The Ovary Flashcards
types of ovarian cysts
- epithelial (serous, mucinous)
- germ cell (dermoid)
ovarian cysts
- unilateral lower quadrant pain
- achy/crampy pain
- acute/sharp pain
most common cysts found on ovary
functional cysts
- follicular
- corpus luteal
- hemorrhagic corpus luteum
SEVERE unilateral lower quadrant pain
- ruptured ovarian cyst
- ovarian torsion
- ectopic pregnancy
when to consider rx for ovarian cysts
> 10cm, persistent, symptomatic, concerning features
serous tubal intraepithelial carcinoma
precursor lesion for a majority of high-grade pelvic cancers
ovarian surface epithelium hypothesis
chronic ovulation –> inflammation/repair from endometriosis
ovarian cancer risk fx
- infertility, nulliparity
- early menarche, late menopause
- hereditary (BRCA, Lynch)
- envio (high fat, others)
ovarian cancer: protective factors
- tubal ligation and salpingectomy
- pregnancy
- OCPs
ovarian cancer can present with which abnormalities of the abd
ascites
ovarian cancer can present with which abnormalities of the pelvis
pelvic mass
cul-de-sac modularity
ovarian tumor marker
CA-125
CA 125 screening recommendation
not recommended for screening among the general population
ovarian cancer spread
- direct extension to pelvic and abd viscera
- lymphatic dissemination
ovarian cancer tx
- surgery/debulking
- chemo (platinum-based)
ovarian staging
I-ovaries only
II-pelvic extension only
III-extrapelvic extension
IV-intraparencymal liver mets, pleural effusion
ovarian cancer prognosis
age
stage
__% of germ cell ovarian cancer is benign
97%
germ cell tumors are more common in
young women
types of ovarian germ cell cancers
- immature teratoma
- dysgerminoma
- endodermal sinus tumor (yolk sac)
- choriocarcinoma
- embryonal carcinoma
HCG
choriocarcinoma
AFP
yolk sac tumors
LDH
dysgerminoma
CA-125
dysgerminoma
immature teratomas
yolk sac tumors
mixed tumors
germ cell ovarian cancer tx
-feritlity-sparing surgery usually an option
female sex cord-stomal ovarian cancer
stromal and granulosa cell
male sex cord-stomal ovarian cancer
sertoli and leydig cells
follicular cysts
- repro age group
- incidental findings or present with menstrual or hormonal abnormalities
- rarely ruptures
- lined by follicle and theca cells
- most regress spontaneously
corpus lute cyst
- repro group
- delayed resolution of physio corpus luteum
- -menstrual irregularities
- cyst wall composed of luteinized granulosa cells
thick, yellow wall
luteinized granulosa and theca cells
endometriosis cyst
- ovary
- thick, altered blood (CHOCOLATE CYST)
- cyst wall=endometrial-type glands, stroma, hemorrhage/hemosiderin
ovarian tumors, malignant or benign
most are benign
which tumors of the ovary represent the highest total % and highest total malignant %
epithelial
- serous
- mucinous
- endometrioid
- clear cell
- transitional cell/Brenner
tubal type epithelium
serous epithelial tumor
endocervical type epithelium
mucinous epithelial tumor
endometrioid type epithelium
endometrioid epithelial tumor
secretory type endometrial epithelium
clear cell tumors
transitional type epithelium
transitional cell/Brenner
surface epithelial tumors show morphology similar to
Fallopian tube/endometrium/cervix
recapitulate cell types formed by Mullerian duct
cystadenoma
- unilocular cysts
- lined by tubal type epithelium
- contain thin, clear serous fluid
benign serous cystadenoma histo
benign tubal-type epithelium
borderline serous cystadenoma histo
more papillary configuration, no stromal invasion
malignant serous cystadenoma histo
complex papillary growth with cytological atypia and stromal invasion
malignant serous cystadenoma
derived from serous tubal intraepithelial carcinoma (STIC) cells of the Fallopian tube, which drop off onto the ovary
*risk reducing salpingectomy may reduce the incidence of this tumor in high risk patients
malignant serous tumors may be cystic or solid
papillary growth
psammoma bodies
calcified spherules found in any papillary tumor
common in serous carcinoma
most ovarian gerrm cell tumors are
mature cystic teratomas (dermoid cysts) - benign, peak 20-30 y/o
dermoid cyst
mature teratoma
one of the most comm ovarian tumors
most common immature element of immature teratoma
neuroepithelium
most comm malignant germ cell tumor
dysgerminoma
tumor similar to the seminoma of the testis and germinoma of the CNS/mediastinum
dysgerminoma
dysgerminoma prognosis
excellent, radiosensitive and usu low stage
dysgerminoma histo
undifferentiated germ cells nests of lg cells w/ clear cytoplasm central nuclei "fried egg" glycogen/lymphocytes
the least differentiated germ cell tumor
embryonal carcinoma
embryonal carcinoma
highly malignant tumor
potential for differentiating towards endodermal sinus tumors, choriocarcinomas or teratomas
yolk sac tumor
aka endodermal sinus tumor
highly malignant tumor w/ differentiation towards yolk sac structures
Schiller-Duval body
AFP
Schiller-Duval body
ovarian yolk sac tumor
glomeruloid body
AFP
prod by ovarian yolk sac tumor
used for dx and therapeutic monitoring
choriocarcinoma
- a highly malignant tumor, mets widely via bloodstream
- 2 types: gestational, ovarian
- malignant CYTOTROPHOBLAST and SYNCYTIOTROPHOBLAST
- prod hCG
most common of the stromal tumors
fibroma
fibroma
- most comm stromal tumor
- NON-estrogenic
- perimenopausal age group
- mass or ascites, esp in larger tumors
- Meig’s syndrome
- benign, look like fibroids, composed of fibroblasts
Meig’s syndorme
ovarian tumor
ascites
pleural effusion
rare presentation of fibroma
Thecoma
- benign, post menopausal
- prod ESTROGEN
complications of thecoma
estrogenic side effects
- abnml uterine bleeding
- endometrial hyperplasia and carcinoma
- breast changes
theca appearance
yellowish color due to stromal theca cell accumulation of lipid
granulosa cell tumor
- malignant
- occur mainly in postmenopausal patients
- fxnl, producing estrogen
- typical grooved nucleus (“coffee bean”)
- small rosettes, recapitulate immature follicles (Call-exner bodies)
Call-exner bodies
granulosa cell tumor
sertoli stromal tumors
- RARE
- young women
- usu benign
- fxnl, prod androgen
ovarian malignant tumors that are metastatic from other sites are commonly from
- other sites in female genital tract (ENDOMETRIUM)
- breast
- lg intestine
- stomach
Krukenberg tumor
bilateral metastatic gastric signet cell carcinoma
classic metastatic tumor of the ovaries
signet ring cells stain with
mucicarmine for mucin