Pathology of the Ovary

Question 1

_______________ line the fallopian tube.

Answer 1

Ciliated columnar epithelium

Question 2

Most ectopic pregnancies occur in the __________.

Answer 2

fallopian tube (90%)

Question 3

What is the frequency of ectopic pregnancy?

Answer 3

About 1/150 • Note: the risk increases with a history of pelvic inflammatory disease.

Question 4

One of the biggest problems occurring with ectopic pregnancy is ________________.

Answer 4

that the developing embryo needs a deep layer of tissue to dive into

Question 5

The classic gross description of endometriosis is _____________.

Answer 5

a dark, “chocolate cyst”

Question 6

About _______ of women have endometriosis.

Answer 6

10%

Question 7

What are signs of endometriosis?

Answer 7

Infertility, pelvic pain, and dysmenorrhea

Question 8

Describe polycystic ovary syndrome.

Answer 8

• Most common in young women • Presents with oligomenorrhea, obesity, and hirsutism • Persistent anovulation due to asynchronous release of LH and FSH • Excess androgens • Raises risk of endometrial cancer

Question 9

What are some factors that increase and decrease ovarian cancer?

Answer 9

• Increase risk: - infertility - unopposed estrogen for greater than 10 years - family history (most important) • Decrease risk: - OCPs - gynecologic surgery - pregnancies - breast feeding

Question 10

The most common subtype of ovarian cancer seen in women with BRCA mutations is ____________.

Answer 10

serous cystadenocarcinoma

Question 11

The mortality in those with BRCA mutations is due to _______________.

Answer 11

ovarian cancer (not breast cancer)

Question 12

Most hereditary disposition to breast and ovarian cancer is due to ______________.

Answer 12

unknown etiologies (in 85% of cases)

Question 13

What are the symptoms of ovarian cancer?

Answer 13

All incredibly nonspecific: - bloating - pelvic or abdominal pain - early satiety - fatigue - dyspareunia - constipation - metrorrhagia

Question 14

Most ovarian cancers (70% of all neoplasms and 90% of malignant neoplasms) arise from _______________.

Answer 14

surface epithelium (often the fimbriated end of the fallopian tube)

Question 15

The second-most common ovarian cancer (20% of all neoplasms and 5% of malignant neoplasms) arise from _____________.

Answer 15

germ cells

Question 16

80% of ovarian masses are ____________.

Answer 16

benign

Question 17

What is unique about the metastasis of ovarian malignancies?

Answer 17

They can directly seed the peritoneum and thus spread extremely rapidly.

Question 18

Describe the technique that is used to evaluate the spread of ovarian cancer.

Answer 18

Saline is washed around the peritoneum and sucked up. The fluid is then cytologically examined for peritoneal seeding.

Question 19

The most frequent subtype of ovarian tumors is ___________.

Answer 19

serous

Question 20

______________ is the only ovarian tumor to start on (and occasionally stay on) the external surface of the ovary.

Answer 20

Serous borderline tumor

Question 21

One thing that is unique about benign mucinous tumors is that _____________.

Answer 21

they express normal and abnormal tissues (whereas other benign neoplasms generally display uniform abnormality)

Question 22

Almost all cases of _____________ carcinoma are associated with endometriosis.

Answer 22

clear cell

Question 23

What are hobnail cells?

Answer 23

Naked nuclei bulging into cysts (found in CCC)

Question 24

Most germ cell tumors in the ovary are _______________.

Answer 24

teratomas

Question 25

In contrast to in men, most germ cells tumors in women are ____________.

Answer 25

not mixed

Question 26

What histologic finding signifies an immature teratoma?

Answer 26

Immature neuroepithelium

Question 27

What are Schiller-Duval bodies?

Answer 27

• Glomeruloid structures with central blood vessels and surrounding neoplastic cells • Associated with yolk sac tumors

Question 28

What cell type is often seen in those with granulosa cell tumors?

Answer 28

Call-Exner bodies: repeat primitive follicles; nuclear inclusions

Question 29

Women with ___________ will often display androgenism.

Answer 29

Leydig/Sertoli tumors (because the tumors recapitulate male testes)

Question 30

Mucin-producing tumors in the abdomen can arise from ________________.

Answer 30

appendiceal tumors

Question 31

You will often see hemosiderin-laden macrophages in _____________.

Answer 31

endometriosis

Question 32

Any kind of inflammation can raise the future risk of ectopic pregnancy, so even ____________ can raise risk.

Answer 32

abdominal surgery

Question 33

What is the five-year survival for ovarian cancer?

Answer 33

41%

Question 34

If you see a verrucous ovarian mass that does not have hemorrhages or necrosis, what is likely the diagnosis?

Answer 34

Borderline

Question 35

What are the four kinds of surface epithelial ovarian tumors?

Answer 35

Serous (papillary architecture) Mucinous (goblet cells and little pellets of mucus) Endometrioid (same as normal endometrium – pseudostratified columnar) Clear cell (“Seers Make Everything Clear.”)

Question 36

Which have better prognoses, germ cell tumors or surface epithelium tumors?

Answer 36

Germ cell tumors – excellent survival rate of ~ 90%