Ovary and Fallopian Tube Pathology 1 Flashcards

Describe the tumor classification for four types of "ovarian tumors."

1
Q

List the four major types of ovarian tumors.

A
  • Surface epithelial neoplasms
  • Sex-cord stromal tumors
  • Germ cell tumors
  • Metastatic tumors
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2
Q

What are the major non-neoplastic ovarian cysts?

A
  • Follicular cyst
    • common lesions of Graafian follicle origin
    • usually multiple and <2cm
    • may produce increased estrogen if theca component is luteinized
      • increased serum estrogen, pain, or hemoperitoneum
    • consist of granulosa and theca cells
    • polycystic ovarian syndrome
  • Corpus lutein cysts (CLC)
    • non-pregnant CLC
    • pregnancy CLC
      • corpus luteum may appear as ovarian neoplasm
    • rupture may cause peritoneal inflammation
  • Non-neoplastic epithelial cysts
    • ovarian surface epithelial cyst
    • ciliate tubal inclusion cyst/Paratubal cyst
    • remnant cyst
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3
Q

What is the clinical presentation, pathophysiology, histology, and long-temr sequelae of PCOS?

A
  • Clinical
    • 5% of reproductive age women
    • obese
    • hirsute (rarely virilized)
    • diabetic (insulin-resistant)
  • Pathophysiology
    • persistent anovulation
    • oligomenorrhea
    • high level of LH & estrogen
      • LH and insulin result in overproduction of androgens that are converted in peripheral tissue to estrogen
  • Histology
    • multiple follicles
    • fibrosis
    • absence of corpus luteum
  • Long-term sequelae
    • endometrial hyperplasia/carcinoma
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4
Q

What are the common sources of ovary/FT surface epithelial tumors?

A
  • Glands of endometriosis
  • Remnants: rete ovary, walthard and mesonephric ducts (secondary Mullerian system)
  • Endosalpingiotic, paraovarian, and paratubal cysts
  • The fimbriated end of secretory epithelia (FTE)
    • gives rise to significant percentage of hihg-grade serous carcinomas
    • fimbria responsible for deposition of neoplastic cells on the surface of the ovary
  • Ovarian surface epithelia?
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5
Q

What are the sources of “sex-cord” stromal tumors?

A
  • Stroma of the ovary: fibroblasts and myofibroblasts
  • Sex cord: the non-germ cell elements of the Graafian follicle
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6
Q

What are the common sources off germ cell neoplasias?

A

germ cells within the follicle are the progenitor cells

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7
Q

What are the major epithelial ovarian tumor classifications?

A
  • Serous:
    • epithelium of tumor resembles fallopian tube epithelium , the most common neoplasms in ovary
  • Mucinous:
    • resembles endocervical (associated with endometriosis and teratoma) or colonic mucosa
  • Endometrioid:
    • resembles proliferative endometrial glands; 30% associated with endometriosis
  • Clear Cell:
    • similar histology at all sites; ~50% to 70% associated with endometriosis
  • Transitional:
    • Brenner tumor most common type; cells resemble transitional (urothelial) cells
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8
Q

What is the detection rate and death rate of ovarian carcinoma?

A
  • Accounts for 50% of female genital tract deaths; The death rate for OC has not changed in the past 50 years.
  • 75% of OC are detected in late stages and 50% are high grade serous carcinoma
  • Recent studies, however, have raised a compelling hypothesis that fallopian tube secretory epithelial cells (FTSECs) may harbor a cell of origin for most high grade serous carcinoma.
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9
Q

What are the major subdivisions of serous epithelial tumors and what are the major features of each?

A
  • Benign (60%):
    • serous Cystadenoma and Cystadenofibroma
  • Borderline or Low Malignant Potential (15%)
    • intraepithelial proliferation
    • 30% to 40% have extra-ovarian spread, called “implants” in omentum, peritoneum or lymph nodes
  • Malignant: Invasive (25%)
    • 50% bilateral; represents 50-60% of all malignant ovarian tumors
    • can be divided into low grade and high grade
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10
Q

Describe the histology of serous cystadenoma.

A
  • Multiple cysts with smooth lining
  • Showing serous cyst adenofibroma (top) and cyst adenoma with simple papillary architecture (bottom).
    • high-power (right) showing fallopian tube-like epithelium
  • Lesion usually lined with a pseudostratified row of tall ciliated columnar cells - resembles fallopian tube epithelium
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11
Q

Describe the histology of serous papillary “borderline” tumors.

A
  • Gross
    • solid and cystic mass
    • yellow tan papillary fronds
  • Typical Histology
    • intraepithelial proliferation
    • pseudo- and true stratified
    • tufting
    • mild to moderate nuclear atypia
    • non or microinvasive
    • hierarchical papillary/micropapillary epithelial proliferation
    • 30-40% have “implants” of serous tumor on extra-ovarian peritoneal surfaces
  • Progression to low-grade invasive serous adenocarcinoma on recurrance has high mortality rate
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12
Q

In serous “borderline” tumors what are important considerations for involvement of extra-ovarian sites?

A
  • Implants vs Metastasis
    • common in omentum, pelvic sidewall, diaphragm and uterine serosal surface
    • can be found in pelvic lymph node
    • can progress to low grade serous carcinoma
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13
Q

What are some features of malignant serous tumors?

A
  • Solid component with invasion into ovarian stroma
  • Increased cellular proliferation with cytologic atypia
  • Cytologic atypia and psamomma bodies
  • High-grade serous carcinomas can also come from mucosa lining fibriated end of the fallopian tube
    • spread diffusely throughout peritoneal cavity
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14
Q

What are some important features of ovarian mucinous tumors?

A
  • Middle-aged adults
    • rare before puberty / after menopause
  • Three groups:
    • endocervical
      • usually benign
      • cystic neoplasms lined by talkk mucin-filled cells
      • associated with endometriosis
    • intestinal
      • maybe benign, LMP, or malignant
      • usually large and multicystic
      • lined by intestinal-type mucosa with goblet cells
    • Mullerian
  • Can be heterogeneous and consist of benign borderline and malignant components with on tumor
  • Malignant tumors are more solid and complex with stromal invasion
  • Must exclude appendiceal or colonic metastasis!
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15
Q

What are the major histologic findings of mucinous cystadenocarcinoma?

A
  • Major histologic features:
    • columnar cells with abundant intracytoplasmic mucin and cytologic atypia
    • Stromal invasion;
    • more solid growth, loss of glandular architecture,
    • necrosis
  • Differentiation:
    • glands are mostly intestinal type
    • endocervical type usually
  • Carcinoma often merges with borderline or benign mucinous tumors
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16
Q

What are the major histologic findings of clear cell carcinoma?

A
  • Less common
  • 50-70% associated with foci of endometriosis in ovaries or pelvis
  • Microscopically characterized by presence of pleomorphic cells with clear, glycogen-rich or lightly eosinophilic cytoplasmic arranged as:
    • tubular glands
    • solid nests
    • papullary structures
  • Clinically agressive
17
Q

What are the major features of endometrioid tumors?

A
  • Common (20% of all ovarian cancers)
  • Grossly, solid and cystic neoplasms with tubular glands resembling endometrium
    • histologically identical to those arising in the endometrium
  • 30% associated with foci of endometriosis
  • co-existing uterine endometrioid carcinoma in 15-30%
18
Q

What are the important histological features of Brenner cell tumors?

A
  • Presents in middle-aged or older adults
  • Commonly, an incidental finding (tumor < 2cm.).
  • 10% to 25% of tumors associated with mucinous cystadenoma
  • Rare “borderline” tumors resemble papillary transitional cell tumors of the bladder
  • Nests of epithelial cells (resembling urothelial cells) with bland, “grooved” nuclei in a cellular fibrous stroma (red arrows)
19
Q

What are the common histologic features of small cell carcinoma of the ovary?

A
  • High-grade carcinoma; affects patients <40 years of age
  • Small pleomorphic cells
  • Nearly 50% are bilateral.
  • About 2/3s of tumors are associated with hypercalcemia.
  • Poor prognosis
20
Q

Describe the FIGO staging of ovarian cancer.

A
  • Stage 1 - Tumor limited to ovaries
  • Stage 2 - Involvement of one or both ovaries with pelvic extension in pelvis
  • Stage 3 - Involvement of one or both ovaries with extension beyond the pelvis
  • Stage 4 - Involvement of one or both ovaries with distant metastases