Ovarian Tumors -Germ Cell Tumors, Sex cord Stromal Tumors, Metastasis

Question 1

What is Krukenberg tumor and what commonly causes it? How is it distinguished from primary mucinous carcinoma?

Answer 1

Metastatic mucinous tumor that involves both ovaries. Most commonly due to metastatic gastric carcinoma (diffuse type). Bilaterality helps distinguish metastases from primary mucinous carcinoma of the ovary, which is usually unilateral.

Question 2

What is a pseudomyxoma peritonei? What causes it and what process is it associated with?

Answer 2

Massive amounts of mucus in the peritoneum due to a mucinous tumor of the appendix. Usually with metastasis to the ovary. (Jelly belly).

Question 3

What is the 2nd most common type of ovarian tumor? Which age group does it occur in?

Answer 3

Germ cell tumor usually in women of reproductive age.

Question 4

Which tumors mimic fetal tissue?

Answer 4

cystic teratoma and embryonal carcinoma

Question 5

Which tumors mimic oocytes?

Answer 5

Dysgerminoma

Question 6

Which tumors mimic yolk sac?

Answer 6

Endodermal sinus tumor

Question 7

Which tumors mimic placental tissue?

Answer 7

Choriocarcinoma

Question 8

What is the most common germ cell tumor in females? How many embryologic layers is it composed of? Is it bilateral? Benign? What is a struma ovarii?

Answer 8

Cystic teratoma composed of 2 or 3 embryologic layers (skin, hair, bone). Bilateral in 10% of cases. Benign but presence of immature tissue (usually neural) or somatic malignancy (usually squamous cell carcinoma of skin) indicates malignant potential. Struma ovarii is a teratoma composed primarily of thyroid tissue

Question 9

What is the most common germ cell tumor in females? How many embryologic layers is it composed of? Is it bilateral? Benign? What is a struma ovarii?

Answer 9

Cystic teratoma composed of 2 or 3 embryologic layers (skin, hair, bone). Bilateral in 10% of cases. Benign but presence of immature tissue (usually neural) or somatic malignancy (usually squamous cell carcinoma of skin) indicates malignant potential. Struma ovarii is a teratoma composed primarily of thyroid tissue

Question 10

What is the most common malignant germ cell tumor in women? What is it composed of? What is it counterpart in males? How is it treated and prognosis? What lab value is elevated?

Answer 10

Dysgerminoma which is a tumor composed of large cells with clear cytoplasm and central nuclei. Seminoma. Good prognosis and responds to radiotherapy. Serum LDH may be elevated.

Question 11

What is the most common germ cell tumor in children? What does it mimic? What is seen on histology? What lab value is elevated?

Answer 11

Endodermal sinus tumor which is a malignant tumor that mimics the yolk sac. Serum AFP is often elevated. Schiller-Duval bodies (glomerulus like structures) are classically seen on histology.

Question 12

What cell types is a choriocarcinoma composed of, what tissue does it mimic and does it have villi? How does it spread and which lab values are highly elevated? What can it lead to? Prognosis?

Answer 12

Malignant tumor composed of cytotrophoblasts and synctiotrophoblasts. Mimics placental tissue but villi are absent. Hematogenous spread. High b hCG produced by syncytiotrophoblasts. May lead to thecal cysts in the ovary and poor response to chemotherapy.

Question 13

Is embryonal carcinoma a benign tumor? What cells is it composed of?

Answer 13

Malignant tumor composed of large primitive cells and is aggressive with early metastasis.

Question 14

What is a fibroma and what is it associated with?

Answer 14

Benign tumor of fibroblasts associated with pleural effusions and ascites (Meigs sndrome) which rsolves with tumor removal.

Question 15

What is a fibroma and what is it associated with?

Answer 15

Benign tumor of fibroblasts associated with pleural effusions and ascites (Meigs sndrome) which rsolves with tumor removal.

Question 16

What structures are associated with Sertoli-Leydig cell tumor and what does it produce and what is it associated with?

Answer 16

Reinke crystals. May produce androgen. Associated with hirsuitism and virilization.

Question 17

What does a granulosa-theca cell tumor produce? What signs does it present with prior to puberty? Reproductive age? Post menopausal?

Answer 17

Often produces estrogen. Precocious puberty prior to puberty. Menorrhagia or metorrhagia in reproductive age and endometrial hyperplasia with post menopausal uterine bleeding in post menopause.