ovarian tumours

Question 1

peak age + prognosis of ovarian cancer

Answer 1

60yrs
poor prognosis due to late diagnosis - 80% have advanced disease at presentation

Question 2

risk factors for ovarian cancer

Answer 2

mutations of BRCA1 or BRCA2 - family history

many ovulations
- early menarche
- late menopause
- nulliparity

Question 3

ovarian cancer presenation

Answer 3

notoriously vague
- abdo distension + bloating
- abdo + pelvic pain
- urinary symptoms - urgency
- early satiety
- diarrhoea

Question 4

ovarian cancer investigations

Answer 4

CA125
- if raised >35 -> urgent US of abdo/pelvis

Ultrasound

Question 5

what other conditions can raise CA125

Answer 5

endometriosis, menstruation
benign ovarian cysts
others

CA125 should not be used for screening for ovarian cancer in asymptommatic women

Question 6

diagnosis + mx of ovarian cancer

Answer 6

difficult, usually involves diagnostic lapartomy

mx = combo of surgery + platinum based chemo

Question 7

ovarian cysts

Answer 7

benign ovarian cysts are extremely common
- germ cell tumours
- epithelial tumours
- sex cord tumours

complex (multi-loculated) ovarian cysts should be biopsied to exclude malignancy

Question 8

physiological/functional cysts

Answer 8

follicular cysts
- commonest type of ovarian cysts
- non-rupture of a dominant follicle
- regresses after several menstrual cycles

corpus luteum cyst
- when corpus luteum doesnt break down and fills with blood/fluid
- px = intraperitoneal bleeding

Question 9

benign germ cell tumours

Answer 9

dermoid cyst (teratoma)
- lined with epitherlial - may contain skin, hair, teeth

most common benign tumour in under 30s
- usually asymptomatic, torsion more likely than other tumours

Question 10

benign epithelial tumours

Answer 10

arise from ovarian surface epithelium

serous cystadenoma
- looks the most like serous carcinoma (commonest ovarian cancer)

mucinous cystadenoma
- large, can become massive
- ruptures can cause pseudomyxoma peritonei

Question 11

4 main types of ovarian tumour

Answer 11

• surface derived tumours
• germ cell tumours
• sex cord-stromal tumours
• metastasis

Question 12

serous cystadenoma vs serous cystadenocarcinoma

Answer 12

serous cystadenoma - benign, oftern bilater, lined with ciliated cells (similar to fallopian tube)

serous cystadenocarcinoma - malignant, oftern bilateral, psammoma bodies seen (collection of calcium)

Question 13

Brenner tumour

Answer 13

benign
- contain Walthard cell rests, similar to transitional cell epithelium

• have coffee bean nuclei

Question 14

commonest malignant germ cell tumour

Answer 14

dysgerminoma
- assoc with turners
- secretes hCG + LDH

Question 15

yolk sac tumour

Answer 15

malignant germ cell tumour
- typically secretes AFP
- Schiller-Duval bodies on histology

Question 16

choriocarcinoma

Answer 16

malignant germ cell tumour
- rare, part of spectrum gestational trophoblastic disease
- increased hCG levels
- early haematogenous spread to lungs

Question 17

which tumour contains Call-Exner bodies

Answer 17

Granulosa cell tumour - malignant

(small eosiinophilic fluid-filled spaces between granulosa cells)

Question 18

are ovarian sertoli-Leydig cell tumours benign or malignant?

Answer 18

Benign!
- produces androgens -> masculinising effects

assoc with peutz-jegner syndrome

Question 19

ovarian fibroma

Answer 19

occur around menopause
- pulling sensation in the pelvis

Benign!
tumour consisting of bundles of spindle shaped fibroblasts

Question 20

krukenberg tumour

Answer 20

malignant! metastatic tumour!

from GI tumour resuling in mucin secreting signet ring cell adenocarcinoma