Ovary-achievers Flashcards
What gynecologic tumor is associated with paraneoplastic syndrome classified with cerebellar ataxia?
ovary (anti-Yo antibodies/anti-Purkinje antibodies)
Ab main target = cerebellar degeneration-related 2-like (CDR2L) antigen expressed by Purkinje cells
T cell mediated
Treatment of psammoma carcinoma with mets less than 1 cm in size?
Surgical management/debulking
rare histologic subtype of serous carcinoma originating in the ovary or peritoneum, characterized by massive psammoma body formation, invasiveness, and low-grade differentiation. Its clinical behavior appears similar to that of serous borderline tumors rather than that of typical invasive serous carcinomas (AW)
Which tumor markers may be elevated in mucinous ovarian tumors?
CEA
CEA elevated in 88%
also CA125, CA19-9
Which IHC markers are elevated in mucinous ovarian tumors? (4)
P16, CK7, CK20, CDX2
What oncogene is abnormal in mucinous ovarian tumors?
KRAS
What oncogenes are overexpressed in Borderline or low grade serous tumors? (2)
KRAS > BRAF
What Tumor suppressor proteins are commonly altered in high grade serous tumors?
BRCA and P53
What Tumor suppressor proteins are commonly altered in endometrioid ovarian cancers?
PTEN, P53
PTEN=MC
p53= 20-30% of endometrioid
ARID1A = 30-40% of endometrioid
p53 in HIGH GRADE endometrioid
What oncogenes are commonly activated in endometrioid ovarian cancers?
CTNNB1(beta catenin), PIK3CA, KRAS
CTNNB1 (30-50%), PIK3CA (20-40%), KRAS (AW)
What germ cell tumors do not require additional treatment? (2)
[repeated 3 times!]
Stage 1 dysgerminoma and Stage 1 Grade 1 immature teratoma (NCCN 2/24)
Which ovarian germ cell tumor displays c-kit staining?
Dysgerminoma
Dysgerminoma is the only OGCT that commonly displays c-kit staining.
Approximately 25% to 50% of dysgerminomas harbor c-kit mutations
Which ovarian germ cell tumor is most common in a patient with gonadal dysgenesis?
Dysgerminoma
small percentage of Dysgerminoma associated with disorders of sexual development with a Y chromosome–containing karyotype. In this situation the tumor may be associated with gonadoblastoma
What is the classic histologic appearance of dysgerminoma?
nests and cords of ovoid to polygonal cells (primitive germ cells), with clear to pale eosinophilic cytoplasm and prominent cytoplasmic borders, enlarged hyperchromatic nuclei.
Fibrous septae containing lymphocytes separate nests of tumor=extensive lymphocytic infiltrate
The “blue balls” nuclei are lymphocytes
(Also blue balls —-> gonadoblastoma —> dysgerminoma malignancy)
Which germ cell tumors do not secrete AFP?
Dysgerminoma, non gestational choriocarcinoma
What is the classic histologic appearance of an endodermal sinus tumor (aka yolk sac)?
Schiller-Duval bodies
cellular structure that is characterized by the presence of a central blood vessel surrounded by layers of tumor cells
What do Schiller-Duval bodies look like?
Central vessel lined by a cystic space and tumor cells
*Endodermal sinus tumors aka yolk sac
What is the serum marker for an endodermal sinus tumor?
AFP
What is the treatment for endodermal sinus tumor (AKA yolk sac tumor)
Surgery, chemo BEP (bleo, etopo, cisplatin 3 cycles good risk / 4 cycles poor risk)
Good risk – Stage IA disease
Intermediate risk – Stage IC to III
Poor risk – Stage IV
What tumor marker does embryonal carcinoma make?
hcg
What are immature teratomas graded on?
Immature neural elements
JS: Grade 1: Immature elements </=1 per low-power field per slide
Grade 2: >1, <4 LPF per slide
Grade 3:>4 LPF
Which germ cell tumors do not secrete AFP? (repeat)
Dysgerminoma, nongestational choriocarcinoma
What ovarian tumor is associated with Peutz-Jeghers?
Sex cord tumor with annular tubules
(Ovarian - sex cord stromal w annual tubules, Cervix - adenoma malignum, Ovarian - Granulosa theca)
What’s the most common cancer to present w/ hemoperitoneum?
Granulosa cell
What would adding TVUS do to elevated CA-125 screening value?
a) increase sensitivity
b) decrease sensitivity
c) increase specifcity
d) decrease specificity
c) increase sensitivity
Staining if ovarian met from colon
CK7- CK 20+ metastatic colon cancer
CK7+ CK20+ Ovarian mucinous
CK7+ CK20- Endometrial
CK7+ CK20- HGSOC
Poor ovca prognostic factor
VEGF-D –assoc with higher stage, LVSI, LN (angiogensis and lymphangiogensis)
(JS) VEGF-A, C, D all are poor prognositc factors. Not much out there for B or E.
A= angiogenesis (also ascites)
C= lymphangiogensis
D= angio + lymphangio (this is why it has the worst prognosis out of the other 2)
Non-epithelial ovarian cancer that sometimes needs secondary cytoreduction
Immature teratoma (THIS ONE). Cases where pt received adj chemo for immature teratoma and have bulky residual even w/ normaliztion of negtive markers; reasonable to do surgery; sometimes path during secondary debulk will not be malignant then observe, if malignant viable tissue then addtll chemo
Napsin A (IHC stain) is associated with which ovarian CA histology
Clear cell ovarian carcinoma
It’s CLEAR I need a NAPsin
Most likely associated with lymph node mets?
A. Dysgerminoma
B. Sertoli-leydig
C. Granulosa cell
D. Immature teratoma
A. Dysgerminoma (28%) - very chemosensitive
mixed germ cell (16%), malignant teratoma (8%) - uptodate
Rare LN involvement in sex cord stromal tumors
JS: saw another question that included endometrioid option…thoughts?
Non-epithelial ovarian cancer that sometimes needs secondary cytoreduction
Immature teratoma. Cases where pt received adj chemo for immature teratoma and have bulky residual even w/ normaliztion of neg markers; reasonable to do surgery; sometimes path during secondary debulk will not be malignant then observe, if malignant viable tissue then addtll chemo
LMP tumor - how to differentiate nonmetastic vs. metastatic implant
a) stromal reaction
b) papillations
c) cytologic atypia
d) mitotic index
a) stromal reaction
JS- implants can be invasive vs non-invasive. Invasive = low-power destructive growth pattern, presence of micropapillary architecture and tumor cell nests surrounded by retraction artifact in dense fibrotic stroma
JS: I don’t like this question, worded poorly
Grade 3, IA endometrioid ovarian cancer - treatment?
a) obs
b) 3 cycles chemo
c) 6 cycles chemo
b) 3 cycles (based on GOG 157)
What is biggest barrier to ovarian cancer screening
low specificity of existing tests
What % of benign teratomas contain thyroid tissue?
10%
What % of struma ovarii are malignant?
10%
Basis of grading for immature teratoma?
Amount of immature neural elements
What % dysgerminomas are bilateral?
10-15%
18yo with adnexal mass and positive alpha 1 antitrypsin staining?
Yolk sac tumor (AKA endodermal sinus tumor)
(yolks give you COPD)
Adjuvant treatment for Grade 1 Stage 1B ovarian cancer (repeated 3 times)
Obs
Which early stage ovarian cancers merit adjuvant chemo (3 answers)
- Any Grade three (endometrioid or serous)
- high risk histology (clear cell, carcinosarcoma)
- Stage IC+
(could also say infiltrative mucinous; however, this isn’t in NCCN criteria 5/2024)
85yo had hyst/bso found to have 4cm granulosa cell tumor whats next step
obs (very low rate of LN mets in sex cord stromal tumors)
Which is most likely to have lymph node mets: dysgerminoma, immature teratoma, sertoli leydig, granulosa cell
(2018 in RED)
Dysgerminoma
Which type of ovarian tumor requires secondary debulking?
Immature teratoma
