Path Ovary, Fallopian, Peritoneum

Question 1

Ectopic Preg

Answer 1

90% are in fallopian tube; occurs in 1/150 pregancy (increased risk if had PID or other tubal scarring)
Most common cause of hematosalpix
Rupture is a medical emergency
Usually present 12 weeks after last menstrual period

Question 2

Endometriosis

Answer 2

‘Chocolate cyst’

Question 3

PCOD

Answer 3

younger women, oligomenorrhea, obesity, and hirsuitism
Persistent anovulatory state
Treat with early intervention, metformin
Increased risk of endometrial cancer from unopposed E2

Question 4

Serous Epithelial Tumor

Answer 4

Most frequent (30%)
Benign, Boderline (KRAS & BRAF)
Borderline: complex papillae, epithelial tufting and
hierarchical branching; psammoma bodiesno stromal
invasion
Carcinoma: very complex, pleomorphic, mitoses, stromal
invasion

Question 5

Mucinous

Answer 5

BIG
Cystadenoma: discrete dilated glands without branching, simple grandular epithelium=columnar
Borderline: stratified epitheium with atypia and scattered nuclei
Carcinoma: can undergo expansile or destructive invasion,

Question 6

Endometrioid Tumor

Answer 6

Resembles uterine adenocarcinoma, so need to always exclude metastasis from uterine tumor
Columnar cells
Common mutations: PTEN/KRAS, beta-catenin

Question 7

Clear Cell

Answer 7

Very rare but aggressive
Almost always associated with endometriosis
Hobnail cells” =nuclei bulging into cystic space without
apparent cytoplasm
Tubulocystic growth pattern

Question 8

Teratoma

Answer 8

Mature (aka dermoid cyst):
o NMDAR encephalitis affects young women (psychosis, memory deficits, seizuresfrequently associated with underlying neoplasm, especially teratoma
Adult-type tissues of all three germ layers but hair and skin are most common

Immature=Always malig (15%) ovarian cancer microscopic identification of embryonal tissue
(usually neuronal)

Question 9

NMDA Encephalopathy

Answer 9

‘Brain on fire’
Psychosis, memory def, seizures
Assoc w/teratomas

Question 10

Dysgerminoma

Answer 10

Assoc w/ isochromosome 12p
“Squared off” nuclei
 Sheets and nests of cells
 Fibrous bands with lots of lymphocytes

Question 11

Yolk sac tumor

Answer 11

Usually in 10-30 yrs, but in perimenopausal women with surface epithelial neoplasms
Produce alpha-fetoprotein (AFP)
 Schiller-Duval Body: glomeruloid structure with central
blood vessel surrounded by neoplastic cells
 AFP positive hyaline globule

Question 12

Schiller

Answer 12

d

Question 13

Adult Granulosa cell tumor

Answer 13

Most common of sex cord tumors
 Adult: 3% of primary ovarian tumors; associated with endometrial neoplasia
Monitor adult with serum inhibin for recurrence (which is usually much later)
 Call-Exner bodies: resemble primitive follicle
 Prominent nuclear grooves

Question 14

Call-Exner bodies

Answer 14

Resemble primitive follicles

Question 15

Fibroma/Thecoma

Answer 15

Almost all benign

Meig’s syndrome = fibroma + ascites + hydrothorax

Question 16

Krukenberg Tumor

Answer 16

Metastatic gastric carcinoma (70%

Signet ring

Question 17

Pseudomyxoma Peritoneii

Answer 17

‘Jelly Belly’
Mucin throughout abdomen
Appendiceal origin