Pathology of the ovary Flashcards
how do ovarian disease manifest?
adnexal masses
what is the incidence of gynecological cancers? prognosis?
incidence: endometrial > ovarian > cervical
worst prognosis: ovarian > cervical > endometrial
what are the 7 types of ovarian cysts?
- follicular
- corpus luteum
- theca-lutein
- hemorrhagic
- dermoid
- endometrioid
- inflammatory
what are the 7 benign ovarian tumors?
- serous cystadenoma
- mucinous cystadenoma
- endometrioma
- mature cystic teratoma (dermoid cyst)
- brenner tumor
- fibroma
- thecoma
what are the 8 malignant ovarian tumors?
- serous cystadenocarcinoma
- mucinous cystadenocarcinoma
- granulosa cell tumor
- immature teratoma
- dysgerminoma
- choriocarcinoma
- yolk sac (endodermal sinus) tumor
- krukenberg tumor
what is the most common ovarian mass in young women?
follicular cyst
what is the cause / pathogenesis of follicular cyst?
distention of unruptured graafian follicle
what is the pathogenesis of corpus luteum cyst?
cystic enlargement of corpus luteum with central hemorrhage, may rupture - peritoneal reaction with fibrosis and hemorrhage mimicking endometriosis
diagnosis of endometriosis should have an exclusion of what type of ovarian cyst?
corpus luteum cyst
theca-lutein cysts are due to what cause?
gonadotropin stimulation
are theca-lutein cysts unilateral or bilateral? single or multiple?
often bilateral
often multiple
theca-lutein cysts are associated with what conditions?
chroriocarcinoma
moles
what is the cause of hemorrhagic cysts?
blood vessel rupture in cyst wall - cyst grows with increased blood retention
what is the most common ovarian tumor in women 20-30 yo?
dermoid cyst
what type of tumor is a dermoid cyst?
germ cell tumor (mature teratoma)
why can dermoid cysts present as hyperthyroidism? what si the term for this?
could contain functional thyroid tissue
stuma ovarii
how does an endometrioid cyst occur?
endometriosis within ovary with cyst formation (varies with menstrual cycle - chocolate cyst)
how does nulliparity affect ovarian cancer risk?
increases risk
what are the four classifications of ovarian neoplasms?
- surface epithelial 65-70%
- stromal 15-20%
- germ cell tumors 5-10%
- metastatic tumors 5%
what is the most common ovarian tumor age 20-50?
serous cystadenoma (benign)
serous cystadenomas are lined by what cell type? what is their gross morphology?
fallopian-like epithelium: tall, ciliated secretory columnar
smooth, thin walled, filled with serous fluid
what is the gross morphology of mucinous cystadenoma?
- multiloculated
- often unilateral and large
histogenetically, mucinous cystadenomas are linked to what structure? why?
cervix
epithelial lining consists of tall, mucus secreting columnar epithelium (but NOT ciliated)
are most mucinous cystadenomas benign, borderline, or malignant?
benign (80%)
where does an endometrioma arise?
from growth of ectopic endometrial tissue
what is a brenner tumor? what is unique about it?
- adenofibroma with nodules of transitional type epithelial cells in a dense fibrous stroma
- contains TRANSITIONAL epithelial cells
what is the gross appearance of a brenner tumor? histologic?
- GROSS: solid tumor that is pale yellow-tan in color and appears encapsulated, unilateral
- HISTOLOGIC: coffee bean nuclei on H&E
brenner tumors are usually associated with what other type of tumor?
teratoma
which type of ovarian tumor contains transitional type epithelium?
brenner tumor
what type of tumor?
- bundles of spindle-shaped fibroblasts
- pulling sensation in groin
- meigs syndrome - triad of ovarian fibroma + ascites + hyrothorax
fibroma
what is meigs syndrome?
triad of
- ovarian fibroma
- ascites
- hyrothorax
how does a thecoma usually present?
abnormal uterine bleeding in a postmenopausal woman
what may thecomas produce?
estrogen
what is the most common ovarian malignancy? is it usually unilateral or bilateral?
serous cystadenocarcinoma
usually bilateral
in what type of ovarian cancer are psammoma bodies found?
serous cystadenocarcinoma
what is the histology of serous cystadenocarcinoma?
- papillary growth
- hyperchromatic cells
- psammoma bodies (small concretions of dystrophic calcification)
what are the three main features of mucinous cystadenocarcinoma?
- complex architecture
- nuclear atypia
- stromal invasion
what is pseudomyxoma peritonei? in which ovarian tumor is it seen?
- intraperitoneal accumulation of mucinous material from ovarian or appendiceal tumor
- mucinous cystadenocarcinoma
an immature teratoma is most typically represented by what type of tissue?
immature / embryonic like neural tissue
which is more likely to contain thyroid tissue - immature or mature teratoma?
mature
are immature teratomas aggressive or non-aggressive?
aggressive
what are call-exner bodies? where are they seen?
- small eosinophilic fluid-filled spaces between granulosa cells, resemble primordial follicles
- granulosa cell tumor (malignant)
what can granulosa cell tumors secrete?
estrogen and progesterone
dysgerminomas are common in which age group?
adolescents
what is the histological appearance of dysgerminoma?
fried egg cells
“fried egg cells” is indicative of which tumor?
dysgerminoma
dysgerminomas have which tumor markers? which transcription factors are expressed for diagnosis?
- hCG, LDH
- Oct3, Oct4, c-KIT
choriocarcinoma is malignancy of what cell type?
trophoblastic tissue (cytotrophoblasts, syncytiotrophoblastic tissue)
how do choriocarcinomas present?
- abnormal BHCG
- SOB
- hemoptysis
are choriocarcinomas responsive to chemotherapy?
yes, very
what are schiller-duval bodies? in which tumor type are they seen?
- resemble glomeruli
- yolk sac tumors
what is the tumor marker for yolk sac tumors?
AFP
what is a krukenberg tumor? what cell type is present?
- GI malignancy which metastasizes to the ovaries
- mucin secreting signet cell adenocarcinoma
