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EndoRepro 2 Exam 1 > Path Pt 4: Ovaries > Flashcards

Path Pt 4: Ovaries Flashcards

1
Q

usually multiple cysts, ranging in size up to 2cm in diameter

  • filled with clear serous fluid, and are lined by a gray, glistening membrane
  • on occasion, cysts larger than 2cm may be diagnosed by palpation or US (may cause pelvic pain)
A

follicle cysts

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2
Q

when are granulosa lining cells are present in follicle cysts?

A

if the intraluminal pressure has not been so great as to cause their atrophy

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3
Q

what would cause outer theca cells to be seen?

A

increased amounts of pale cytoplasm (a change referred to as lutenization)
- may be associated with increased estrogen production and endometrial abnormalities

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4
Q

cysts that are present in normal ovaries of women of reproductive age

  • these cytsts are lined by a rim of bright yellow tissue containing lutenized granulosa cells
  • they occasionally rupture and cause a peritoneal reaction
  • sometimes the combination of old hemorrhage and fibrosis may make their distinction from endometriotic cysts difficult
A

luteal cysts

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5
Q

these may present as either a multicystic lesion in which papillary epithelium is contained within a few fibrous walled cysts (intracystic), or as a mass projecting from the ovarian surface

A

serous ovarian tumors

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6
Q

these tumors typically have a smooth glistening wall with no epithelial thickening or with small papillary projections

A

benign ovarian tumors

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7
Q

these tumors contain an increased number of papillary projections

A

borderline ovarian tumors

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8
Q

what features are associated with malignancy in ovarian tumors?

A

larger areas of solid or papillary tumor mass, tumor irregularity, and fixation or nodularity of the capsule

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9
Q

what is common, and occurs in 20% of benign serous cystadenomas, 30% of serous borderline tumors, and approx 66% of serous carcinomas?

A

bilaterality

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10
Q

a significant proportion of both serous borderline tumors and malignant serous tumors involve what?

A

the surface of the ovary

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11
Q

these tumors exhibit increased complexity of the stromal papillae, stratification of the epithelium and mild nuclear atypia, but invasion of the stroma is not seem

A

serous borderline tumors

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12
Q

serous borderline tumors often grows in a delicate, papillary pattern referred to as “micropapillary carcinoma”, which is thought to be the precursor to what?

A

low-grade serous carcinoma

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13
Q

these are distinguished from low-grade tumors by having more complex growth patterns and widespread infiltration or frank effacement of the underlying stroma

A

high-grade serous carcinoma
- the individual tumor cells display marked nuclear atypia, including pleomorphism, atypical mitotic figures and multinucleation

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14
Q

these carcinomas consist of cells morphologically identical to high-grade serous carcinomas, but are distinguished by the lack of invasion

A

serous tubal intraepithelial carcinomas

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15
Q

the cells of these type of tumor can become so undifferentiated that serous features are no longer recognizable

A

invasive high-grade serous carcinoma

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16
Q

what is a characteristic of serous tumors, but are not specific for neoplasia?

A

concentric calcifications (psammoma bodies)

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17
Q

these tumors have a propensity to spread to the peritoneal surface and omentum, and are commonly associated with the presence of ascites

A

both low and high-grade ovarian serous tumors

- as with other tumors, the extent of the spread outside the ovary determines the stage of disease

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18
Q

these differ from the serous variety in several ways:

  • the surface of the ovary is rarely involved and only 5% of primary mucinous cystadenomas and mucinous carcinomas are bilateral
  • tend to produce larger cystic masses, some have been recorded with weights more than 25kg
  • multiloculated tumors filled with sticky, gelatinous fluid rich in glycoproteins
A

mucinous tumors

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19
Q

these tumors are characterized by a lining of tall, columnar epithelial cells with apical mucin that lack cilia
- the vast majority demonstrate gastric or intestinal type differentiation

A

benign mucinous tumors

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20
Q

how are mucinous borderline tumors distinguished from cystadenomas?

A

by epithelial stratification, tufting, and/or papillary intraglandular growth, often producing an appearance strikingly similar to tubular adenomas or villous adenomas of the intestine

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21
Q

these tumors characteristically demonstrate confluent glandular growth that is now recognized as a form of “expansive” invasion

A

mucinous carcinomas
- mucinous carcinomas that have spread beyond the ovary are usually fatal, but they are uncommon and must be distinguished from metastatic mucinous adenocarcinomas

22
Q

these carcinomas typically present with solid and cystic areas of growth

  • 40% involve both ovaries which usually implies extension of the neoplasm beyond the genital tract
  • low-grade tumors that reveal glandular patterns bearing a strong resemblance to those of endometrial origin
A

endometrioid ovarian carcinoma

23
Q

these neoplasms may be solid, or cystic, are usually unilateral, and vary in size from small lesions less than 1cm in diameter to massive tumors up to 20-30cm

A

transitional cell ovarian tumors

24
Q

in transitional cell tumors, the fibrous stroma, resembling that of the normal ovary, is marked by what?

A

sharply demarcated nests of epithelial cells resembling the epithelium of the urinary tract, often with mucinous glands in their center
- sometimes the stroma is composed of somewhat plump fibroblasts resembling theca cells (may have hormonal activity)

25
Q

most Brenner tumors are what?

A

benign, but borderline (atypical proliferative Brenner tumor)
- malignant counterparts have been reported

26
Q

tumors with benign Brenner nests mixed with malignant tumors are referred to as what?

A

malignant Brenner tumors
- while tumors with greater than 5-% of malignant transitional type epithelium are considered transitional cell carcinomas of the ovary

27
Q

about 80% of all ovarian epithelial tumors are what?

A

benign and occur in young women
- the malignant tumors occur most commonly in older women and account for approximately 3% of all cancers in women in the US

28
Q

the majority of malignant epithelial ovarian tumors are what?

A

high-grade serous carcinomas which have a poor prognosis, in large part due to the fact that they are detected late and have spread

29
Q

what are the 3 major histologic types of epithelial ovarian tumors?

A

serous, mucinous, endometrioid

- all of which have a benign, borderline and malignant category

30
Q

it’s clear that what gene-related tumors, as well as a subset of sporadic, ovarian serous tumors are likely to arise from fallopian tube epithelium instead of ovarian epithelium

A

BRCA1, BRCA2

31
Q

these tumors are bilateral in 10-15% of cases

  • characteristically they are unilocular cysts containing hair and sebaceous material
  • sectioning reveals a thin wall lines by an opaque, gray-white, wrinkled epidermis, frequently with protruding hair shafts
  • within the wall, it is common to find grossly evident tooth structures and areas of calcification
A

benign teratomas

32
Q

about 1% of dermoids undergo malignant transformation, most commonly to what?

A

squamous cell carcinoma, but also to other cancers as well (thyroid carcinoma, melanoma)

33
Q

teratomas presumably have the same histogenic origin as what?

A

dermoid cysts, but lack preponderant differentiation into ectodermal derivatives
- these neoplasms may be difficult to distinguish on gross inspection, from malignant immature teratomas

34
Q

these tumors are bulky and have a smoot hexternal surface and tend to be solid on sectioning

  • hair, sebaceous material, cartilage, bone, and calcification may be present, along with areas of necrosis and hemorrhage
  • on microscopy, there are varying amounts of immature neuroepithelium, cartilage, bone, muscle and other elements
A

immature malignant teratoma
- an important risk for subsequent extraovarian spread is the histologic grade of tumor (I - III), which is based on the proportion of tissue containing immature neuroepithelium

35
Q

most of these tumors are unilateral, ranging in size from barely visible nodules to masses that virtually fill the entire abdomen
- on cut surface, they have a solid yellow-white to gray-pink appearance and are often soft and fleshy

A

dysgerminoma

36
Q

like a seminoma, these tumors are composed of large vesicular cells having a clear cytoplasm, well-defined cell boundaries, and centrally place regular nuclei

A

dysgerminoma

37
Q

dysgerminoma cells grow in sheets or cords separated by what?

A

scant fibrous stroma, which is infiltrated by mature lymphocytes and may contain occasional granulomas

38
Q

where can dysgerminomas be found occasionally?

A

in the wall of an otherwise benign cystic teratoma

- conversely, a predominantly dysgerminomatous tumor may contain a small cytsic teratoma

39
Q

germ cell tumors constitue what percentage of ovarian tumors?

A

15-20%

40
Q

the majority of ovarian tumors are what?

A

mature cytsic teratomas (dermoid cysts) in women of reproductive age
- the remainder occur in young women and children -> usually malignant in these age groups

41
Q

how do you distinguish immature teratomas from mature teratomas?

A

by the presence of immature elements, most often consisting of primitive neuroepithelium

42
Q

germ cell tumors show various lines of differentiation toward what?

A

oogonia (dysgerminoma), extraembryonic yolk sac (yolk sac tumors), placenta (choriocarcinoma), or multiple germ layers (teratoma)

43
Q

these tumors are usually unilateral and vary from microscopic foci to large, solid and cystic encapsulated masses
- tumors that are hormonally active have a yellow coloration to their cut surfaces, due to intracellular lipids

A

granulosa cell tumors

44
Q

granulosa cell tumors are small, cuboidal to polygonal cells that may grow in anastomosing cords, sheets or stands
- in occasional cases, small distinctive, gland-like structures filled with an acidophilic material are called what?

A
  • *Call-Exner bodies**

- gives a straighforward diagnosis when these are evident

45
Q

occasionally in granulosa cell tumors, there is a predominant thecoma component that consists of what?

A

clusters or sheets of cuboidal to polygonal cells
- in some tumors, the granulosa or theca cells my appear plumper and have ample cytoplasm characteristic of luternization

46
Q

these tumors are unilateral, and may resemble granulosa cell tumors grossly

  • the cut surface is usually solid and varies from gray to golden brown in appearance
  • microscopically, a range is seen
A

sertoli-leydig tumors

47
Q

what do well-differentiated sertoli-leydig tumors show?

A

tubules composed of sertoli or leydig cells interspersed with stroma

48
Q

what do intermediate forms of sertoli-leydig tumors show?

A

only outlines of immature tubules and large eosinophillic leydig cells

49
Q

what do poorly differentiated sertoli-leydig tumors show?

A

they have a sarcomatous pattern with a disorderly disposition of epithelial cell cords

  • leydig cells may be absent
  • heterologous elements, such as mucinous glands, bone, and cartilage may be present
50
Q

the most common malignant ovarian tumor

  • they are indolent tumors, but can recur in 10-20 years after resection of the primary tumor
  • they are often hormonally active and are associated with endometrial hyperplasia/cancer
A

granulosa cell tumors

51
Q

relatively common benign tumors composed of fibroblasts

- they are predominantly unilateral and are generally hormonally active

A

fibromas

52
Q

these tumors commonly present with masculinization and less than 5% recur or metastasize

A

sertoli-leydig cell tumors

EndoRepro 2 Exam 1 (25 decks)

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