ovarian tumours Flashcards
what are the three main subtypes of ovarian tumour
epithelial
germ cell
stromal/sex cord
what are the main types of epithelial ovarian tumour
serous mucinous endometrioid transitional (Brenner) clear cell
what are the main types of sex cord/stromal tumours
theca fibroma fibrothecoma sertoli cell leydig cell granulosa cell
what are the main types of germ cell ovarian tumour
teratoma dysgerminoma choriocarcinoma yolk sac embryonal
what is the commonest type of ovarian tumour
epithelial
what is commonest epithelial ovarian tumour
serous tumour
are serous ovarian tumour most commonly malignant or benign
benign (60%)
borderline (15%)
malignant (25%)
malignant serous carcinoma occurs in which age group
older patients
serous ovarian tumour are histologically similar to
normal fallopian tubal epithelium
how are serous ovarian tumours classified
benign: no cellular proliferation or invasion
borderline: cellular proliferation and minor nuclear atypia without invasion
malignant: cellular proliferation and nuclear atypia and stroll invasion
radiographic features of serous ovarian tumours
unilocular (single cyst)
homogenous
bilateral
psammomatous calcification
what features suggest malignancy over benign cystic neoplasia
large cystic mass thick irregular walls and septa papillary projections large soft tissue component ascites evidence of invasive spread or adenopathy
radiographic features of mucinous tumours
larger than serous
multilocular with small cystic components
calcification not very common
unilateral
endometrioid tumours tend to be benign/malignant
malignant
‘appearance of tubular glands and bears a strong resemblance to the endometrium’
endometrioid tumour
gross morphological appearance of endometrioid tumour
mass with solid and cystic areas
peak age for clear cell tumour
55 years
gross appearance of clear cell tumour
large unilocular cystic mass with protruding solid nodules
are clear cell tumours more likely to be benign or malignant
malignant
are mucinous tumours likely to be benign or malignant
benign
Brenner cell tumour re histologically similar to which other type of epithelium
urothelium (transitional)
radiographic features of Brenner tumour
multilocular cystic mass with solid component or mostly solid mass
usually small
often lack of invasion
calcification is common
are Brenner tumour mostly benign or malignant
benign
germ cell tumours are more common in which age group
children and adolescents
what is the commonest primary benign tumour of the ovary and commonest germ cell tumour
teratoma
what are the two main subtypes of teratoma
mature
immature
mature ovarian teratoma is also known as
dermoid cyst
teratomas are best assessed with which imaging modality
USS
clinical presentation of mature teratoma
tend to be asymptomatic
can predispose to ovarian torsion (acute pelvic pain)
what are the criteria of a teratoma
well-differentiated derivations from at least two of;
ectoderm
mesoderm
endoderm
how do teratomas appear on USS
cystic adnexal mass with some mural components
at which point is resection of mature teratoma recommended
7 cm
complications of mature teratoma
ovarian torsion
rupture
malignant transformation (SCC)
superimposed infection
immature teratoma are most common in which age group
first two decades
how do immature teratomas differ from mature teratomas
presence of immature or embryonic tissue
more immature tissue = higher grade
macroscopic appearance of immature teratoma
large, encapsulated mass with prominent solid component
features such as hair, cartilage, bone, calcification
which markers are associated with immature teratoma
elevated serum AFP
where can immature teratomas metastasise to
peritoneum, liver, lung
treatment of immature teratoma
oophorectomy
post-op chemo if distant mets
what is the most common malignant germ cell tumour
dysgerminoma
dysgerminomas typically affect which age group
2nd-3rd decade
macroscopic appearance of dysgerminoma
solid
multilobulated
yolk sac tumour affect which age group
2nd decade
macroscopic appearance of yolk sac tumour
well-encapsulate round to oval mass
markers associated with yolk sac tumours
AFP
radiographic features of yolk sac tumour
large, complex pelvic mass that extends into the abdomen
contains solid and cystic components
prognosis of yolk sac tumour
early lymphatic spread and invasion
fast growing
are yolk sac tumours benign or malignant
malignant
are embryonal tumours benign or malignant
malignant
average age of embryonal tumour
14 years
clinical presentation of embryonal tumour
precocious puberty
menstrual irregularity
markers for embryonal tumour
b-hCG
AFP
treatment of embryonal tumour
salpingo-oophrxectomy and chemo
choriocarcinoma are formed from what type of tissue
placental trophoblastic tissue
choriocarcinoma most commonly occur during
pregnancy
gestational choriocarcinoma show what kind of spread
haematogenous
radiographic features of choriocarcinoma
vascular solid tumours with cystic, haemorrhage and necrotic areas
what is the mainstay of treatment of choriocarcinoma
chemo
are fibromas benign or malignant
benign
what age group get fibroma
middle aged
fibromas are composed of what cell type
spindle cells forming variable amounts of collagen
appearance of fibroma
chalky-white surface with a whorled appearance similar to fibrosis
what is Meigs syndrome
ovarian fibroma with ascites and pleural effusion
fibrothecoma occur in which age group
mostly postmenopausal women
why might a patient with fibrothecoma present with abnormal bleeding and endometrial hyperplasia
theca component of tumour can produce oestrogen
what types of tissue are in a fibrothecoma
fibrous tissue
thecal cells
why are thecomas described as functional ovarian tumours
they secrete oestrogen
thecfmas affect which age group
postmenopausal women
clinical presentation of thecoma
uterine bleeding
microscopic appearance of thecoma
swollen lipid-laden stromal cells with a small component of fibroblasts
sertoli-leydig tumours present in which age group
<30
mean age 14
clinical presentation
virilisation
abdominal pain/mass
clinical presentation of granulosa cell tumour
nonspecific symptoms (abdo pain, distension, bloating)
uterine bleeding
granulosa cell tumours secrete…
oestrogen
inhibin
mullerian inhibiting substance
granulosa cell tumours may be associated with…
endometrial hyperplasia
endometrial polyps
endometrial carcinoma
CA-125 is elevated in…
most ovarian malignancies
AFP levels are elevated in…
immature ovarian teratomas
yolk sac tumours
b=HCG is raised in…
some dysgerminomas
genetic predispositions to ovarian cancer
BRCA1/2
Lynch syndrome
stage 1 ovarian cancer
limited to ovaries
1a: one ovary
1b: two ovaries
1c: 1/2 ovaries with rupture/surface spread
stage 2 ovarian cancer
one or both ovaries with pelvic extension
2a: extension to uterus/Fallopian tubes
2b: other pelvic intraperitoneal tissues
stage 3 ovarian cancer
1/2 ovaries or Fallopian tubes with spread to peritoneum outside the pelvis/mets to retroperitoneal nodes
3a: nodes only
3b: mets <2 cm
3c: mets >2 cm
stage 4 ovarian cancer
distant mets
4a: pleural effusion
4b: distant mets
