219/222 - Ovary/Fallopian Tubes and Adenexal Mass + Pathology Flashcards Preview

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Flashcards in 219/222 - Ovary/Fallopian Tubes and Adenexal Mass + Pathology Deck (37)
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1

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

2

Which type of tumor is derived from pluripotent stem cells?

Germ cell tumors

  • Teratoma
  • Yolk sac tumor
  • Dysgerminoma

 

3

Elevated inhibin A or B may be indicative of which ovarian tumors?

Stromal tumors

(Theca or granulosa cell)

4

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

5

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

6

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

 

7

Is the following true of  Type I or Type II ovarian epithelial tumors?

 

Stepwise development: benign -> borderline -> malignant

Type I

8

Which germ cell tumor is most likley to produce AFP?

What is the histopathologic hallmark of this tumor?

Yolk sact tumor

Schiller duval body

9

What type of ovarian tumor arises from endometriosis?

What is the histologic hallmark?

Clear cell carcinoma 

(Type I)

10

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

11

List 2 sex-cord stromal ovarian tumors

Granulosa cell tumor

Fibrothecoma 

12

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?

13

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

14

List 2 epithelial ovarian tumors

Serous carcnioma

Clear cell carcinoma

15

In what age groups do germ cell tumors (teratoma, yolk sac, dysgerminoma) usually occur?

Children through early reproductive age

16

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

17

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

 

18

When is a theca-lutein cyst normal?

Pregnancy

19

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!

 

20

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)

21

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

22

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

 

23

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)

24

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

25

In which patient population is a fibrothecoma most common?

Describe the appearance

Post-menopausal patients

  • Fibroblasts w/collagenous stroma, spindled 
  • Theca cells: plump, round, abundant cytoplasm 

 

All epithelial tumors are more common in post-menopausal patients

26

List 2 hereditary mutations associated with ovarian caner

BRCA 1 or 2 mutation

Lynch syndrome

27

Is the following true of  Type I or Type II ovarian epithelial tumors?

 

Aggressive; usually high stage at diagnosis

Type II

 

 

28

What is the most likely diagnosis of this cyst?

Mucinous cystadenoma

29

What is the name for this histoligical finding?

(Bulbous protusion of nucleus into lumen)

What type of ovarian cancer is it associated with?

Hob-nailing (aka hobnail cell)

Associated with ovarian clear cell carcinoma

 

Arises from teh endometrium 

30

List 3 risk factors for ectopic pregnancy

  • Prior ectopic pregnancy
  • History of tubal sterilization
  • History of PID/salpingitis