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GOBBLERS 2023 > Ovary-achievers > Flashcards

Ovary-achievers Flashcards

1
Q

What gynecologic tumor is associated with paraneoplastic syndrome classified with cerebellar ataxia?

A

ovary (anti-Yo antibodies/anti-Purkinje antibodies)

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2
Q

Treatment of psammoma carcinoma with mets less than 1 cm in size?

A

Surgical management/debulking

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3
Q

Which tumor markers may be elevated in mucinous ovarian tumors?

A

CEA

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4
Q

Which IHC markers are elevated in mucinous ovarian tumors? (4)

A

P16, CK7, CK20, CDX

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5
Q

What oncogene is abnormal in mucinous ovarian tumors?

A

KRAS

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6
Q

What oncogenes are overexpressed in Borderline or low grade serous tumors? (2)

A

KRAS and BRAF

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7
Q

What Tumor suppressor proteins are commonly altered in high grade serous tumors?

A

BRCA and P53

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8
Q

What Tumor suppressor proteins are commonly altered in endometrioid ovarian cancers?

A

PTEN, P53

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9
Q

What oncogenes are commonly activated in endometrioid ovarian cancers?

A

CTNNB1(beta catenin), PIK3CA, KRAS

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10
Q

What germ cell tumors do not require additional treatment? (2)
[repeated 3 times!]

A

Stage 1 dysgerminoma and a Stage 1 Grade 1 immature teratoma (NCCN 7/23)

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11
Q

Which ovarian germ cell tumor displays c-kit staining?

A

Dysgerminoma

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12
Q

Which ovarian germ cell tumor is most common in a patient with gonadal dysgenesis?

A

Dysgerminoma

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13
Q

What is the classic histologic appearance of dysgerminoma?

A

extensive lymphocytic infiltrate
The “blue balls” nuclei are lymphocytes
(Also blue balls —-> gonadoblastoma —> dysgerminoma malignancy)

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14
Q

Which germ cell tumors do not secrete AFP?

A

Dysgerminoma, non gestational choriocarcinoma

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15
Q

What is the classic histologic appearance of an endodermal sinus tumor?

A

Schiller-Duval bodies

cellular structure that is characterized by the presence of a central blood vessel surrounded by layers of tumor cells

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16
Q

What do Schiller-Duval bodies look like?

A

Central vessel lined by a cystic space and tumor cells

*Endodermal sinus tumors aka yolk sac

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17
Q

What is the serum marker for an endodermal sinus tumor?

A

AFP

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18
Q

What is the treatment for endodermal sinus tumor (AKA yolk sac tumor)

A

Surgery, chemo BEP (bleo, etopo, cisplatin 3 cycles good risk / 4 cycles poor risk)

19
Q

What tumor marker does embryonal carcinoma make?

A

hcg

20
Q

What are immature teratomas graded on?

A

Immature neural elements

21
Q

Which germ cell tumors do not secrete AFP? (repeat)

A

Dysgerminoma, nongestational choriocarcinoma

22
Q

What tumor is associated with Peutz-Jeghers?

A

Sex cord tumor with annular tubules

(Ovarian - sex cord stromal w annual tubules, Cervix - adenoma malignum, Ovarian - Granulosa theca)

23
Q

What’s the most common cancer to present w/ hemoperitoneum?

A

Granulosa cell

24
Q

What would adding TVUS do to elevated CA-125 screening value?
a) increase sensitivity
b) decrease sensitivity
c) increase specifcity
d) decrease specificity

A

c) increase specificity

25
Q

Staining if ovarian met from colon

A

CK7- CK 20+ metastatic colon cancer

CK7+ CK20+ Ovarian mucinous
CK7+ CK20- Endometrial
CK7+ CK20- HGSOC

26
Q

Poor ovca prognostic factor

A

VEGF-D –assoc with higher stage, LVSI, LN,

27
Q

Non-epithelial ovarian cancer that sometimes needs secondary cytoreduction

A

Immature teratoma (THIS ONE). Cases where pt received adj chemo for immature teratoma and have bulky residual even w/ normaliztion of negtive markers; reasonable to do surgery; sometimes path during secondary debulk will not be malignant then observe, if malignant viable tissue then addtll chemo

28
Q

Napsin A (IHC stain) is associated with which ovarian CA histology

A

Clear cell carcinoma

It’s CLEAR I need a NAPsin

29
Q

Most likely associated with lymph node mets?
A. Dysgerminoma
B. Sertoli-leydig
C. Granulosa cell
D. Immature teratoma

A

A. Dysgerminoma (28%) - very chemosensitive
mixed germ cell (16%), malignant teratoma (8%) - uptodate
Rare LN involvement in sex cord stromal tumors

30
Q

Non-epithelial ovarian cancer that sometimes needs secondary cytoreduction

A

Immature teratoma. Cases where pt received adj chemo for immature teratoma and have bulky residual even w/ normaliztion of neg markers; reasonable to do surgery; sometimes path during secondary debulk will not be malignant then observe, if malignant viable tissue then addtll chemo

31
Q

LMP tumor - how to differentiate nonmetastic vs. metastatic implant
a) stromal reaction
b) papillations
c) cytologic atypia
d) mitotic index

A

a) stromal reaction

32
Q

Grade 3, IA endometrioid ovarian cancer - treatment?
a) obs
b) 3 cycles chemo
c) 6 cycles chemo

A

b) 3 cycles (based on GOG 157)

33
Q

What is biggest barrier to ovarian cancer screening

A

low specificity of existing tests

34
Q

What % of benign teratomas contain thyroid tissue?

A

10%

35
Q

What % of struma ovarii are malignant?

A

10%

36
Q

Basis of grading for immature teratoma?

A

Amount of immature neural elements

37
Q

What % dysgerminomas are bilateral?

A

10-15%

38
Q

18yo with adnexal mass and positive alpha 1 antitrypsin staining?

A

Yolk sac tumor (AKA endodermal sinus tumor)

(yolks give you COPD)

39
Q

Adjuvant treatment for Grade 1 Stage 1B ovarian cancer (repeated 3 times)

A

Obs

40
Q

Which early stage ovarian cancers merit adjuvant chemo (3 answers)

A
  • Any Grade three (endometrioid or serous)
  • high risk histology (clear cell, carcinosarcoma)
  • Stage IC+

(could also say infiltrative mucinous; however, this isn’t in NCCN criteria 7/23)

41
Q

85yo had hyst/bso found to have 4cm granulosa cell tumor whats next step

A

obs (very low rate of LN mets in sex cord stromal tumors)

42
Q

Which is most likely to have lymph node mets: dysgerminoma, immature teratoma, sertoli leydig, granulosa cell
(2018 in RED)

A

Dysgerminoma

43
Q

Which type of ovarian tumor requires secondary debulking?

A

Immature teratoma

GOBBLERS 2023 (28 decks)

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