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RGU 2 > Pathology of Fallopian Tubes and Ovarian Neoplasm > Flashcards

Pathology of Fallopian Tubes and Ovarian Neoplasm Flashcards

1
Q

From what 3 cell types can ovarian tumors arise?

A
  1. SURFACE EPITHELIUM
  2. GERM CELLS
  3. SEX CORD STROMA
    * also can arise from metastases
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2
Q

What is the most common type of ovarian tumor?

A

SURFACE EPITHELIAL TUMOR (derived from coelomic epithelium).

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3
Q

What all does coelomic epithelium embryologically produce?

A
  • the epithelial lining of the fallopian tube (serous cells), endometrium, and endocervix (mucinous cells).
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4
Q

What are the 2 most common subtypes of SURFACE EPITHELIAL tumors?

A
  1. SEROUS= full of watery fluid.
  2. MUCINOUS= full of mucus-like fluid. Also no cilia.
    * both usually cystic.
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5
Q

Can both mucinous and serous tumors (SURFACE EPITHELIAL tumor types) be benign, borderline, or malignant?

A

YES

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6
Q

What are BENIGN mucinous or serous tumors (SURFACE EPITHELIAL tumor types)?

A
  • CYSTADENOMAS= composed of a SINGLE cyst with a simple, flat lining.
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7
Q

In what age group do cystadenomas (SURFACE EPITHELIAL tumor type) arise?

A
  • premenopausal women (30-40)
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8
Q

What are MALIGNANT mucinous or serous tumors (SURFACE EPITHELIAL tumor types)?

A
  • CYSTADENOCARCINOMA= composed of COMPLEX cysts with a thick, shaggy lining.
  • cells invade into the connective tissue of the cyst wall.
  • MUCINOUS will have solid growth pattern.
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9
Q

In what age group do cystadenocarcinomas (SURFACE EPITHELIAL type) arise?

A
  • postmenopausal women (60-70)
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10
Q

What are borderline tumors (SURFACE EPITHELIAL type)?

A
  • have features in between benign and malignant tumors. Increased number of papillary projections with complex stromal papillae.
  • better prognosis that malignant tumors, but still carry metastatic potential.
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11
Q

What specific mutation carries an increased risk for SEROUS carcinoma of the ovary and fallopian tube?

A

BRCA1

*remember this is also related to breast cancer.

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12
Q

What do BRCA1 carriers often elect to do?

A
  • have a prophylactic salpingo-oophorectomy (along with prophylactic mastectomy due to the increased risk for breast cancer).
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13
Q

What are 2 other less common SURFACE EPITHELIAL ovarian tumors?

A
  1. ENDOMETRIOID (composed of endometrial-like glands).

2. BRENNER tumor= composed of bladder-like epithelium (urothelium or transitional epithelium with grooved nuclei).

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14
Q

Do endometrioid tumors (SURFACE EPITHELIAL type) tend to be benign or malignant?

A
  • MALIGNANT :(
  • may be associated with ENDOMETRIOSIS and 15% of these tumors are associated with an INDEPENDENT ENDOMETRIAL carcinoma (endometrioid type).
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15
Q

So if you have endometrioid carcinoma of the ovary, what else must you always consider?

A
  • look in the endometrium for cancer there as well.
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16
Q

Are Brenner tumors (SURFACE EPITHELIAL type) usually malignant or benign?

A
  • BENIGN :)

* think “B” for Brenner and Benign.

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17
Q

How do SURFACE EPITHELIAL ovarian tumors clinically present?

A
  • LATE with vague abdominal symptoms (pain and fullness) or signs of compression (urinary frequency).
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18
Q

Do SURFACE EPITHELIAL ovarian tumors usually have a good or bad prognosis?

A

BAD because they present late :(

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19
Q

*** How do SURFACE EPITHELIAL ovarian tumors tend to spread?

A
  • LOCALLY via LYMPHATICS, especially to the PERITONEUM (will see “OMENTAL CAKING).
  • remember, most often carcinomas spread via lymphatics and sarcomas spread hematogenously ( via blood).
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20
Q

What is a useful serum marking to MONITOR TREATMENT response and SCREEN for RECURRENCE in SURFACE EPITHELIAL ovarian tumors?

A
  • CA-125

* should go down once tumor is removed surgically.

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21
Q

What is the 2nd most common type of ovarian tumor?

A
  • GERM CELL tumors
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22
Q

Do ovarian GERM CELL tumors usually occur in women of reproductive age?

A

YES (age 15-30)

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23
Q

What are the 5 ovarian GERM CELL tumor types?

A
  1. Cystic Teratoma (from fetal tissue).
  2. Embryonal carcinoma (from fetal tissue).
  3. Dysgerminoma (from oocytes).
  4. Endodermal sinus tumor (from yolk sac).
  5. Choriocarcinoma (from placental tissue).
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24
Q

*** What is a cystic teratoma of the ovary (GERM CELL type)?

A
  • BENIGN cystic tumor composed of fetal tissue derived from 2 or 3 embryologic layers. Also called “dermoid” tumor.
  • bilateral in 10% of cases.
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25
Q

What is the most common GERM CELL ovarian tumor?

A
  • CYSTIC TERATOMA
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26
Q

What 2 things must we EXCLUDE to ensure a cystic teratoma (ovarian GERM CELL type) is actually BENIGN?

A
  1. presence of IMMATURE tissue (usually neural)

2. somatic malignancy= cancer of the tissue growing inside the teratoma (ex. squamous cell carcinoma of the skin).

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27
Q

*** What is the most common type of immature tissue that likes to show up in an immature teratoma (ovarian GERM CELL type)?

A
  • neural ectoderm
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28
Q

*** What is the most common malignancy that shows up in an ovarian teratoma (GERM CELL type)?

A

squamous cell carcinoma of the skin of the teratoma.

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29
Q

What is Struma ovarii?

A
  • a teratoma composed primarily of thyroid tissue.

* pts may develop hyperthyroidism

30
Q

*** What is a dysgerminoma (ovarian GERM CELL type)?

A
  • MALIGNANT tumor composed of large cells with clear cytoplasm and central nuclei (resembles oocyte).
  • Good prognosis and responds well to radiotherapy.
  • testicular counterpart is seminoma.
31
Q

What is the most common MALIGNANT GERM CELL tumor of the ovary?

A

DYSGERMINOMA

32
Q

What may be elevated in dysgerminoma?

A
  • serum LDH

- chorionic gonadotropin

33
Q

*** What is an endodermal sinus tumor (ovarian GERM CELL type)?

A
  • MALIGNANT tumor that mimics the YOLK SAC.

- SCHILLER-DUVAL BODIES (glomerulus-like) are seen on histology.

34
Q

*** What is the most common ovarian GERM CELL tumor in CHILDREN?

A
  • ENDODERMAL SINUS TUMOR

* so if you have a 5 year old girl with an ovarian mass, think this.

35
Q

What is often elevated in endodermal sinus tumors (ovarian GERM CELL type)?

A
  • serum alpha-feto protein (AFP)
36
Q

*** What is choriocarcinoma (ovarian GERM CELL type)?

A
  • MALIGNANT tumor composed of cytotrophoblasts and syncytiotrophoblasts; mimics placental tissue, but villi are absent.
  • small, hemorrhagic tumor with early hematogenous spread :(
37
Q

What will be elevated in choriocarcinomas (ovarian GERM CELL type)?

A

B-hCG

*may lead to thecal cysts in the ovary.

38
Q

Will women with choriocarcinoma (ovarian GERM CELL type) have a good response to chemotherapy?

A

NO :(

39
Q

*** What is embryonal carcinoma (ovarian GERM CELL type)?

A
  • aggressive MALIGNANT tumor composed of large primitive cells.
  • makes sense that this has early metastasis since these are primitive cells which are early cells that have the ability to spread.
40
Q

What are SEX CORD-STROMAL ovarian tumors?

A
  • tumors that resemble the normal sex cord-stromal tissue of the ovary.
41
Q

*** What is a granulosa-theca cell tumor (ovarian SEX CORD-STROMAL type)?

A
  • MALIGNANT neoplasm of both GRANULOSA and THECA cells that often produces ESTROGEN.
  • CALL-EXNER BODIES= small gland-like structures.
42
Q

How do granulosa-theca cell tumors (ovarian SEX CORD-STROMAL type) present?

A

with signs and symptoms of ESTROGEN EXCESS:

  • prior to puberty= precocious puberty.
  • reproductive age= menorrhagia or metrorrhagia.
  • postmenopause (most common setting for granulosa-theca cell tumors)= endometrial hyperplasia with postmenopausal uterine bleeding.
  • also high levels of INHIBIN.
43
Q

*** What is an ovarian sertoli-leydig cell tumor (SEX CORD-STROMAL type)?

A
  • tumor that mimics the sex cord-stromal elements of the testicle. It is composed of SERTOLI cells that form tubules and LEYDIG cells (between tubules) with characterstic REINKE CRYSTALS.
44
Q

What will ovarian sertoli-leydig cell tumors (SEX CORD-STROMAL type) produce?

A
  • androgen and are thus associated with hirsutism or virilization (deep voice and muscles).
45
Q

*** What is an ovarian fibroma (SEX CORD-STROMAL type)?

A
  • BENIGN tumor of fibroblasts that is associated with PLEURAL EFFUSION and ASCITES (MEIGS SYNDROME).
46
Q

Will Meigs syndrome resolve with removal of tumor?

A

YES :)

47
Q

*** What is a Kruckenberg tumor?

A
  • a METASTATIC mucinous tumor that involves BOTH ovaries and is most commonly due to metastatic GASTRIC CARCINOMA (diffuse type; remember SIGNET RING cells).
48
Q

How can you distinguish a Kruckenberg tumor metastasis to the ovary from a primary SURFACE EPITHELIAL mucinous carcinoma?

A
  • Kruckenberg will be both ovaries!
49
Q

*** What is pseudomyxoma peritonei?

A
  • massive amounts of mucus in the peritoneum (called “JELLY BELLY”) due to a mucinous tumor of the APPENDIX, usually with metastasis to the ovary causing mucinous cystadenocarcinoma (SURFACE EPITHELIAL type).
50
Q

What is Tuner’s syndrome?

A
  • (45,X) is a condition in which a female is partly or completely missing an X chromosome.
  • girl will have short stature, COARCTATION of the AORTA, streak ovaries, infertility, and amenorrhea.
51
Q

What is ovarian torsion?

A
  • causes enlargement of ovary due to twisting of the ovary and sometimes the fallopian tube, cutting off the blood supply of these organs.
  • can mimic cystic disease and or tumors.
52
Q

What are the nonneoplastic and functional ovarian cysts?

A
  • follicle cysts
  • luteal cysts
  • polycystic ovaries (PCOS)
  • stromal hyperthecosis
53
Q

What are follicular cysts of the ovary?

A
  • unruptured grafian follicles filled with clear serous fluid (so common that they are almost physiologic).
54
Q

What are luteal cysts of the ovary?

A
  • lined by a rim of bright yellow luteal tissue containing luteinized granulosa cells.
  • may rupture and cause PERITONEAL REACTION.
55
Q

What will you see with PCOS?

A
  • numerous follicular cysts with increased ovarian surface area.
  • pt may present with anovulation, obesity, hirsutism, and virulism due to increased production of androgens from the theca interna cells being stimulated by increased LH, as well as increased estrogen (from conversion of androgens to estrogens).
56
Q

What is stromal hyperthecosis?

A
  • bilateral uniform enlargement of the ovary seen in postmenopausal women.
  • tan, white appearance of ovary.
  • hypercellular stroma
  • luteinized stromal cells
  • similar to PCOS but clinical features are more severe.
57
Q

Are most ovarian tumors benign?

A

YES :) and most occur in younger women (age 20-45).

*however, if over age 50, the chance of malignancy is much higher :(

58
Q

Are mutations in p53 found in 50% of ovarian cancers?

A

YES

59
Q

Why is oral contraceptive use associated with decreased incidence of ovarian tumors?

A

OCs prevent ovulation and decrease injury to surface epithelium.

60
Q

What is the most common all around malignant ovarian tumor?

A

SEROUS CYSTADENOCARCINOMA

61
Q

What genetic mutation is associated with MUCINOUS CYSTADENOMAS (BENIGN)?

A
  • KRAS and BRAF
62
Q

What will you see with CLEAR CELL tumors (SURFACE EPITHELIAL type) of the ovary?

A
  • solid tumors with clear cells arranged in sheets or tubules.
  • clear cytoplasm with a “HOBNAIL cytoplasm.”
  • aggressive
63
Q

What 2 tumors have a “coffee-bean” like nucleus?

A
  1. Granulosa-Theca cell tumor (SEX CORD-STROMAL type).

2. Brenner tumor (SURFACE EPITHELIAL type).

64
Q

*** What is Sex Cord tumor with Annular Tubules (SCAT)?

A
  • has features similar to granulosa cell tumors and a growth pattern similar to sertoli cells.
  • complex annular tubules containing eosinophilic hyaline bodies.
  • associated with PEUTZ-JEGHERS SYNDROME
65
Q

What commonly affects the fallopian tubes?

A
  • acute suppurative salpingitis (PID)
  • Neisseria gonorrhoeae
  • Chlamydia trachomatis
66
Q

*** What is ectopic pregnancy?

A
  • implantation of fertilized ovum at a site other than the uterine wall; most common site is the lumen of the fallopian tube.
  • rupture can be fatal!
67
Q

What what conditions is ectopic pregnancy associated?

A
  • PID and chronic salpingitis
68
Q

What is the key risk factor of ectopic pregnancy?

A

scarring (e.g. secondary to PID or endometriosis)

69
Q

What is the classic presentation of ectopic pregnancy?

A
  • LQ abdominal pain a few weeks after a missed period.

* surgical emergency due to bleeding into the fallopian tube (hematosalpinx) and rupture.

70
Q

Can a tubal ectopic pregnancy often regress on its own?

A

YES

RGU 2 (24 decks)

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