Path Pt 4: Ovaries Flashcards
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)
follicle cysts
when are granulosa lining cells are present in follicle cysts?
if the intraluminal pressure has not been so great as to cause their atrophy
what would cause outer theca cells to be seen?
increased amounts of pale cytoplasm (a change referred to as lutenization)
- may be associated with increased estrogen production and endometrial abnormalities
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
luteal cysts
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
serous ovarian tumors
these tumors typically have a smooth glistening wall with no epithelial thickening or with small papillary projections
benign ovarian tumors
these tumors contain an increased number of papillary projections
borderline ovarian tumors
what features are associated with malignancy in ovarian tumors?
larger areas of solid or papillary tumor mass, tumor irregularity, and fixation or nodularity of the capsule
what is common, and occurs in 20% of benign serous cystadenomas, 30% of serous borderline tumors, and approx 66% of serous carcinomas?
bilaterality
a significant proportion of both serous borderline tumors and malignant serous tumors involve what?
the surface of the ovary
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
serous borderline tumors
serous borderline tumors often grows in a delicate, papillary pattern referred to as “micropapillary carcinoma”, which is thought to be the precursor to what?
low-grade serous carcinoma
these are distinguished from low-grade tumors by having more complex growth patterns and widespread infiltration or frank effacement of the underlying stroma
high-grade serous carcinoma
- the individual tumor cells display marked nuclear atypia, including pleomorphism, atypical mitotic figures and multinucleation
these carcinomas consist of cells morphologically identical to high-grade serous carcinomas, but are distinguished by the lack of invasion
serous tubal intraepithelial carcinomas
the cells of these type of tumor can become so undifferentiated that serous features are no longer recognizable
invasive high-grade serous carcinoma
what is a characteristic of serous tumors, but are not specific for neoplasia?
concentric calcifications (psammoma bodies)
these tumors have a propensity to spread to the peritoneal surface and omentum, and are commonly associated with the presence of ascites
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
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
mucinous tumors
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
benign mucinous tumors
how are mucinous borderline tumors distinguished from cystadenomas?
by epithelial stratification, tufting, and/or papillary intraglandular growth, often producing an appearance strikingly similar to tubular adenomas or villous adenomas of the intestine
these tumors characteristically demonstrate confluent glandular growth that is now recognized as a form of “expansive” invasion
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
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
endometrioid ovarian carcinoma
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
transitional cell ovarian tumors
in transitional cell tumors, the fibrous stroma, resembling that of the normal ovary, is marked by what?
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)
most Brenner tumors are what?
benign, but borderline (atypical proliferative Brenner tumor)
- malignant counterparts have been reported
tumors with benign Brenner nests mixed with malignant tumors are referred to as what?
malignant Brenner tumors
- while tumors with greater than 5-% of malignant transitional type epithelium are considered transitional cell carcinomas of the ovary
about 80% of all ovarian epithelial tumors are what?
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
the majority of malignant epithelial ovarian tumors are what?
high-grade serous carcinomas which have a poor prognosis, in large part due to the fact that they are detected late and have spread
what are the 3 major histologic types of epithelial ovarian tumors?
serous, mucinous, endometrioid
- all of which have a benign, borderline and malignant category
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
BRCA1, BRCA2
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
benign teratomas
about 1% of dermoids undergo malignant transformation, most commonly to what?
squamous cell carcinoma, but also to other cancers as well (thyroid carcinoma, melanoma)
teratomas presumably have the same histogenic origin as what?
dermoid cysts, but lack preponderant differentiation into ectodermal derivatives
- these neoplasms may be difficult to distinguish on gross inspection, from malignant immature teratomas
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
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
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
dysgerminoma
like a seminoma, these tumors are composed of large vesicular cells having a clear cytoplasm, well-defined cell boundaries, and centrally place regular nuclei
dysgerminoma
dysgerminoma cells grow in sheets or cords separated by what?
scant fibrous stroma, which is infiltrated by mature lymphocytes and may contain occasional granulomas
where can dysgerminomas be found occasionally?
in the wall of an otherwise benign cystic teratoma
- conversely, a predominantly dysgerminomatous tumor may contain a small cytsic teratoma
germ cell tumors constitue what percentage of ovarian tumors?
15-20%
the majority of ovarian tumors are what?
mature cytsic teratomas (dermoid cysts) in women of reproductive age
- the remainder occur in young women and children -> usually malignant in these age groups
how do you distinguish immature teratomas from mature teratomas?
by the presence of immature elements, most often consisting of primitive neuroepithelium
germ cell tumors show various lines of differentiation toward what?
oogonia (dysgerminoma), extraembryonic yolk sac (yolk sac tumors), placenta (choriocarcinoma), or multiple germ layers (teratoma)
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
granulosa cell tumors
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?
- *Call-Exner bodies**
- gives a straighforward diagnosis when these are evident
occasionally in granulosa cell tumors, there is a predominant thecoma component that consists of what?
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
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
sertoli-leydig tumors
what do well-differentiated sertoli-leydig tumors show?
tubules composed of sertoli or leydig cells interspersed with stroma
what do intermediate forms of sertoli-leydig tumors show?
only outlines of immature tubules and large eosinophillic leydig cells
what do poorly differentiated sertoli-leydig tumors show?
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
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
granulosa cell tumors
relatively common benign tumors composed of fibroblasts
- they are predominantly unilateral and are generally hormonally active
fibromas
these tumors commonly present with masculinization and less than 5% recur or metastasize
sertoli-leydig cell tumors
