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life cycles test 1 > ovary fallopian tube pathology > Flashcards

ovary fallopian tube pathology Flashcards

1
Q

ectopic pregnancy sx

A

severe abdominal pain approx 6 weeks after LMP, but can develop much longer. Most common cause of hematosalpinx

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2
Q

types of benign ovarian cysts

A

Chocolate cyst- hemosiderin laden macrophages. Cortical inclusion cysts. Simple serous cyst- no excresences

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3
Q

PCOS pathphys

A

Persistent anovulation due to asynchronous release of FSH and LH. Excess androgens with peripheral conversion to E2

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4
Q

PCOS sx and treatment

A

Infertility, oligomenorrhea, obesity, hirsutism. Ovaries twice normal size and absent corpora lutea. Treat: metformin

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5
Q

Cystic ovarian teratoma incidence, Sx, path

A

aka dermoid cyst. Most common ovarian tumor. Contains adult type tissues from all three germ layers. Most are asymptomatic. Anti-NMDAR mediated paraneoplastic encephalitis associated with ovarian teratoma

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6
Q

What is the origin of most ovarian epithelial tumors

A

fimbriated end of fallopian tube

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7
Q

describe the ovarian surface epithelial tumors

A

“Seers make everything clear” 1. Serous: Hierarchical branching, cuboidal cells. 2. mucinous: Huge tumors, Intestinal vs Endocervical epithelium. 3. endometrioid: Same appearance as uterine endometrioid tumors. 4. clear cell: associated with endometriosis

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8
Q

risk factors for ovarian tumors

A

Decreased risk: OCPs, full term pregnancy, gyn surgery, breast feeding. Increased risk: infertility, unopposed estrogen for >10 yrs, family hx

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9
Q

Genes associated with risk for ovarian cancer

A
  1. BRCA1 and BRCA2. DNA repair genes. Risk of breast and ovarian cancer, with mortality higher from ovarian. Typically cause high grade serous carcinoma. 2. HNPCC: mutated mismatch repair genes MLH1, MSH2, PMS2 or MSH 6 leads to microsatellite instability. Colon cancer, endometrial cancer
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10
Q

type I vs type II epithelial tumors

A

type I: progression. Type II: sporadic/ de novo

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11
Q

Borderline ovarian epithelial tumors responsiveness to therapy

A

Low proliferative rate ∴ not responsive to radiotherapy or chemotherapyLow proliferative rate ∴ not responsive to radiotherapy or chemotherapyLow proliferative rate ∴ not responsive to radiotherapy or chemotherapyLow proliferative rate ∴ not responsive to radiotherapy or chemotherapy

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12
Q

Sx of malignant ovarian tumor

A

vaginal bleeding, increased abdominal girth

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13
Q

spread of epithelial ovarian tumors

A
  1. Direct invasion can occur in uterus, fallopian tubes, peritoneum and broad ligament. 2. Exfoliated tumour cells are transported by peritoneal fluid and implant on the peritoneum and mesothelial linings of pelvic and abdominal organs (serosa). Nests of tumor cells can be found on the omentum, mesenteryand diaphragm. 3. lymphatic spread to pevlic and paraaortic lymph nodes. 4. hematogenous spread is rare but can involve any organ, esp liver.
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14
Q

Sx associated with intraperitoneal dissemination of ovarian cancer

A

ascites

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15
Q

describe ovarian serous neoplasms pathology and list the types

A

type of surface epithelial ovarian tumor. Tubal type epithelium (ciliated columnar cells), with epithelial tufting. Serous cystadenoma, serous borderline tumor and serous carcinoma

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16
Q

serous ovarian neoplasms survival

A

Benign (100%), Borderline (80%), Malignant (20%)

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17
Q

ovarian serous cystadenoma path

A

One or multiple thin-walled cysts. Broad papillae with fibrovascular cores. No cytologic atypia or mitoses

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18
Q

ovarian serous borderline tumor path

A

Large cystic or solid masses with soft papillary projections or surface excrescences. Complex papillae with epithelial tufting and hierarchical branching. No stromal invasion. +/- surface involvement; potential to spread. Psammoma bodies (targetoid calcifications), and detached tufts of cuboidal epithelial cells with moderate cytologic atypia

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19
Q

ovarian serous borderline tumor sx, mutations/ markers

A

Most common in 4-5th decades and often asymptomatic. Elevated CA-125. K-RAS and BRAF mutations common

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20
Q

ovarian Serous carcinoma gross pathology

A

Solid, cystic, mixed. Friable with hemorrhage and necrosis. Cysts contain “straw-like” proteinaceous fluid

21
Q

ovarian serous carcinoma histology

A

Stromal invasion, complex architectureal patterns, cytologic atypia (pleomorphism and mitoses), may be glandular or solid

22
Q

ovarian mucinous cystadenoma histology

A

Simple glandular epithelium with small basal nuclei and abundant blue (mucinous) apical cytoplasm

23
Q

ovarian mucinous tumors survival and age range

A

Benign: 80%, 30-50 yrs ol. Borderline: 15%, >60 yrs. Malignant: 5%, > 60yrs

24
Q

ovarian mucinous borderline tumor histology and survival

A

10 yr survival is 80%. Stratified epithelium with atypia and scattered mitoses. Intestinal type has goblet cells. Endocervical/ seromucinous type has acute inflammation

25
Q

ovarian mucinous carcinoma- survival, types of invasion

A

10 year survival = 35%. 2 types of invasion: Destructive (25% recur), Expansile (<5% recur).

26
Q

ovarian endometrioid tumors- pathology

A

Resembles uterine adenocarcinoma. Gland-forming neoplasm w columnar cells and cytologic atypia. Similar genetic alterations as low grade endometrial carcinoma

27
Q

Ovarian clear cell carcinoma pathology and associations

A

Very rare. Associated with endometriosis. Can be glandular or papillary (fibrovascular core with lining of epithelial cells). tubulocystic growth pattern. Hobnail cells: nuclei bulging into cystic space without apparent cytoplasm. Eccentric, rounded or angular, hyperchromatic nuclei. Minimal to marked cytologic atypia

28
Q

list the cell types involved in serous, mucinous, endometrioid and clear cell epithelium

A

serous: cuboidal. Mucinous: columnar. Endometrioid: columnar. Clear cell: hobnail cells

29
Q

list the germ cell tumors

A

Mature teratoma (benign), immature teratoma, dysgerminoma (undifferentiated), yolk sac carcinoma, embryonal carcinoma, choriocarcinoma

30
Q

List another name for mature cystic teratoma

A

dermoid cyst

31
Q

Mature cystic teratoma histology

A

Adult-type tissues representing all three germ layers typically present. Ectodermal: Epidermis, sebaceous, hair follicles. Mesodermal: fat, cartilage, bone, teeth. Endodermal: respiratory and GI epithelium, thyroid

32
Q

what is a Rokitanskys protuberance

A

A rounded polypoid solid mass usually made of fat sen in mature cystic teratomas

33
Q

Immature teratoma histology and grading

A

Immature neuroepithelium: Tightly packed small dark cells w lots mitoses. Grading based on amount of immature neural tissue (more is worse)

34
Q

Ovarian dysgerminoma - prognosis, male counterpart, incidenc

A

Excellent prognosis, even with widespread metastases. Highly sensitive to radiation and chemotherapy. 10 year survival exceeds 90%. Female counterpart to male seminoma. 50% of malignant germ cell tumors
Excellent prognosis, even with widespread metastases. Highly sensitive to radiation and chemotherapy. 10 year survival exceeds 90%. Female counterpart to male seminoma. 50% of malignant germ cell tumors

35
Q

ovarian dysgerminoma histology

A

Sheets and nests of cells with large central nuclei and prominent nucleoli. Clear cytoplasm, squared off nuclear contour, isochromosome 12p.

36
Q

ovarian yolk sac tumor - age, tumor markers

A

10-30yrs, but can occur perimenopausal when associated with surface epithelial neoplasms. Produces alpha-fetoprotein (AFP)

37
Q

ovarian yolk sac tumor- histology

A

Schiller-Duval body: Glomeruloid structure with central blood vessel surrounded by neoplastic cells. AFP positive hyaline globules

38
Q

List the sex cord stromal tumors of the ovaries

A

Granulosa cell tumor, thecoma-fibroma, and sertoli-Leydig cell tumors

39
Q

Adult granulosa cell tumor of ovaries- associations, labs to monitor progress

A

Associated with endometrial neoplasia. Serum inhibin used to monitor recurrence. Estrogenic manifestations in 2/3

40
Q

Granulosa cell tumor of ovary- histology

A

Call-Exner bodies: resembles primitive follicle. Central space with secretions. Prominent nucear grooves and corded growth pattern

41
Q

Fibroma - prognosis and associations

A

Almost all benign, but 1/5 have concurrent endometrial carcinoma.

42
Q

Fibroma histology

A

Pink variably cellular stroma composed of fibroblasts without significant nuclear atypia or very many mitotic figures

43
Q

Meigs syndrome

A

triad of ovarian fibroma, ascites and hydrothorax.

44
Q

Thecoma- who gets it and histology

A

Post-menopausal. Plumper cells with more abundant clear cytoplasm. Abundant reticulin fibers

45
Q

Sertoli-Leydig cell tumor of ovaries- who gets it, sx

A

25 yrs avg. 1/3 pts show virilization

46
Q

compare primary vs metastatic ovarian tumors

A

primary: unilateral, no surface growth, absence of nodularity, large. Metastatic: bilateral, surface and hilar involvement, nodular growth pattern, infiltrative growth, small.

47
Q

Krukenberg tumor

A

metastatic gastric carcinoma in the ovary. Signet ring cell morphology

48
Q

Pseudomyxoma peritoneii

A

metastatic appendiceal tumor in the ovary

49
Q

Tubal intraepithelial carcinoma

A

fimbriated end of fallopian tube. Putative precursor to most ovarian high grade serous carcinomas. Histology: nuclear enlargement, pleomorphism, at least 1 mitosis, stratification

life cycles test 1 (19 decks)

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