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Reproductive Pathology > Ovaries and Fallopian Tubes > Flashcards

Ovaries and Fallopian Tubes Flashcards

1
Q

What are 3 common reasons to see infectious inflammation of the Fallopian Tube?

A
  1. Chlamydia
  2. Gonorrhea
  3. TB
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2
Q

T or F: Tumors often arise from the fallopian tube.

A

False, but it is generally accepted that serous tumors of the ovary actually arise from cells in the fallopian tube

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3
Q

What are the 3 general subtypes of ovarian tumors?
- which is most common?

A

3 Subtypes:

  • *- Epithelial (90%)
  • Sex Cord Stromal Tumor
  • Germ Cell Tumor**
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4
Q

What are the subtypes of ovarian epithelial tumors?

A

Epithelial Tumors:

  • *- Serous
  • Mucinous
  • Clear Cell
  • Brenner
  • MMMT
  • Metastatic**
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5
Q

What the the subtypes of Sex Cord Stromal Tumors?

A

Granulosa Cell
Fibromas
Fibromathecomas
Sertoli-Leydig Cell Tumors

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6
Q

What are the subtypes of ovarian Germ Cell Tumors?

A

Mixed
Yolk Sac Tumor
Dysgerminoma
Teratoma

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7
Q

Follicular Cysts

  • Presentation?
  • Course of “disease”?
  • Histology?
A

Presentation:
- Most often present as a cysts (3 cm or less) in a REPRODUCTIVE AGE woman

Course:
- Most often these spontaneously rupture and disappear

Histology:
- Normal Dilated Follicle without an Egg inside (has a normal or possible compressed lining of granulosa cells with prominent theca cells)

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8
Q

Corpus Luteal Cyst

  • Presentation?
  • Most likely time for it to occur?
  • Histology?
A

Presentation:
- Most often a reproductive age woman who may be pregnant (20% o these occur in reproductive age women)

Histology:
- blood filled cyst with a bright yellow lining

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9
Q

While Follicular Cysts are not associated with any real complications, Corpus Luteal Cysts are. What are these complication?

A

Corpus Luteal Cyst complications

  • *- Ovarian Torsion
  • Rupture into the Peritoneal Cavity requiring Surgery

*****Remember the are most often BENIGN CYSTIC TERATOMAS***

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10
Q

Differentiate the following pathologies in epithelial ovarian tumors on the basis of cyst number, cyst lining, and age of presentation.

  • Benign
  • Borderline
  • Malignant
A

Benign:

  • Single Cyst
  • Flat Lining
  • Premenopausal 30-40

Borderline:
- Features of Both

Malignant:

  • Complex Cysts
  • Shaggy lining
  • Post menopausal 60-70 years old
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11
Q

Which Epithelial Ovarian Tumors can have a borderline malignant classification?

A

Serous, Mucinous, Clear Cell, Brenner

Others:
MMMT and Metastatic

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12
Q

In general how do ovarian epithelial tumors present?
- at what stage do these cancers often present?

A

Presentation:

  • Often presents as Abdominal Ascites in a Post-Menopausal women
  • This presentation suggests advanced stage cancer

**Cancer can often be bilateral**

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13
Q

Note: Risk factors for epithelial ovarian tumors include Never Having Children and BRCA1 and BRCA2 mutations

A

Note: Risk factors for epithelial ovarian tumors include Never Having Children and BRCA1 and BRCA2 mutations

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14
Q

What does a type II epithelial ovarian tumor refer to?

A

Type II:
- HIGH GRADE serous lesion that progresses from the fallopian tube to the ovary

Type I:

  • LOW-grade serous, endometroid, or mucinous ovarian CA
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15
Q

What mutations are associated with type II ovarian Carcinomas?

A

BRCA mutations are associated with High-grade serous tumors whose cells originate from the fallopian tube and cause cancer in the ovary

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16
Q

What is the most common malignant tumor of the ovary?

A

SEROUS type of epithelial ovarian tumor

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17
Q

T or F: while serous epithelial tumors of the ovary are the most common malignant tumor of the ovary, the majority are benign

A

True, 70% of serous epithelial ovarian tumors are benign

18
Q

What are the 3 classifications of Serous epithelial ovarian carcioma?

A
  • *1. Benign
    2. Borderline
    3. Carcinoma**
19
Q

Benign Serous Epithelial Ovarian Tumor:

  • 2 subtypes
  • Histologic Characteristics or each subtypes
  • Chances of the tumors being bilateral?
A

2 types:
**20% of the time these are bilateral**

Serous Cystadenoma
- Stromal Papillae with Columnar Epithelium

Serous Cysadenofibroma
- Fibrous and Pink Stroma

20
Q

Borderline Serous Ovarian Tumor

  • Histologic Characteristics?
  • how often is this bilateral?
A

No obvious invasion of surrounding tissue, but cells have increased Architectual Complexity

**Bilateral in 30% of cases**

21
Q
  • *Serous CARCINOMA** of the ovary
  • how often are these bilateral?
  • Compare histology of Low Grade vs. High Grade Lesions.
A

Serous Carcinoma of the ovary
**Bilateral 66% of the time**

Low Grade:
- Complex Micropapillary growth with Medussa Head appearance - NO INVASION of underlying stroma

High Grade:
- Cells look more malignant in invade the stroma extensively

22
Q

How can you differentiate Serous and Mucinous Neoplasms of the ovary on the basis of gross inspection?

A

Serous:
- typically consists of watery fluid

Mucinous:
- typically consists of thick viscous fluid

**Both appear the same before you cut them open

23
Q
  • *Mucinous** Epithelial Ovarian Tumor
  • Gene mutations often associated with this tumor?
  • Histology?
A

KRAS mutations are commonly found in mucinous ovarian tumors

Histology:
- Lots of “bubbly” cytoplasm (not seen in serosal). Serosal penetration and solid areas are highly indicative of malignancy

24
Q

Brenner Tumor (Transitional Cell Tumor)
Gross Appearance**
Histology

A

Gross:
- Brown/Yellow color to the tumor

Histology:
- Very nested appearance with cells that resemble Urothelium

**These can be benign, borderline, or malignant**

25
Q

Most Mestastic Tumors to the ovary come from where?
- what are some other tumors that may metastasize to the ovary?

A

Most metstatic tumors of the ovary have a **Mullerian Origin

Other:
GI tract
Breast**

26
Q

What are 2 important tumors to remember that metastasize from the GI tract to the Ovary?

  • Tumor Origin?
  • Histology of each?
A
  • *1. KRUKENBERG TUMOR**
  • GASTRIC origin
  • Bi-lateral Metastases composed of Mucin-Producing Signet-ring cancer cells
  • *2. Pseudomyxoma Peritonei**
  • APPENDICEAL origin
27
Q

What cells are are Sex Cord Stromal Tumors of the ovary composed of?

A

Granulosa, Thecal, Fibrous, Leydig, and Sertoli Cells

28
Q

Granulosa (sex cord stromal tumors)
- Presentation on the basis of age: Before puberty, Reproductive age, Post menopausal

A

Before Puberty:
- Precocious Puberty

Reproductive age:

  • Menorrhagia
  • Metorrhagia

Post Menopausal:
- Post-menopausal Uterine Bleeding

29
Q

Granulosa Tumors (Sex Cord Stromal Tumors)

  • Key Histological Features (including IHC)
  • Pathophysiology behind presentations
A

Key Histological Features:

  • Call-Exner Bodies - **Sheets of tumor cells punctuated by follicle-like structures
  • COFFEE BEAN-LIKE CELLS**
  • STRONGLY positive for Inhibin B

Pathophysiology:
- Granulosa cells secrete lots of ESTROGEN so you get hyperestrogenism symptoms in each age group

30
Q

What two Syndromes should you associate with Fibromas, Fribrothecomas, and Thecomas (sex cord stromal tumors) in the ovary?
**Characteristics of these tumors?

A
  • *1. Meigs Syndrome**
    • Ovarian Tumors
  • Hydrothorax
  • Ascites*
  1. Basal Cell Nevus Syndrome - PTCH gene mutation (signaling protein between the SHH receptor and the Smoothened Receptor) - Vismodegib possible tx?
31
Q

Fibromas, Fibrothecomas, and Thecomas (sex cord stromal tumors)
- Gross Appearance?

A

Gross:
- Large Tumors with Mixing of White (fibrous) and Yellow (thecal) tissue

32
Q

Sertoli-Leydig Cell Tumors (sex cord stromal tumors of the ovary)

  • Patient Presentation
  • Risk of Metastasis?
  • Histological Appearance
A

Patient Presentation:
- Reinke Crystsals in Leydig Cells = KEY

33
Q

How can you differentiate between the type of ovarian a patient is likely to have on the basis of age?

A
  • *15-30
  • Germ Cell Tumor**
  • *35-40
  • Benign Surface Epithelial Tumor**
  • *60-70**
  • Malignant Surface Epithelial Tumor
34
Q

T or F: Germ cell tumors are the second most common neoplasm of the ovary behind epithelial ovarian tumors

A

True

35
Q

Teratoma (Germ cell ovarian neoplasm)

  • 3 subtypes
  • how many tissue types usually compose the tumor?
A

3 Subsets of Teratomas
Mature
Immature
Monodermal

2-3 tissue types usually compose the tumor

36
Q

Compare Mature, Immature, and Monodermal Teratomas (Germ cell neoplasms) on the following features.
Benign or Malignant
Key Characteristics

A

Mature Teratomas - Benign
- Some forme cysts with keratin = Desmoid Cyts

Immature Teratomas - Malignant

  • prepubertal adolescents and young women
  • GRADE is VERY IMPORTANT (how much immature neuroepithelium is there)

Monodermal Teratomas - highly specialized
E.g. STRUMA OVARII - monodermal THYROID tissue

37
Q

What two tissue types are most often involved in malignant teratomas?

A
  1. Neuroectoderm (from immature teratomas)
  2. SCC (from mature teratomas that just happen to develop skin cancer)
38
Q

Dysgerminoma

  • Histological Appearance (Key Markers)
  • Gene mutation
  • Testicular Equivalent
A

Histological Appearance:
- Looks like a bunch of oocytes (very distinct Fried-Egg appearance + Lymphocytes)
- Key markers: CD117+, PLAP+
Gene mutation:
KIT mutations are often associated with Dysgerminomas

Testicular Equivalent is the Seminoma

39
Q

What is the prognosis of Dysgerminomas?

A

Dysgerminomas are Malignant but only 1/3 Spread Aggressively
- very radiosensitive (80% cured)

**Similar Indolence is seen in the testicular seminomas

40
Q

Yolk Sac Tumor (Germ Cell neoplasm of the ovary)

  • Key Serum Markers
  • Histology**
  • Prognosis
A

Serum Markers:
AFP

Histology:
Schiller-Duval Bodies - glomerular-like appearance with Hyaline Droplets

Prognosis:
VERY POOR

41
Q

What is the use of CA-125 in ovarian cancer?

A

CA-125
- elevated in 70-90% of EPITHELIAL ovarian cancers, but is undetected in 1/2 of women who have cancer limited to the ovary

  • It may also be elevated in benign conditions

For these reasons CA-125 is a better For Monitoring Epithelial Ovarian cancer than Detecting it

42
Q
A

Reproductive Pathology (6 decks)

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