Ovary Witrak

Question 1

What causes Polycystic Ovarian Syndrome (PCOS)?

Answer 1

Don’t know…it is thought to maybe be hypothalamic or pituitary malfunction

Question 2

What are some characteristics of PCOS?

Answer 2

Menstrual irregularity

Hyperandrogenism

Question 3

What are some of the potential downstream effects of the menstrual irregularity seen with PCOS?

Answer 3

Anovulation → chronic/sustained estrogen effect → increased risk of endometrial hyperplasia/carcinoma

Question 4

What are some of the potential downstream effects of the hyperandrogenism seen with PCOS?

Answer 4

Hyperandrogenism → Hirsutism, acne, and male pattern balding

Question 5

What are some associations of PCOS?

Answer 5

Enlarged ovaries with polycystic features
Obesity
Insulin resistance/Diabetes

Question 6

A transvaginal ultrasound is performed on a patient, and polycystic ovaries are seen. Is this enough to diagnose this patient with PCOS?

Answer 6

NO…polycystic ovaries can be seen in normal women

Question 7

What are the potential ovarian tumor origins?

Answer 7

Ovarian surface (Mullerian) epithelium
Sex cord/stromal cells
Germ Cells
Metastatic from somewhere else

Question 8

What origin of ovarian tumors occurs most often?

Answer 8

Ovarian surface (Mullerian) epithelium

Question 9

What are the two main types of Mullerian epithelium ovarian tumors?

Answer 9

Serous

Mucinous

Question 10

Do serous tumors tend to be unilateral or bilateral?

Answer 10

Serous tend to be bilateral

Question 11

Do mucinous tumors tend to be unilateral or bilateral?

Answer 11

Mucinous tend to be unilateral

Question 12

What is the most common cause of GYN cancer death?

Answer 12

Epithelial ovarian carcinoma

Question 13

What familial cancer syndromes are associated with epithelium ovarian carcinoma?

Answer 13

BRCA1 (35-46%)
BRCA2 (13-23%)
Lynch (3-14%)

Question 14

What cancer marker is associated with epithelial ovarian carcinoma?

Answer 14

CA-125

Question 15

How is CA-125 used?

Answer 15

Used to follow for tumor recurrence and to monitor treatment

Question 16

Are sex cord/stromal cell ovarian tumors usually bad?

Answer 16

Not really…usually low grade/stage and are surgically curable

Rarely reoccur or metastasize

Question 17

What are three types of sex cord/stromal cell ovarian tumors?

Answer 17

Fibroma/thecoma
Granulosa cell tumors
Sertoli/Leydig cell

Question 18

What type of sex cord/stromal cell ovarian tumors is most common?

Answer 18

Fibroma/thecoma (70%)

Question 19

What is often seen with fibroma?

Answer 19

Large tumors

Ascites and pleural effusion (Meig’s syndrome)

Question 20

What type of sex cord/stromal cell ovarian tumor most commonly causes neoplastic estrogen excess?

Answer 20

Granulosa cell tumor…makes sense…

Question 21

Are sex cord/stromal cell tumors typically unilateral or bilateral?

Answer 21

Sex cord/stromal cell tumors are typically unilateral

Question 22

What is the average age of diagnosis with a sex cord tumor?

Answer 22

50 (12% < 30)

Question 23

What are the symptoms associated with sex cord tumors?

Answer 23

Adrenal mass/pelvic displacement
Precocious puberty
Abnormal uterine bleeding
Endometrial hyperplasia/CA
Hirsutism/overt virilization

Question 24

What markers can by used for stromal cell tumors?

Answer 24

Estrogen
Androgen
Inhibin

Question 25

What category of ovarian tumors makes up 70% of ovarian neoplasms in 10-30yo women?

Answer 25

Germ Cell Tumors (GCTs)

Question 26

What is an example of a benign GCT?

Answer 26

Mature cystic teratoma (majority of germ cell tumors)

Question 27

Are mature cystic teratomas typically unilateral or bilateral?

Answer 27

Mature cystic teratomas are bilateral 10-12% of the time

Question 28

What is the female equivalent of testicular seminoma?

Answer 28

Dysgerminoma

Question 29

Is dysgerminoma usually bad?

Answer 29

Make up 33% of all malignant GCTs | Rarely aggressive

Question 30

What do dysgerminoma cells resemble? (Pathoma)

Answer 30

Oocytes...large cells with clear cytoplasm and central nuclei

Question 31

Yolk sac (endodermal sinus) tumors are also malignant, but they tend to be more AGGRESSIVE. Who usually develops these tumors? what serum marker is elevated in these markers?

Answer 31

Yolk sac tumors are the most common germ cell tumor in kids Serum α-fetoprotein is often elevated

Question 32

Besides yolk sac tumors, what are some other aggressive malignant GCTs?

Answer 32

Immature teratomas | Mixed germ cell tumor

Question 33

What are some rare forms of GCTs?

Answer 33

Pure embryonal carcinoma Non-gestational choriocarcinoma Pure polyembryoma

Question 34

What are some general symptoms of GCTs?

Answer 34

Mass/torsion/rupture

Question 35

What is a Kruckenburg carcinoma?

Answer 35

Bilateral mucinous carcinoma usually from the stomach Signet cells are seen on histology