219/222 - Ovary/Fallopian Tubes and Adenexal Mass + Pathology Flashcards
(37 cards)
What are the findings indicated by the arrows called?
What ovarian tumor are they associated with?
Cal-Exner bodies
Associated with granulosa cell tumor
Low malignant potential, but produce estrogen -> can cause endometrial hyperplasia
Which type of tumor is derived from pluripotent stem cells?
Germ cell tumors
- Teratoma
- Yolk sac tumor
- Dysgerminoma
Elevated inhibin A or B may be indicative of which ovarian tumors?
Stromal tumors
(Theca or granulosa cell)
Is the following true of Type I or Type II ovarian epithelial tumors?
Histologic types include endeometroid, low-grade serous, mucinous, and clear cell carcinomas
Type I
What is the appropriate management for “borderline” epithelial tumors?
Conservative treatment
- These tumors are usually have atypical proliferation and low malignant potential*
- Unusual features = we can’t definitively say its benign onr malignant*
- If tumor is invasive, considered carcinoma*
How does the pathogenesis of ovarian Type I and Type II tumors differ?
- Type 1 (ex: clear cell)
- Originates in stepwise fashion (hyperplasia -> dysplasia -> carcinoma)
- Associated with MAPK pathway
- Usually more indolent
- Type 2 (ex: high-grade serous)
- Arise de novo, likely from fallopian tube
- Associated with p53 mutation
- Aggressive, presents at advanced stage
Is the following true of Type I or Type II ovarian epithelial tumors?
Stepwise development: benign -> borderline -> malignant
Type I
Which germ cell tumor is most likley to produce AFP?
What is the histopathologic hallmark of this tumor?
Yolk sact tumor
Schiller duval body
What type of ovarian tumor arises from endometriosis?
What is the histologic hallmark?
Clear cell carcinoma
(Type I)
What is the precursor legion for high-grade serous ovarian cancer?
Serous tubal intra-epithelial carcinoma (STIC)
Often contains p53 mutation
High-grade serous = type II
List 2 sex-cord stromal ovarian tumors
Granulosa cell tumor
Fibrothecoma
What is the imaging modality of choice for adenexal masses?
Ultrasound
Transvaginal give a better picture than abdominal
Adenexal mass = ovarian and/or fallopian tube mass?
Is the following true of Type I or Type II ovarian epithelial tumors?
Associated with p53 and/or BRCA1 and/or BRCA2 mutations
Type II
List 2 epithelial ovarian tumors
Serous carcnioma
Clear cell carcinoma
In what age groups do germ cell tumors (teratoma, yolk sac, dysgerminoma) usually occur?
Children through early reproductive age
A patient with a uterus is recently found to have a BRCA1 mutation. They ask you what prophylactic treatment will offer the MOST protection from developing ovarian cancer.
What do you tell them?
Bilateral salpingooophorectomy
Need to take ovaries AND tubes - Serous tubal intraepithelial carcinoma (of the tube) is a precursor for ovarian cancer; if no ovaries, can get to other places instead
How do theca cells and granulosa cells differ in appearance?
- Granulosa
- Multi-layered
- Don’t stick together
- Small blue nuclei
- Theca
- Spindled
- Eventually blend into backgorund stroma
When is a theca-lutein cyst normal?
Pregnancy
What are the indications for surgery on an ovarian mass? (5)
- Any adnexal mass >10cm
- Complex adnexal cyst >5cm
- Any cyst >5cm w/o resolution after 6-8 weeks
- To avoid torsion or rupture
- To confirm not malignant
- Solid ovarian lesions
- Symptomatic for pain
- Worry for ovarian torsion - this is an emergency! Intervene surgically!
What findings on ultrasound are concerining for adenexal malignancy?
What is the next step in management?
- Internal echos
- Intramural nodules
- Solid components
Order serum tumor markers if you see any of these!
CA-125 (ovarian cancer)
bHCG, AFP, LDH (germ cell tumors)
Inhibitn A/B (stromal tumors)
In general:
Sex cord stromal tumors are more likely in [younger/older] patients
Germ cell tumors are more likely in [younger/older] patients
Sex cord stromal tumors are more likely in older patients
Germ cell tumors are more likely in younger patients
What is the most common ovarian carcinoma?
What is the proposed pathogenesis?
High-grade serous carcinoma (aka type II)
Originates from in situ lesions in the fimbriated end of the fallopian tube -> implants on the ovarian surface. Associated with p53 mutation
Which ovarian tumor will have elvated LDH?
Dysgerminoma (type of germ cell tumor)
- Note: LDH not specific to dysgerminoma*
- CA-125 (ovarian cancer)*
- bHCG, AFP, LDH (germ cell tumors)*
- Inhibitn A/B (stromal tumors)*
Is the following true of Type I or Type II ovarian epithelial tumors?
Histologic types include high-grade serous carcinoma, carcinosarcoma, and undifferentiated carcinoma
Type II
