path of ovary 12/10

Question 1

surface inclusion cysts

Answer 1

secondary to invagination of suface epithelium

Question 2

theca lutein cysts

Answer 2

theca interna cells overstimulated by high levels of gonadotropin

cysts lined by theca lutein cells

Question 3

PCOS

Answer 3

also called Stein-leventhal syndrome

Question 4

stromal hyperplasia and hyperthecosis

Answer 4

usually in post-menopausal women who present with symptoms similar to PCOS

grossly see uniform enlargement of both ovaries

micro. shows hypercellular stroma with luteinnization of stromal cells

Question 5

ovarian tumors overview

Answer 5

most are benign

benign are common in young females and malignant in older females

most non-functional

often discovered late

Question 6

tumors of surface epithelium

benign

Answer 6

usually cystic with smooth lining

Question 7

surface epithelium

malignant

Answer 7

show papillary projections and solid areas

can seed peritoneum resulting in ascites

usually discovered late CA-125

Question 8

surface epithelium tumor

Answer 8

most common ovarian tumors

serous cystadenoma(-adenocarcinoma)–>mucinous

–>endometroid–>clear cell adenocarcinoma–>brenner

Question 9

features of benign serous tumors

Answer 9

one or several cysts with smooth inner and outer surfaces

cysts lined by a layer of tall columnar,serous secreting,ciliated or non-ciliated cells with no atypia

outer surface covered by mesothelium

when there is abundant fibrous stroma–> cystadenofibroma

Question 10

features of malignant serous tumors

Answer 10

numerous cysts with many papillary projections and solid areas

epithelium piles up–>more than one layer

solid masses of epithelial cells that invade into wall of cysts

Question 11

common finding in serous papillary cystadenocarcinoma

Answer 11

psammoma bodies

Question 12

mucinous tumors

Answer 12

less often bilateral than serous

see tall columnar,mucin secreting cells

are often very large

pseudomyxoma peritonei (jelly belly) is a common complication in 2-5% of pts

Question 13

endometroid tumor of surface epithelium

Answer 13

most are malignant

histo. similar to endometrial CA

some have endometriosis in ovaries

some are associated with independent endometrial carcinoma in uterus

Question 14

clear cell adenocarcinoma

Answer 14

variant of endometriod CA

may be solid or cystic

see large cells with clear cyto or hobnail type cells, arranged in solid,tubular or papillary configuration

aggressive, poor prognosis beyond ovary

Question 15

brenner tumor

Answer 15

transitional cell (urothelial)

most are benign

Question 16

germ cell tumors

Answer 16

most are mature teratomas(Dermoid cysts)–>benign

Question 17

malignant teratoma

Answer 17

immature

seen in kids and young adults

contain immature embryonic tissues,mostly solid with focal necrosis and hemorrhage

Question 18

monodermal germinal tumors

Answer 18

specialized

struma ovarii

Question 19

dysgerminomama

Answer 19

ovarian counterpart of seminoma

always malignant

50% of malignant ovarian germ cell tumors

often produce gonadotropins

large cells with clear cyto. and centrally located nuclei in cords or sheets, seperated by thin, fibrous septae that contains lymphocytes

serum LDH may be elevated

Question 20

endodermal sinus (yolk sac) tumor

Answer 20

malignant and very aggressive

children and young women

schiller-Duval bodies that contain intracyto. hyalin droplets. (glumeroloid)

droplets contain AFP and A1-antitrypsin

Question 21

choriocarcinoma

Answer 21

much more malignant than placental choriocarcinoma and spreads widely very early

produces chorionic gonadotropin

Question 22

embryonal CA

Answer 22

solid with necrosis and hemorrhage

see solid sheets and nests of large primitive cells

can see syncytiotrophoblast-like cells, secrete chorionic gonadotropin

can also see elevated AFP

Question 23

sex cord stromal tumors

Answer 23

granulosa cell tumor

thecoma and fibroma

sertoli-leydig (arrhenoblastoma)

leydig (hilus cell tumor)

lipid cell tumor

Question 24

granulosa cell tumor

Answer 24

smooth surface, lobulated, gray-yellow color

microfollicular with call-exner bodies: see coffee-bean nuclei

75% associated with hyperestrinism–> endometrial hyperplasia or precocious puberty

Vimentin positive

Keratin negative

Question 25

thecoma and fibroma

Answer 25

65% in post-menopausal

nearly all are benign

round,firm solids

fascicles of spindle cells, can sometimes see fat in thecomas

may see hyperestrinism in thecomas

Question 26

Meigs’ syndrome

Answer 26

seen in fibroma

ascites and right sided hydrothorax

Question 27

Sertoli-leydig cells

(virilizing tumors)

Answer 27

rare, average age is 25

see Reinke crystals in Leydig cell tumor (benign)

Question 28

lipid cell tumor

Answer 28

rare, yellow or brown (25% malignant)

gynandroblastoma: mix of granulosa and sertoli-leydig tumor

sex cord tumor with annular tubules. 1/3 of cases are associated with Peutz-Jegher

Question 29

Krukenberg tumor

Answer 29

mets from stomach

usually bilateral, solid diffuse infiltration by signet ring cells

Question 30

acute salpingitis

Answer 30

most common organism is gonoccus, but also E.Coli

bacteroids, strep and chlamydia

Question 31

chronic salpingitis

Answer 31

repeated inflammation

see fibrous adhesions

can result in pyo or hydrosalpinx

see lymphocytes

can find granulomatous salpingitis in pts with TB

Question 32

other lesions

Answer 32

salpingitis isthmica nodosa: diverticular lesion of tubal epithelium in isthmus

paratubal cyst: benign

endosalpingitis: presence of tubal epithelium in sites other than fallopian tube