Pathoma: Ovarian Tumors

Question 1

What is included in the term “sex cord stroma”?

Answer 1

Granulosa cells
Theca cells
Stromal cells

Question 2

The most common type of ovarian tumor is _____________.

Answer 2

surface epithelial tumor

Question 3

There are two names for the epithelium that lines the ovaries: _______________.

Answer 3

germinal mesothelium and coelomic epithelium

Question 4

The two most common subtypes of surface epithelial ovarian tumors are ______________.

Answer 4

mucinous and serous

Note: both of these are named for the type of fluid that they contain!

Question 5

What is the term for benign ovarian tumors?

Answer 5

Cystadenoma

Question 6

Cystadenomas most common present in younger, pre-menopausal women and appear as ____________.

Answer 6

cysts with flat lining

Question 7

Describe cystadenocarcinoma.

Answer 7

• Malignant cyst with thick, shaggy lining

* More common in older, post-menopausal women (60-70)

Question 8

What are borderline tumors?

Answer 8

Any kind of ovarian cancer that is between benign and malignant

These tumors can still metastasize, but they have a better prognosis than malignant ovarian cancers.

Question 9

BRCA1 mutations increase the risk of which ovarian cancer?

Answer 9

Serous cystadenocarcinoma of the ovary and fallopian tube

Think BRCA raises the risk of watery CAncer under the BRidge.

Question 10

Brenner tumors recapitulate which type of epithelium?

Answer 10

Urothelium

Question 11

What is one reason surface epithelial ovarian tumors carry a poor prognosis?

Answer 11

They typically present late.

Question 12

When surface epithelial ovarian cancers spread to the peritoneum, they often cause what pathology?

Answer 12

“Omental caking” –building up locally on the peritoneum

Question 13

How is CA-125 used?

Answer 13

It isn’t great for screening, but in patients who’ve had ovarian cancer with high CA-125s it can be useful to monitor for recurrence.

Question 14

Talk about how age can be used to predict the most likely ovarian tumor.

Answer 14

Age 15 - 35: germ cell tumors are most common
Age 35 - 50: benign surface epithelial tumors are most common
Age 65 and up: malignant surface epithelial tumors are most common

Question 15

Germ cell tumors that produce fetal tissue are called _____________.

Answer 15

cystic teratomas

Question 16

What kinds of germ cell tumors are there?

Answer 16

• Cystic teratoma
• Embryonal carcinoma
• Yolk sac tumor
• Dysgerminoma
• Choriocarcinoma

All of these arise from the oocyte!

Question 17

______________ tumors present bilaterally in about 10% of cases.

Answer 17

Cystic teratomas

Question 18

True or false: the most common type of germ cell tumor in a female is predominately benign.

Answer 18

True! Cystic teratomas are the most common female germ cell tumor and they are benign.

Caveat: immature teratomas – characterized by immature neuroepithelium – are malignant but they are less common.

Question 19

Describe the cancer-within-a-cancer that can occur with teratomas.

Answer 19

Teratomas can develop mature tissue that then gets a somatic mutation that can metastasize. The most common somatic mutation is squamous cell carcinoma.

Question 20

What is struma ovarii?

Answer 20

Teratomas that recapitulate thyroid tissue that leads to hyperthyroidism

Question 21

The most common malignant germ cell tumor has what morphologic appearance?

Answer 21

Dysgerminomas are the most common malignant germ cell tumor and because they are oocytes they look like oocytes –large nuclei with clear cytoplasm.

Question 22

Serum LDH may be elevated in ______________.

Answer 22

dysgerminomas

Question 23

Schiller-Duval bodies are found in tumors arising from ______________.

Answer 23

the yolk sac

Question 24

Beta-human chorionic gonadotropin will be elevated in those with tumors arising from _______-blasts.

Answer 24

tropho

The stem describes choriocarcinoma, a malignant proliferation of primitive placental cells.

Question 25

What histologic feature will be absent in those with choriocarcinoma?

Answer 25

Villi

Question 26

What makes choriocarcinoma so aggressive?

Answer 26

Trophoblasts are designed to find blood supply for the placenta. Choriocarcinomas then display rapid hematogenous spread; their classic description, then, is a small primary tumor with widespread metastasis.

Question 27

Briefly characterize embryonal carcinomas.

Answer 27

• Large, primitive cells

* Early metastasis

Question 28

Describe the various presentations of granulosa-theca cell tumors.

Answer 28

• Young children: early, primary puberty
• Adult, premenopausal women: heavy menstrual bleeding
• Postmenopausal adults: abnormal uterine bleeding without a menstrual cycle

Note: all of the above effects are mediated by excess estrogen.

Question 29

Sertoli-Leydig cell tumors are very distinctive because of the _______________ in Leydig cells.

Answer 29

Reinke crystals –pink crystals within Leydig cells

Question 30

A woman presents with an ovarian mass and pleural effusion. What description likely characterizes the mass?

Answer 30

Fibromas often cause pleural effusion and ascites in women and have a fatty/fibrotic appearance.

Question 31

In the gastric cancer that can lead to Krukenberg tumor, why do they have the characteristic signet-ring look?

Answer 31

Their cytosols are full of mucin!

Question 32

Pseudomyxoma peritonei arises from ______________.

Answer 32

a mucinous tumor of the appendix