Ovary - Pathoma Flashcards
What is the functional unit of the ovary?
Follicle
What forms when there is hemorrhage into the corpus luteum?
hemorrhagic luteal cyst
What do you call a follicle that has degenerated?
follicular cyst
What causes the multiple follicular cysts in the ovary in PCOD?
hormone imbalance: increased LH, low FSH
LH:FSH >2
What is the classic presentation of PCOD?
Obese young woman, with infertility
oligomenorrhea and hirsutsm
some patients have insulin resistance
High circulating levels of estrone in women with PCOD increases the risk for what condition?
Endometrial carcinoma
What are the three categories of ovarian tumors?
- Surface epithelial
- Germ cell
- Sex-cord stromal
What is the most common type of ovarian tumor?
Surfac epithelial tumors
What are the two most common subtypes of surface epithelial tumors that are both usually cystic?
Serous and Mucinous
What are benign surface epithelial tumors called?
Cystadenoma
What are Cystadenomas composed of?
single cyst with simple, flat lining
What patient population do Cystadenomas generally present in?
premenopausal women (age 30-40s)
What are malignant surface epithelial tumors called?
Cystadenocarcinoma
What are Cystadenocarcinomas composed of?
complex cysts with thick, shaggy lining
cells invade into the underlying connective tissue
What patient population do Cystadenocarcinomas generally arise in?
Post-menopausal women (age 60-70s)
What type of surface epithelial tumors have features in between benign and malignant tumors and have a better prognosis than clearly malignant tumors, but they still carry a malignant potential?
Borderline Tumors (malignant tumors)
Carriers of what mutation have an increased risk for Serous Carcinoma of the ovary and fallopian tube?
BRCA1
What is an Endometrioid Tumor of the ovary?
Ovarian Surface Epithelial Tumor with endometrial histology (looks like endometrial cells)
- usually malignant => carcinoma
- may be associated with endometriosis
- 15% will also have carcinoma of the endometrium in the uterus
What is a Brenner Tumor of the ovary?
Ovarian Surface Epithelial Tumor that contains urothelium
When do Surface Epithelial Tumors of the ovary typically present?
LATE => poor prognosis
What are common symptoms of Surface Epithelial Tumors of the ovary?
Vague abdominal pain symptoms (pain, fullness)
Signs of compression (urinary frequency)
Where do Surface Epithelial Tumors (carcinomas) of the ovary tend to spread?
Locally => especially peritoneum (“omental caking”)
What is a useful serum marker used to monitor treatment response and screen for recurrence of Surface Epithelial Tumors of the ovary?
CA-125
not used for initial screening
What is the second most common type of ovarian tumor?
Germ Cell Tumor = 15% of all cases
What population of women do Germ Cell Tumors generally occur in?
women of reproductive age
What are the tumor subtypes of Germ Cell Tumors?
Mimic tissues normally produced by germ cells
Fetal => Cystic teratoma / Embryonal Carcinoma
Yolk Sac => Yolk Sac Tumor
Germ Cells => Dysgerminoma
Placenta => Choriocarcinoma
What is a Cystic Teratoma composed of?
fetal tissue derived from two or three embryologic layers
What is the most common germ cell tumor in females?
Cystic Teratoma
How common do Cystic Teratomas arise bilaterally?
10% of the time (more common in board questions)
Are cystic teratomas benign or malignant?
Benign
What two things need to be excluded in a Cystic Teratoma to ensure that the tumor is benign?
- Presence of immature tissue, most commonly neural ectoderm (immature teratoma => malignant potential)
- Cancer in the tissue of the teratoma/Somatic malignancy, most commonly squamous cell carcinoma of the skin
What is Struma ovarii?
Cystic teratoma composed primarily of thyroid tissue => may present as hyperthyroidism
What is the most common malignant germ cell tumor of the ovary that is composed of large cells with clear cytoplasm and central nuclei (resembles oocyte)?
Dysgerminoma
What is the testicular form of Dysgerminomas?
Seminoma
What is the prognosis of Dysgerminomas?
Good prognosis => responds to radiotherapy
What serum marker may be elevated in the setting of a Dysgerminoma?
LDH
What do you call a malignant germ cell tumor of the ovary that mimics the yolk sac?
Endodermal Sinus Tumor
What is the most common germ cell tumor in children?
Endodermal Sinus Tumor
What serum marker may be elevated in the setting of an Endodermal Sinus Tumor?
AFP
What unique histological finding is common in Endodermal Sinus Tumors
Schiller-Duval bodies = glomeruli-like structures
What do you call a malignant Germ Cell Tumor composed of trophoblasts and syncytiotrophoblasts (villi are absent)?
Choriocarcinoma = malignant proliferation of placental-like tissue
How does a Choriocarcinoma spread? How can it spread early?
Small, hemorrhagic tumor with early hematogenous spread
How? => genetically programmed to invade blood vessels from the early beginning
What serum marker is present in the setting of Choriocarcinoma?
High beta-hCG
Do Choriocarcinomas have a good or bad response to chemotherapy?
Bad! Unforunately, they respond poorly
What do you call a malignant Germ Cell Tumor composed of large primitive cells that are embryo-like?
Embryonal Carcinoma
Do Embryonal Carcinomas typically metastasize?
Yes, aggressive with early metastasis
What various cell types can give rise to Sex-cord Stromal Tumors?
Granulosa cells
Theca cells
Fibroblasts, fibrous tissue
Sertoli cells
Leydig cells
What do you call a Sex-cord Stromal Tumor composed of neoplastic granulosa and theca cells and which produces estrogen?
Granulosa-Theca Cell Tumor
What are the presenting symptoms of Granulosa-Theca Cell Tumors?
Signs of excess estrogen
Child => precoccious (early) puberty
Pre-menopausal Adult => Heavy/abnormal menstrual bleeding
Post-menopausal adult => abnormal uterine bleeding
What are the unique features of Sertoli-Leydig Cell Tumors?
Sertoli cells form tubules (mimics testicles)
Leydig cells contain characteristic Reinke Crystals
Why is a Sertoli-Leydig Cell Tumor associated with hirsutism and virilization?
tumor may produce androgen
What do you call a benign tumor of fibroblasts that is associated with pleural effusion and ascites (Meigs syndrome)?
Fibroma
What are the two classic examples of Metastasis to the ovaries?
- Kruckenberg tumor: mucinous carcinoma that spreads to BOTH ovaries, e.g. can arise from gastric carcinoma
- Pseudomyxoma peritonei: abundant amount of mucin in the peritoneum, primary mucinous carcinoma tumor in appendix
