Week 9: Ovarian Pathology

Question 1

ID

Answer 1

Normal Ovary with fully developed corpus luteum

Question 2

What are 3 non-neoplastic lesions of the ovary?

Answer 2

• Follicular Cyst
• Corpus Luteum/Luteal Cyst
• Endometrioma (Chocolate Cyst)

Question 3

ID

Answer 3

Follicular Cyst

follicle doesn’t release an egg and instead fills with fluid

Question 4

ID

Answer 4

Follicular Cyst

Question 5

ID

Answer 5

Luteal Cyst

corpus luteum cysts form after ovulation when the follicle, now the corpus luteum, fails to shrink and instead fills with fluid

Question 6

ID

Answer 6

Luteal Cyst

Question 7

presence of endometrial glands and stroma outside the uterus

Answer 7

Endometriosis

Question 8

ID

Answer 8

Ovarian Endometrioma (Chocolate Cyst)

Question 9

What are 3 epithelial neoplasms of the ovaries?

Answer 9

• Serous Ovarian Tumors
• Mucinous Ovarian Tumors
• Endometriod Carcinoma

Question 10

ID

Answer 10

Serous Cystadenoma

Question 11

ID

Answer 11

Serous Borderline Tumor

Question 12

ID

Answer 12

Serous Carcinoma

Question 13

What mutation is associated with Serous Ovarian Tumors

Answer 13

BRCA1 and BRCA2

Question 14

ID

Answer 14

Serous Cystadenoma

A lot of times bilateral benign tumors with a simple, flat cyst lining of ciliated columnar (tubal-like) epithelium (cyan arrow)

Question 15

ID

Answer 15

Serous Borderline Tumor

increased number of papillary projections (yellow circle), but lack stromal invasion (yellow arrow)

Question 16

ID

Answer 16

Low-Grade Serous Carcinoma

increased epithelial atypia and stroma invasion (yellow ellipse)

Question 17

ID

Answer 17

Low-Grade Serous Carcinoma

increased epithelial atypia and stroma invasion (yellow ellipse)

Question 18

ID

Answer 18

High-Grade Serous Carcinoma

Question 19

ID

Answer 19

Mucinous Cystadenoma

Endocervical-like epithelium

Question 20

ID

Answer 20

Mucinous Borderline Tumor

Question 21

ID

Answer 21

Mucinous Carcinoma

Question 22

What mutation is associated with Mucinous Ovarian Tumors

Answer 22

KRAS proto-oncogene

Question 23

ID

Answer 23

Endometrioid Carcinoma

Question 24

ID

biopsy from ovary

Answer 24

Endometrioid Carcinoma

Presence of tubular glands resembling benign of malignant endometrium

Question 25

What is 1 Germ Cell Tumor

Answer 25

Teratoma

Question 26

What are 3 types of Teratomas

Answer 26

* Mature - elements from all three germ layers * Immature teratoma - immature neuroepithelium and resembles embryonal and immature fetal tissue * Struma Ovarii - monodermal or specialized teratoma composed entirely of mature thyroid tissue

Question 27

ID ## Footnote Rokitansky nodule or tubercle (yellow arrow) refers to a solid protuberance projecting from an ovarian cyst

Answer 27

Mature Cystic Teratoma

Question 28

ID

Answer 28

Dermoid Cyst ## Footnote teratoma comprised mostly of ectodermal derivatives like epidermis (top left), hair shafts (top right), and teeth (bottom - bell stage)

Question 29

ID

Answer 29

Struma Ovarii

Question 30

ID

Answer 30

Immature Teratoma

Question 31

What are 3 types of Sex Cord Stromal Tumors

Answer 31

* Fibroma * Fibrothecoma * Granulosa Cell Tumor * Sertoli-Leydig Cell Tumor

Question 32

ID

Answer 32

Fibroma

Question 33

ID

Answer 33

Fibrothecoma ## Footnote fibroblasts with collagenous stroma (top 1/2) and plump spindle cells with lipid droplets (bottom 1/2)

Question 34

Out of a fibroma, fibrothecoma, and thecoma, which is most likely to be hormonally active?

Answer 34

thecoma ## Footnote very vare and may be hormonally active - estrogen secreting

Question 35

ID

Answer 35

Granulosa Cell Tumor

Question 36

ID

Answer 36

Granulosa Cell Tumor ## Footnote Granulosa cells have a coffee bean nuclei (yellow arrow), and Call-Exner bodies - give a follicle like appearance (yellow circles) with small eosinophilic fluid-filled punched out hyalinized spaces between granulosa cells (orange arrows)

Question 37

What do the granulosa cells produce that stains brown on Immunohistochemistry (IHC)?

Answer 37

Inhibin

Question 38

If a granulosa cell tumor secretes estrogen what 2 things may it cause?

Answer 38

* precocious sexual development in prepubertal girls * adult women leads to proliferative breast disease and endometrial hyperplasia/carcinoma

Question 39

ID

Answer 39

Sertoli-Leydig Cell Tumor

Question 40

ID

Answer 40

Sertoli-Leydig Cell Tumor ## Footnote Reinke Crystals are pathognomonic of Leydig cells (white arrows)

Question 41

What mutation is associated with Sertoli-Leydig Cell Tumors?

Answer 41

DICER1

Question 42

ID

Answer 42

Krukenberg Tumor ## Footnote note bilaterality (top half) and signet-ring cancer cells of gastric origin (bottom half)

Question 43

ID

Answer 43

Diffuse Type Gastric Cancer (Adenocarcinoma) ## Footnote Linitus Plastica - abnormally thickened gastric folds and reduced gastric distention (bottom half) and signet-ring cancer cells (top half)

Question 44

What mutation is associated with Krukenberg Tumor?

Answer 44

CDH1 and CTNNA1 gene

Question 45

ID

Answer 45

Pseudomyxoma Peritonei (PMP) ## Footnote Most commonly caused by a mucinous appendiceal neoplasm rupturing. Clinical syndrome caused by mucin accumulation in the peritoneal cavity

Question 46

ID

Answer 46

Mucinous Appendiceal Neoplasm ## Footnote most common cause of Pseudomyxoma peritonei

Question 47

ID

Answer 47

Mucinous Carcinoma Peritonei ## Footnote most likely form appendix

Question 48

What mutation is associated with Mucinous Appendiceal Neoplasm, Mucinous Carcinoma Peritonei, and Pseudomyxoma peritonei (PMP)

Answer 48

KRAS and GNAS