Ovaries Flashcards
the condition seen in the image is due to ____ during the ___ phase
the condition seen in the image is due to increased estrogen during the follicular phase
chocolate cysts of the ovary is caused by ___ (repeated ___) which induces ____
chocolate cysts of the ovary is caused by endometriosis (repeated cyclical hemorrhage) which induces fibrosis, adhesions, severe pain
the morphology of chocolate cysts is normal ____ amidst stroma with ____
the morphology of chocolate cysts is normal endometrial glands amidst stroma with hemorrhages (hemosiderin-laden macrophages)
chocolate cysts of the ovary may extend along ___ and is associated with ___ (due to __ scars)
chocolate cysts of the ovary may extend along pelvic ligaments and is associated with infertility (due to tubal scars)
“normal endometrial glands amidst stroma with hemorrhages (hemosiderin-laden macrophages”
what is a complication of this condition?
infertility
in PCOD, ___ levels are high while ___ levels are low
in PCOD, LH levels are high while FSH levels are low
describe the pathogenesis of PCOD
- theca cells make androgen → androgen converted to estrogen in adipose tissue (aromatization mediated by aromatase) → increased estrogen → negative feedback on AP → decreased FSH
describe the presentation of PCOD
- virilization
- hirsutism
- not ovulating (b/c need LH surge, not a constant elevation as seen in this disease)
- infertility
- amenorrhea, oligomenorrhea
- infertility
- obesity
- peripheral insulin resistance → T2D
list the complications of PCOD
- diabetes (due to insulin resistance)
- infertility
- increased estrogen → fibrocystic change in breast and endometrial hyperplasia/carcinoma
- fibroadenoma/leiomyoma grow bigger
describe what is seen in the ovaries of PCOD patients
- ovaries: large, thick capsule, multiple unruptured follicles as cysts lined by granulosa cells and hypertrophied theca interna cells
- thick, hypertrophied stroma
“patient presents with virilization and hirsutism–not ovulating. what is a complication of this condition?”
increased estrogen → endometrial hyperplasia
in general, ____ and ____ reduce the risk of ovarian cancer
in general, increased ___ leads to increased risk of ovarian tumors
in general, pregnancy and oral contraceptives reduce the risk of ovarian cancer
increased ovulation = increased risk (early menarche, late menopause increase risk)
list the surface epithelial tumors of the ovary (4)
- serous
- mucinous
- endometrioid
- Brenner’s
list the germ cell tumors of the ovary (4)
- choriocarcinoma = placental tissue
- endometrial sinus = yolk sac
- dysgerminoma = oocytes
- teratoma = fetal tissue (mature/immature/specialized)
list the 3 sex cord stromal tumors of the ovary
- granulosa-theca
- Sertoli-Leydig
- fibrothecoma
____ are the most common ovarian tumor
serous ovarian tumors are the most common ovarian tumor
in the condition seen in the image, low grade tumors have a mutation in ___ while high grade tumors have a mutation in ____
in the condition seen in the image, low-grade tumors have a mutation in KRAS, BRAF while high-grade tumors have a mutation in p53, BRCA1/2
the condition seen in the image is lined by ____
the condition seen in the image is lined by single layer of tall columnar ciliated cells
describe the histology of the condition seen in the image
borderline: multilayering, moderate mitosis, nuclear atypia BUT NO stromal invasion
describe the histology of the condition seen in the image
malignant: multilayering, nuclear atypia and stromal INVASION
the histology of the condition seen in the image is similar to the histology of ____
the histology of serous ovarian tumors is similar to the histology of fallopian tubes = tall columnar ciliated
the condition seen in the image is (unilateral or bilateral?) and (unilocular or multilocular?)
the condition seen in the image is bilateral and unilocular
the condition seen in the image is a ____ cyst with sticky ____ material rich in ____
the condition seen in the image is a multiloculated cyst with sticky gelatinous material rich in glycoproteins
the condition seen in the image are lined by ____ which is similar to ____
the condition seen in the image are lined by tall columnar non-ciliated with goblet cells (MUCIN) which is similar to endocervix/intestine
describe a complication of the condition seen in the image
peritoneal implant (pseudomyxomaperitonei/jelly belly) in borderline & malignant stage → intestinal obstruction
most cases of pseudomyxoma peritonei are ____ and usually arise from the ____ with secondary ___ and ___ spread
most cases of pseudomyxoma peritonei are extraovarian and usually arise from the appendix with secondary ovarian and peritoneal spread
mutations in which 4 tumor suppressor genes can lead to endometrioid tumors?
PTEN
KRAS
B-catenin
MSI (microsatellite instability)
describe the gross appearance of endometrioid tumors
solid and cystic, small, papillae, velvety surface
the histology of the condition seen in the image is like ____ epithelium
the histology of the condition seen in the image is like transitional epithelium
describe the histology of the condition seen in the image
spindle cells with nests of urothelium
a complication of the condition seen in the image is ___ but NOT ____
a complication of the condition seen in the image is torsion but NOT rupture
____ is a marker to monitor response to ovarian cancer therapy and disease progression
CA-125 is a marker to monitor response to ovarian cancer therapy and disease progression
the condition seen in the image is derived from ___ cells
the condition seen in the image is derived from 2-3 layers of germ cells
teeth & hair = ectoderm
sebaceous glands = mesoderm
the condition seen in the image is an incidental finding when ____
the condition seen in the image is an incidental finding when a calcified tooth is found on x-ray
describe the complications of the condition seen in the image
rupture, torsion, infertility, transformation to invasive squamous cell carcinoma
a complication of the condition seen in the image is that it can transform into ____
a complication of the condition seen in the image is that it can transform into invasive squamous cell carcinoma
describe struma ovarii
- origin = germ cell
- pathogenesis:
- thyrotoxicosis d/t production of T3/T4
- suppresses TSH → thyroid atrophy
immature teratoma is commonly found in ____ (demographic)
immature teratoma is commonly found in 18-year-old women (demographic)
___ found in an immature/malignant teratoma is a poor prognostic sign
neuroepithelium found in an immature/malignant teratoma is a poor prognostic sign
in an immature/malignant teratoma, the absence of ____ carries an excellent chance of cure
in an immature/malignant teratoma, the absence of recurrence in the first 2 years carries an excellent chance of cure
an endodermal sinus tumor is derived from ____
an endodermal sinus tumor is derived from the yolk sac
the tumor markers for endodermal sinus tumor are ___ and ____
the tumor markers for endodermal sinus tumor are AFP and A1AT
____ are found in an endodermal sinus tumor; describe the appearance
Schiller-Duval bodies are found in an endodermal sinus tumor
layers of epithelial cells around blood vessels (glomerulus-like)
“5 year old with ovarian mass” or young women = which tumor?
endodermal sinus tumor (derived from yolk sac)
describe the histology of the condition seen in the image
fried-egg cells (sheets of monomorphic cells with prominent nucleus/nucleolus & abundant cytoplasm filled with mucin)
the male counterpart to the condition seen in the image is ____
the male counterpart to the condition seen in the image is seminoma of the testes
the condition seen in the image is commonly seen in ___ patients due to ____
the condition seen in the image is commonly seen in Turner’s patients due to gonadal dysgenesis
the tumor marker for the condition seen in the image is ____
the tumor marker for the condition seen in the image is LDH
the cell type seen in the condition in the image is found in which 2 other conditions?
- seminoma of the testes
- medullary carcinoma of the breast
“a patient with Turner’s has a histo slide with sheets of cells with dark blue nucleus and lots of cytoplasm; which similar tumor is found in men?”
seminoma of the testes
“a patient with Turner’s has a histo slide with sheets of cells with dark blue nucleus and lots of cytoplasm; which similar tumor is found in breasts?”
medullary carcinoma
describe what is seen in choriocarcinoma
hemorrhage, necrosis, pleomorphism, giant cells, multi-nucleation
in an ovarian choriocarcinoma, ____ and ___ cells are found
in an ovarian choriocarcinoma, malignant cytotrophoblasts (mono-nucleated) and syncytiotrophoblasts (multi-nucleated) cells are found
“young girl (<18) with amenorrhea and exaggerated morning sickness”
which tumor?
ovarian choriocarcinoma
morning sickness = B-hCG
a tumor marker for ovarian choriocarcinoma is ____
a tumor marker for ovarian choriocarcinoma is B-hCG
ovarian choriocarcinoma spreads via ___ NOT ____
ovarian choriocarcinoma spreads via blood NOT lymph
the tumor marker for the condition seen in the image is _____
the tumor marker for the condition seen in the image is tissue inhibin (which inhibits FSH)
on histology of the condition seen in the image, ____ bodies are seen which are ____
on histology of the condition seen in the image, Call-Exner bodies are seen which are cuboidal granulosa cells arranged around a central lumen
describe the presentation of the condition seen in the image before puberty
precocious puberty
describe the presentation of the condition seen in the image in peri-menopausal women
endometrial hyperplasia w/ uterine bleeding
“patient presents with tumor in ovary and endometrial thickening”
OR
“10 yr old with early onset of menarche, heavy periods and precocious puberty”
which tumor?
granulosa cell tumor
describe the histology of the theca component of the condition seen in the image
lipid-leydencells
describe the histology of the condition seen in the image
large polygonal cells & spindle cells forming gland-like structures around an acidophilic core recapitulating immature follicles
describe the complications of the condition seen in the image
- metastasis
- increased estrogen
- breast cancer
- fibrocystic change
- endometrial carcinoma
- enlargement of leiomyoma/fibroadenoma
describe the histology of the condition seen in the image
lipid-leyden (thecoma) & spindle-shaped (fibroma) cells
the condition seen in the image has an association with ascites + right sided pleural effusion (hydrothorax) which is ____
the condition seen in the image has an association with ascites + right sided pleural effusion (hydrothorax) which is Meig’s syndrome
the condition seen in the image is also associated with ____
the condition seen in the image is also associated with basal cell nevus syndrome
“lady has a palpable abdominal mass that caused abdominal ascites and pleural effusion on the right side”
what is a complication of this condition?
TORSION
____ are seen in a Sertoli-Leydig cell tumor
Reinke crystals are seen in a Sertoli-Leydig cell tumor
masculinization is seen in Sertoli-Leydig cell tumors due to increased ____
masculinization is seen in Sertoli-Leydig cell tumors due to increased androgens (hirsutism, male distribution of hair, hypertrophy of clitoris, voice changes, virilization)
list the 3 origins of Krukenberg tumors
- colon cancer
- diffuse gastric carcinoma
- invasive lobular carcinoma of the breast
all 3 Krukenberg tumors have __ mutations
all 3 Krukenberg tumors have E-cadherin mutations
describe the histology of Krukenberg tumors
signet ring cells with eccentric nuclei and mucin in the cytoplasm
