian follicles that have ruptured and sealed

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2
Q

What are cystic follicles filled with?

A

clear serous fluid

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3
Q

What is the minimum size at which a tumor can be palpated?

A

2cm

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4
Q

What size does the cystic follicle have to reach in order to cause pain?

A

2cm

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5
Q

How do the outer theca cells look in a cystic follicle?

A

pale cytoplasm luteinized

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6
Q

How do corpus luteal cyst look like?

A

lined by rim of bright yellow tissue= luteinized granules ells

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7
Q

What is a consequence of corpus luteal cyst?

A

can rupture and cause a peritoneal reaction

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8
Q

what is a DD for corpus luteal cyst?

A

Endometriosis

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9
Q

What is Polycystic Ovary?

A

numerous cystic follicles and associated oligomenorrhea

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10
Q

What are the features of polycystic ovary?

A

-Persistent anovulation Hirsutism Virillism

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11
Q

Describe the size of the ovary in polycystic ovary?

A

The ovary is twice the size

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12
Q

Describe the pathology of polycystic ovary?

A

Increased LH->stimulates theca lutein cells of follicles->produce more androgen->converted to estrone

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13
Q

What is polycystic ovary linked to?

A

insulin resistance

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14
Q

How do you treat polycystic ovary/ Stein-Leventhal Syndrome?

A

metforman glitazones clomiphene

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15
Q

What is Stromal Hyperthecosis/Cortical Stromal hyperplasia?

A

proliferation of ovarian stroma with luteinization

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16
Q

What age group is stromal hyperthecosis usually seen in?

A

post menopausal women

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17
Q

Is Stromal Hyperthecosis/Cortical Stromal hyperplasia bilateral or unilateral?

A

bilateral

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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

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19
Q

What is a similar condition to Stromal Hyperthecosis/Cortical Stromal hyperplasia?

A

theca lutein hyperplasia of pregnancy (proliferation of theca cells)

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20
Q

Benign tumors are usually seen in what age women?

A

premenopausal

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21
Q

malignant tumors are usually seen in what age women?

A

post menopausal

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22
Q

List the types of surface epithelial cell tumors?

A

serous mucinous endometrioid clear cell brenner cystadenofibroma

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23
Q

List the types of germ cell tumors?

A

Teratoma dysgerminoma endodermal sinus tumor choriocarcinoma

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24
Q

list the types of sex cord tumors?

A

fibroma granulosa theca cell tumor sertoli-leydig tumor

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25
Q

What is surface epithelium derived from?

A

coelomic epithelium

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26
Q

what are germ cells derived from?

A

the yolk sac and are pluripotent (immature/stemcells)

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27
Q

Where do the sex cords come from?

A

ovarian tumor

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28
Q

What are the clinical symptoms of an ovarian tumor?

A

abdominal pain distention urinary and go symptoms vaginal bleeding fullness

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29
Q

What are the markers for ovarian epithelial tumors?

A

CA125 (serous and endometriod carcinomas) osteopontin

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30
Q

Why is CA125 not that reliable of a marker for ovarian epithelial tumors?

A

because it can be seen with irritation of the peritoneum (endometriosis, inflammation)

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31
Q

How to prevent ovarian cancer?

A

fallopian tubal ligation and Oral contraceptive therapy screening for BRCA mutations prophylactic saplingo-oophorectomy

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32
Q

Mullein ducts are formed from ________epthelium and become serous_____, endometrioid______ and mutinous_____epithelilia

A

coelomic tubal like endometrial like cervical like

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33
Q

what are the two pathway that epilethial tumors arise?

A

Malignant with borderline (well differentiated KRAS or BRAF mutations) De novo (poorly differentiated p53mutations)

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34
Q

What is the most common malignant ovarian tumor?

A

serous epithelial tumors

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35
Q

What is the micro of serous epithelial tumors?

A

cystic tall columnar epithelial cells

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36
Q

Are serous epithelial tumors usually bilateral or unilateral?

A

bilateral

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37
Q

What are type I serous epithelial tumors associated with?

A

borderline tumors and endometriosis

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38
Q

what are the type 1 serous epithelial tumors

A

low grade serous endometrioid and mutinous tumors

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39
Q

where do type 2 serous epithelial tumors arise from?

A

fallopian tubes

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40
Q

what are the genes for low grade serous epithelial tumors?

A

serous borderline KRAS BRAF ERB2 and wild type P53

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41
Q

what are the genes for serous epithelial tumors serous epithelial tumors?

A

TP5 application of PIK3CA (No KRAS No BRAS)

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42
Q

What are the risk factors for serous epithelial tumors

A

BRCA1 BRCA2 weak: nulliparity, family hx

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43
Q

what decreases the risk for serous epithelial tumors?

A

OCP and tubal ligation

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44
Q

what is the gross pathology of serous epithelial tumors?

A

cystic can be lined by papillary projections (the more malignant the more complex the papillary projections and solid areas)

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45
Q

what is the micro for benign serous tumors?

A

cyst lined by columnar epithelium with cilia bland papillae

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46
Q

What is the micro for borderline serous tumors?

A

increased complexity of the storm papillae stratification of the epithelium mild nuclear atypic localized

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47
Q

what is a complication of borderline serous tumors?

A

can lead to intestinal obstruction

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48
Q

what is the micro? for low grade “micropaipillary” serous epithelial tumors/ carcinoma?

A

complex micro papillary growth spread to peritoneal surfaces and momentum ascites

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49
Q

what is the micro for high grade serous carcinoma?

A

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

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50
Q

At what age do you seen mucinous tumors ?

A

mid adult life (rare before puberty and after menopause)

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51
Q

are mucinous tumors benign or malignant?

A

most ases benign/borderline

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52
Q

what is the risk factor for mucinous tumors

A

smoking

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53
Q

what is the gene mutation associated with mutinous tumors?

A

KRAS

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54
Q

What is the gross of mutinous tumors?

A

surface involvement rare usually unilateral larger cystic masses (THE LARGEST) fluid

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55
Q

what type of fluid is seen in mutinous tumors?

A

sticky gelatinous fluid rich in GLYCOPROTEINS

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56
Q

what is the micro of mutinous tumors?

A

bengin tall columnar cells apical mucin NO cilia a lot of gland like/papillary growth nuclear atypic stratification

57
Q

Mullein Mutinous cyst adenoma can arise from?

A

endometriosis

58
Q

mutinous tumors are precursors too __?

A

most cystadenocarcinomas

59
Q

describe the micro of cystadenocarcinomas?

A

areas of solid growth within cyst epithelial cella type and stratification LOSS of glands Necrosis

60
Q

what does cystadenocarcinomas look like?

A

colonic cancer?

61
Q

if cystadenocarcinomas spread beyond ovaries it is ___?

A

fatal

62
Q

how often do cystadenocarcinomas spread beyond ovaries?

A

rare

63
Q

what is Pseudomyxoma Peritonei?

A

Extensive mutinous ascities cystic epithelial implants on the peritoneal surfaces adhesions Mutinous tumor involving the ovaries

64
Q

what can Pseudomyxoma Peritonea lead to?

A

intestinal obstruction nd death

65
Q

how do you get Pseudomyxoma Peritonea?

A

APPENDICIEAL primary mutinous tumor mets to bilateral ovaries and peritoneum

66
Q

Primary mucinous ovarian tumors are bilateral or unilateral?

A

unilateral if bilateral think mets

67
Q

Describe Endometrioid carcinomas?

A

tubular glands resembling endometirum

68
Q

Where can Endometrioid carcinomas arise from?

A

endometriosis ovarian surface epithelium

69
Q

if Endometrioid carcinomas are associated with endometriosis does it improve or worsen the prognosis and by how long?

A

improves by a decade

70
Q

are Endometrioid carcinomas usually bilateral or unilateral?

A

bilateral

71
Q

what gene mutation is associated with Endometrioid carcinomas?

A

PTEN TUMOR suppressor gene KRAS and beta-catenin p53 (because poorly differentiated)

72
Q

Describe the malignancy of clear cell carcinomas?

A

always benign and borderline

73
Q

how prevalent are clear cell carcinomas?

A

very very rare

74
Q

what is the micro of clear cell carcinomas?

A

large epithelial cells iwht abundant clear cytoplasm (looks like hypersecretory gestational endometrium)

75
Q

what are clear cell adenomas associated with

A

endometriosis or endometrioid carcinoma of the ovary?

76
Q

what is a cystadenofibroma?

A

benign increased proliferation of the fibrous stroma

77
Q

what is brenner tumor?

A

adenofibroma

78
Q

what type of epithelium is seen in a brenner tumor?

A

uroepithelium (urinary)

79
Q

what age group do you usually see germ cell tumors?

A

women of reproductive age

80
Q

what type of germ cell tumor is benign and which type is malignant?

A

benign (mature cells) malignant (immature cells)

81
Q

what are benign/mature teratomas also called?

A

dermatoid cyst

82
Q

What do teratomas consist of?

A

skin hard feet teeth different embryologic layers cheesy sebaceous material

83
Q

Are teratomas usually malignant or benign?

A

Benign

84
Q

what make be indicative of a malignant teratoma?

A

if it involves immature tissue (neuroectoderm) if it has somatic malignancy (skin of teratoma malignant)

85
Q

If the skin of the teratoma is malignant it can lead to ?

A

**squamous cell carcinoma hyperthyroidism (if there is thyroid tissue) melanoma

86
Q

describe the micro of benign/mature teratomas?

A

cyst wall-squamous epithelium with underlying sebaceous glands hair shafts and other skin adnexal structures structures from other germ layers

87
Q

where can teratomas been seen?

A

within the walls of a mutinous cyst adenoma

88
Q

Mono dermal/specialized teratomas are usually bi lateral or unilateral?

A

unilateral

89
Q

what is the most common type of Mono dermal/specialized teratomas?

A

1** carcinoid most common other type is strictly thyroid tissue (struma ovarii)

90
Q

what can struma ovarii cause

A

hyper thyroidism

91
Q

what is cacinoid

A

arises from intestinal epithelium in the teratoma

92
Q

what can carcinoids produce/cause

A

5HT-carcincoid syndrome

93
Q

what age group do you see immature/malignant teratomas?

A

prepubertal adolescents and young women

94
Q

how do you treat malignant teratomas in ovary?

A

prophylactic chemotherapy

95
Q

what is dysgerminoma?

A

equal to seminoma of the testies

96
Q

are dysgerminoma usually malignant or benign?

A

malignant

97
Q

what age groups are dysgerminoma usually seen?

A

kids to teens

98
Q

what is the predisposing condition for dysgerminoma?

A

gonadal dysgenesis (pseduhermaphroditism)

99
Q

what are the serum markers for dysgerminoma?

A

oct 3/4 and Nanogo+ C-kit+

100
Q

what is the cure rate for dysgerminoma?

A

96% with SO if unilateral and confined to ovary very chemresponsive

101
Q

what is the gross appearance of dysgerminoma?

A

small nodules to huge tumor yellow-white to gray pink soft and fleshy

102
Q

what is the micro of dysgerminoma?

A

large vesicular cells with clear cytoplasm centrally placed regular nuclei

103
Q

where can dysgerminoma be seen?

A

in walls of benign cystic teratoma or have a small cystic teratoma in it

104
Q

Where are endodermal sinus tumors derived from?

A

yolk sac

105
Q

how do you treat endodermal sinus tumors ?

A

chemo

106
Q

what do you see in the micro of endodermal sinus tumors ?

A

-schiller-ducal body: looks like glomerulus with central blood vessels -hyaline droplets in tumor with AFP

107
Q

what is the serum marker for endodermal sinus tumors ?

A

AFP

108
Q

is choriocarcinoma malignant or benign?

A

malignant

109
Q

where are choriocarcinomas from?

A

more often from placenta from ovary if prepubertal

110
Q

what are serum markers of choriocarcinoma?

A

serum HCG is high

111
Q

is choriocarcinoma from the ovary responsive to chemo?

A

no

112
Q

is choriocarcinoma from the placenta responsive to chemo?

A

yes

113
Q

granulosa-theca cell tumors seen in what age?

A

any age

114
Q

what do granulosa-theca cell tumors produce?

A

estrogen

115
Q

what is the serum marker for granulosa-theca cell tumors ?

A

inhibitin

116
Q

what do you see in the micro of granulosa-theca cell tumors ?

A

yellow due to lipids hormonally active call-exner bodies

117
Q

what are fibromas?>

A

tumor of fibroblast that arise in ovarian stroma

118
Q

what disease do you see a triad of fibromas right hydrothorax and ascites?

A

Miens syndrome

119
Q

are fibromas benign or malignant?

A

benign

120
Q

what type of tumor defeminizes women?

A

sertoil-leydig cell tumors

121
Q

what are also known as chocolate cyst?

A

endometriomas filled with blood and endometrial glands/stroma (on the covary)

122
Q

what are the risk factors for ovarian cancer?

A

increases in age incessant ovulations early menarche late menopause nulliparity family hx brace and braca2 but especially brace SMOKING

123
Q

what are protective factors of ovarian cancer?

A

inhibit ovulation: cop, multiparty, breastfeeding surgical occlusion/excision: salpino-oophorectomy, tubal ligation hysterectomy

124
Q

how to treat ovarian cancer

A

grade 1 1a/1b(confined to ovaries) surgery alone anything past that chemotherapy (paclitaxel and carboplatin)

125
Q

what is PID?

A

actue infection of the upper genital tract

126
Q

what are the causes of PID?

A

Neisseria gonorrhoeae Chlamydia trachomatis

127
Q

what s the clinical px

A

Fever pelvic pain vaginal discharge cervical motion tenderness pelvic tenderness

128
Q

PID can lead to _______?

A

tuboovarian abscess

129
Q

what is tubooarian abscess?

A

inflammatory mass involving the fallopian tube ovary and the other adjacent pelvic organs

130
Q

how to treat PID?

A

CEftriaxone Doxycycline Metronidazole Cefoxitin

131
Q
A

cystic follicle with lutenized (pale cytoplasm) theca cells

132
Q
A

corpus luteal cyst

133
Q
A

Pcos

134
Q
A

serous epithelial tumors

135
Q
A

benign serous tumor with broad papillae

136
Q
A

borderline serous tumor with more defined papillae

137
Q
A

low grade micropapillary serous carcinoma

138
Q
A

Pathology/ICM-GYN Module (11 decks)

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