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Anatomic pathology > Female 2 > Flashcards

Female 2 Flashcards

1
Q

Follicular cyst vs. serous cystadenoma.

A

Follicular cyst: Theca interna layer.

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2
Q

Luteinized follicular cyst of pregnancy:

A. Median size.
B. Histology.

A

A. 25 cm.

B. Lined by luteinized cells with hyperchromatic, pleomorphic nuclei.

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3
Q

Corpus-luteum cyst: Presentation (3).

A

Incidental.

Endocrine abnormalities, e.g. hyperestrinism, irregular menstruation.

Rupture and bleeding into the peritoneum.

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4
Q

Corpus-luteum cyst vs. corpus luteum.

A

The cyst is more than 2 cm in diameter.

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5
Q

Follicular cyst: Syndrome.

A

McCune−Albright:

− Polyostotic fibrous dysplasia.
− Irregular patches of pigmented skin.
− Endocrine dysplasia.

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6
Q

Hyperreactio luteinalis:

A. Association.
B. Presentation (2).

A

A. Elevated hCG as in pregnancy, gestational trophoblastic disease.

B. Usually asymptomatic; may cause a mass.

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7
Q

Hyperreactio luteinalis: Gross pathology.

A

Both ovaries are enlarged by multiple thin-walled cysts filled with blood or serous fluid.

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8
Q

Hyperreactio luteinalis: Histology (2).

A

Cysts lined by luteinized theca interna with or without granulosa layer.

Ovarian stroma may be edematous.

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9
Q

Hyperreactio luteinalis vs. large luteinized follicular cyst of pregnancy.

A

The latter is solitary.

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10
Q

Hyperreactio luteinalis: Associated tumor.

A

Rarely coexists with a pregnancy luteoma.

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11
Q

Polycystic ovarian syndrome: Typical age at presentation.

A

Third decade.

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12
Q

Polycystic ovarian syndrome: Laboratory abnormalities (2).

A

Most cases: Increased ratio of LH to FSH.

Some cases: Hyperprolactinemia.

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13
Q

Polycystic ovarian syndrome: Histology (3).

A

Ovarian cortex: Thickened, collagenous; thick-walled vessels.

Cysts: Follicular cysts in which only the theca interna is luteinized.

Stroma: Nodular luteinization; no corpora lutea or albicantia.

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14
Q

Polycystic ovarian syndrome: Pathogenesis.

A

Hyperandrogenemia with increased conversion of androstenedione to estrone.

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15
Q

Polycystic ovarian syndrome: Possible effects on the endometrium (2).

A

Hyperplasia.

Adenocarcinoma.

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16
Q

Stromal hyperthecosis: Typical age at presentation.

A

Postmenopausal.

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17
Q

Stromal hyperthecosis in premenopausal women: Presentations (2).

A 
More common: 
− Virilization.
− Obesity.
− Glucose intolerance.
− Hypertension.

Less common: Resembles PCOS.

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18
Q

Stromal hyperthecosis: Gross pathology.

A

The cut surface of BOTH ovaries contains white or yellow areas.

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19
Q

Stromal hyperthecosis: Histology.

A

Luteinized cells in the stroma occur singly or in clusters or nodules.

These luteinized cells are not associated with follicles.

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20
Q

HAIR-AN syndrome: Components.

A

Hyperandrogenemia.

Insulin resistance.

Acanthosis nigricans.

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21
Q

HAIR-AN syndrome: Histology of ovary.

A

In some cases, there is stromal hyperthecosis + edema and fibrosis.

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22
Q

Stromal hyperplasia: Presentation.

A

Similar to that of stromal hyperthecosis in premenopausal women.

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23
Q

Stromal hyperplasia: Gross pathology.

A

Similar to that of stromal hyperthecosis.

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24
Q

Stromal hyperplasia: Histology (2).

A

Diffuse or vaguely nodular increase in stromal cells.

Minimal collagen.

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25
Q

Stromal hyperplasia vs. ovarian fibroma.

A

Fibroma:

− Much collagen.
− Larger nuclei.

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26
Q

Stromal hyperplasia vs. low-grade endometrial stromal sarcoma of the ovary (2).

A

LGESS:

− More mitotic figures.
− Regularly distributed thin-walled vessels.

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27
Q

Massive edema and fibrosis of the ovary:

A. Age group.
B. Presentation.

A

A. Second decade.

B. Abdominal pain.

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28
Q

Massive edema and fibrosis of the ovary:

A. Laterality.
B. Possible complication.

A

A. Usually unilateral.

B. Torsion.

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29
Q

Massive edema of the ovary: Gross pathology.

A

White cut surface with seeping fluid and sometimes with hemorrhage.

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30
Q

Massive edema of the ovary: Histology (3).

A

Edema of stroma with sparing of outer cortex.

Venous congestion and dilatation of lymphatics.

May contain clusters of lutein cells.

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31
Q

Fibromatosis of the ovary: Gross pathology.

A

Smooth or lobulated cut surface, sometimes with cysts.

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32
Q

Fibromatosis of the ovary: Histology.

A

Proliferating spindle cells and collagen surround follicles.

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33
Q

Fibroma vs. fibromatosis.

A

In ovarian fibroma, there are no follicles.

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34
Q

Pregnancy luteoma: Typical patient.

A

Black multipara in her third or fourth decade.

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35
Q

Pregnancy luteoma: Possible presentation (2).

A

Mother: Hirsutism, virilization.

Infant: Virilism.

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36
Q

Pregnancy luteoma: Gross pathology (3).

A

Multiple in half of cases.

Bilateral in one third of cases.

Yellow-brown or gray on cut surface.

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37
Q

Pregnancy luteoma: Architecture.

A

Well-circumscribed nodules in a sparse stroma.

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38
Q

Pregnancy luteoma: Cytology.

A

Nuclei: Round; may be hyperchromatic; may show moderate mitotic activity.

Cytoplasm: Polygonal, abundant, eosinophilic, granular.

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39
Q

Pregnancy luteoma vs. luteinized thecoma (2).

A

Pregancy luteoma:

− Related to pregnancy.
− Contains no lipid.

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40
Q

Pregnancy luteoma vs. lipid-poor steroid tumor.

A

Lipid-poor steroid tumor
− Rarely bilateral.
− More mitotic activity.

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41
Q

Endometriosis: Inflammatory reaction.

A

Histiocytes, pseudoxanthoma cells.

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42
Q

Endometriosis vs. endometrioid cystadenoma.

A

Endometrioid cystadenoma: No endometrial stroma.

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43
Q

Endometriosis: Benign histologic variations (2).

A

Hyperplasia, metaplasia.

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44
Q

Ovarian malignancy associated with endometriosis:

A. Risk factor.
B. Most common types (2).

A

A. Hyperestrogenic state.

B. Endometrioid carcinoma of the ovary, clear-cell carcinoma of the ovary.

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45
Q

Follicular cyst: Layers.

A

Luminal: Granulosa cells (small and dark).

Basal: Theca interna cells (large and pale).

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46
Q

Benign ovarian serous tumors: Types (5).

A

Cystadenoma.

Papillary cystadenoma.

Surface papilloma.

Adenofibroma.

Cystadenofibroma.

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47
Q

Benign ovarian serous tumors: Lining cells.

A

Typically resemble those of the Fallopian tube; may also be columnar secretory cells.

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48
Q

Ovarian serous cystadenoma vs. epithelial inclusion cyst.

A

Inclusion cyst: Less than 1 cm in diameter.

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49
Q

Simple cyst.

A

Term used when it is unclear whether a structure is a follicular cyst or a serous cystadenoma.

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50
Q

Rete cystadenoma:

A. Origin.
B. Histology.

A

A. Rete ovarii.

B. Nonciliated epithelial lining; smooth muscle and hilus cells in the wall.

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51
Q

Serous borderline tumor:

A. Synonym.
B. Age group.

A

A. Atypical proliferative serous tumor.

B. 30-60 years of age.

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52
Q

Serous borderline tumor: Histology (2).

A

Complex papillae with hierarchical branching.

No destructive stromal invasion.

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53
Q

Serous borderline tumor: Implants (3).

A

Consist of proliferating epithelium with complex glands, resembling the tumor in the ovary.

Not regarded as metastasis.

Present in peritoneum or in lymph nodes.

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54
Q

Serous borderline tumor: Immunohistochemistry (2).

A

Positive: WT-1.

Usually weak or negative: p53.

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55
Q

Micropapillary serous carcinoma: Histology.

A

Micropapillae

− Long and thin; no hierarchical branching.
− No fibrovascular core (by definition).
− Arise from edematous true papillae that do not invade the stroma.

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56
Q

Micropapillary serous carcinoma: Classification.

A

Regarded as a serous borderline tumor and as a low-grade carcinoma.

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57
Q

Serous borderline tumor: Treatment.

A

Tumors confined to the ovary: Surgical excision cures more than 95% of patients.

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58
Q

Ovarian carcinomas of type 1:

A. Stage at presentation.
B. Behavior.

A

A. Usually stage 1.

B. Slow-growing and usually retain low grade.

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59
Q

Ovarian carcinomas of type 1:

A. Histology.
B. Genetics.

A

A. Analogous to that of cystadenomas and borderline tumors.

B. Mutations in KRAS/BRAF are more common than mutations in TP53.

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60
Q

Ovarian carcinomas of type 1: Examples (5).

A

Serous carcinoma (grade 1).

Mucinous, endometrioid, and clear-cell carcinomas.

Transitional-cell carcinomas.

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61
Q

Ovarian carcinomas of type 2:

A. Stage at presentation.
B. Behavior (2).

A

A. Usually high stage.

B. Arises de novo; aggressive behavior.

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62
Q

Ovarian carcinomas of type 2: Genetics.

A

Mutations in TP53 are much more common than mutations in KRAS/BRAF.

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63
Q

Ovarian carcinomas of type 2: Examples (2).

A

Serous carcinoma (grade 2 or grade 3).

Carcinosarcoma.

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64
Q

Low-grade ovarian serous carcinoma: Gross pathology (2).

A

Bilateral in 80% to 90% of cases.

More than 90% of tumors are in advanced stage.

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65
Q

Low-grade ovarian serous carcinoma: Histology (3).

A

Papillae with infiltration of ovarian stroma.

Psammoma bodies
− Present in most well-differentiated tumors.
− May exceed the epithelial component (“psammocarcinoma”).

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66
Q

High-grade ovarian serous carcinoma: Origin.

A

Fimbriae of Fallopian tubes.

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67
Q

High-grade ovarian serous carcinoma: Gross pathology (2).

A

Bilateral in about 65% of cases.

May be mostly cystic (if well-differentiated) or solid.

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68
Q

High-grade ovarian serous carcinoma: Architecture (2).

A

Desmoplastic invasion of stroma.

Few papillae; mostly solid growth.

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69
Q

High-grade ovarian serous carcinoma: Cytology.

A

High-grade nuclei with atypical mitotic figures.

Cellular budding and stratification.

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70
Q

High-grade ovarian serous carcinoma: Additional finding.

A

Serous tubal intraepithelial carcinoma in the Fallopian tube.

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71
Q

Serous ovarian carcinomas: Immunohistochemistry (5,1).

A

Positive: Cytokeratin, EMA, vimentin, CA125, WT-1.

Negative: CEA.

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72
Q

Retiform Sertoli-Leydig cell tumor of the ovary:

A. Age group.
B. Presentation.

A

A. First decade.

B. May cause virilization.

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73
Q

Retiform Sertoli-Leydig cell tumor of the ovary: Histology (2).

A

Bland cells with scant cytoplasm line tubules and cysts.

Other types of Sertoli-Leydig cell tumor usually coexist.

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74
Q

Proportion of ___ ovarian tumors that are benign.

A. Serous.
B. Mucinous.

A

A. 70%.

B. 75-85%.

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75
Q

Benign ovarian mucinous tumors: Histology (2).

A

Endocervical- or intestinal-type epithelium.

May contain Paneth cells.

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76
Q

Benign ovarian mucinous tumors: Immunohistochemistry.

A

Positive: CK7.

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77
Q

Mucinous cystadenoma vs. mucin-secreting serous cystadenoma.

A

In a serous tumor, any mucin is apical only.

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78
Q

Follicular cyst: Special stain.

A

Reticulin stains demonstrates network around thecal cells but not about granulosa cells.

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79
Q

Follicular cyst: Age group.

A

Occur most often in the reproductive years but can appear at any age.

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79
Q

Benign ovarian mucinous tumors: Associated tumors (4).

A

Dermoid cyst.

Appendiceal mucoceles.

Pseudomyxoma peritonei.

Brenner tumors.

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79
Q

Pseudomyxoma peritonei: Associated tumors (2).

A

Appendiceal tumor.

Mucinous ovarian tumor.

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80
Q

Mucinous borderline tumors: Possible laboratory abnormality.

A

Elevated serum inhibin.

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81
Q

Mucinous borderline tumors: Types.

A

Endocervical-type: Less common, more likely to be bilateral, smaller.

Intestinal-type: More common, less likely to be bilateral, larger.

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82
Q

Mucinous borderline tumor vs. benign mucinous tumor (4).

A

Borderline mucinous tumor:

− More crowding of structures.
− More nuclear atypia.
− More nuclear stratification.
− More mitotic activity.

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83
Q

Mucinous carcinoma of the ovary: Possible laboratory findings (4).

A

Elevated

− CEA.
− CA19-9.
− CA125.
− Inhibin.

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84
Q

Mucinous carcinoma of the ovary: Laterality.

A

Less than 20% are bilateral.

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85
Q

Mucinous carcinoma of the ovary: Immunohistochemistry (3,2).

A

Positive: CK7, CK20, CEA.

Negative: Vimentin, WT-1.

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86
Q

Krukenberg’s tumor: Origin (2).

A

Stomach (#1).

Breast.

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87
Q

Krukenberg’s tumor vs. mucinous carcinoma of the ovary.

A

Krukenberg’s tumor:

− Usually bilateral.
− Contains signet-ring cells.

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88
Q

Mucinous carcinoma of the ovary: Prognosis.

A

Five-year-survival rate is about 40%.

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89
Q

Endometrioid tumors of the ovary: Types.

A

Carcinoma (most tumors).

Benign tumors (rare).

Borderline tumors (rare).

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90
Q

Endometrioid tumors of the ovary: Laboratory finding.

A

Elevated serum CA125.

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91
Q

Endometrioid carcinoma of the ovary: Laterality.

A

About 30% of tumors are bilateral.

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92
Q

Endometrioid tumors of the ovary: Histology (3).

A

Benign: Usually adenofibromatous.

Borderline: Usually adenofibromatous; squamous morules often.

Malignant: Stromal invasion; squamous morules often.

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93
Q

Clear-cell tumors of the ovary: Types.

A

Carcinoma (most tumors).

Benign tumors (rare).

Borderline tumors (rare).

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95
Q

Clear-cell tumors of the ovary: Risk factors (2).

A

Endometriosis.

Malignant clear-cell tumor: Nulliparity.

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95
Q

Clear-cell tumors of the ovary: Histology (3).

A

Benign: Usually adenofibromatous; mature glands.

Borderline: Usually adenofibromatous; atypical glands.

Malignant: Stromal invasion.

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97
Q

Clear-cell tumors of the ovary: Stains (2).

A

Positive: PAS (diastase sensitive), cytokeratin.

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98
Q

Clear-cell carcinoma of the ovary: Appearances of cells (5).

A

Hobnail.

Flat.

Signet-ring.

Clear.

Oxyphilic.

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99
Q

Clear-cell carcinoma of the ovary: Additional cytologic features (3).

A

Inconspicuous nucleoli.

Many abnormal mitotic figures.

Hyaline globules.

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100
Q

Clear-cell carcinoma of the ovary: Patterns of growth (4).

A

Papillary.

Tubulocystic.

Solid.

Mixed.

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101
Q

Transitional-cell tumors of the ovary:

A. Synonym.
B. Types (3).

A

A. Brenner tumors.

B. Benign (most cases), borderline, malignant.

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102
Q

Benign transitional-cell tumor of the ovary: Cytology (2).

A

Nucleus: Grooved.

Cytoplasm: Pale.

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103
Q

Benign transitional-cell tumor of the ovary: Architecture (3).

A

Well-defined nests and trabeculae of transitional epithelium.

Cysts lined by glandular epithelium.

Densely fibrotic stroma.

104
Q

Borderline transitional-cell tumor of the ovary: Cytology.

A

More necrosis, more mitotic activity than in benign tumor.

105
Q

Borderline transitional-cell tumor of the ovary: Architecture.

A

Nests are poorly defined.

106
Q

Transitional-cell carcinoma of the ovary: Cytology (3).

A

More pleomorphism.

More mitotic activity.

Occasional necrosis.

107
Q

Transitional-cell carcinoma of the ovary: Architecture (2).

A

Destructive stromal invasion.

Some single tumor cells.

108
Q

Transitional-cell tumors of the ovary: Immunohistochemistry (2).

A

Positive: CK8/18.

Negative: CK20.

109
Q

Benign transitional-cell tumor vs. mucinous cystadenoma.

A

Mucinous cystadenoma: No transitional cells.

110
Q

Transitional-cell tumors of the ovary: Associated tumors (4).

A

Dermoid cyst.

Struma ovarii.

Carcinoid tumor.

Mucinous cystadenoma.

111
Q

Transitional-cell carcinoma of the ovary: Prognosis.

A

Poor unless unilateral.

112
Q

Malignant mixed müllerian tumor of the ovary: Epithelial component (2).

A

Serous or endometrioid carcinoma.

There may be bizarre tumor cells.

113
Q

Malignant mixed müllerian tumor of the ovary: Mesenchymal component (6).

A

Homologous
− Endometrial stromal sarcoma.
− Fibrosarcoma.
− Leiomyosarcoma.

Heterologous
− Chondrosarcoma.
− Rhabdomyosarcoma.
− Osteosarcoma.

114
Q

Malignant mixed müllerian tumor of the ovary vs. immature teratoma (3).

A

Immature teratoma
− First and second decades of life.
− Contains immature neuroectodermal tissue.
− Cartilage is immature rather than chondrosarcomatous.

115
Q

Malignant mixed müllerian tumor of the ovary: Behavior.

A

Early metastasis to omentum, pelvic organs, liver.

116
Q

Most common ovarian sex cord−stromal tumor.

A

Fibroma.

117
Q

Ovarian fibroma: Genetic association.

A

Basal-cell-nevus syndrome.

118
Q

Ovarian fibroma: Nongenetic associations.

A

Meigs’ syndrome: Ascites, hydrothorax, ovarian fibroma.

No hormonal association (nonfunctioning tumor).

119
Q

Ovarian fibroma:

A. Laterality.
B. Size.

A

A. The vast majority are bilateral.

B. Most are greater than 3 cm; if less than 1 cm, it is a fibromatosis nodule.

120
Q

Ovarian fibroma: Cytology (2).

A

Bland spindle cells, often in a storiform pattern, with few mitotic figures.

A minor sex-cord component (tubules) may be present.

121
Q

Ovarian fibroma: Stroma.

A

Hyalinized and often exhibits intercellular edema.

122
Q

Thecoma: Clinical types.

A

Classic: Postmenopausal women.

Luteinized: Younger patients, estrogenic, can cause endometrial hyperplasia and carcinoma.

123
Q

Thecoma: Laterality.

A

Most are unilateral.

124
Q

Classic thecoma: Histology (3).

A

Plump, lipid-laden, haphazardly arranged spindle cells.

Hyaline plaques may be present.

Granulosa cells make up less than 10% of the tumor.

125
Q

Luteinized thecoma: Histology.

A

Theca cells and spindle cells are luteinized (much clear or pink cytoplasm; central, round nucleus).

126
Q

Thecoma: Stains (2).

A

Positive: Reticulin (fibers surround cells), inhibin.

127
Q

Thecoma vs. stromal hyperthecosis.

A

Stromal hyperthecosis: Almost always bilateral.

128
Q

Adult granulosa-cell tumor: Age of peak incidence.

A

Fifth decade.

129
Q

Adult granulosa-cell tumor: Possible hormonal manifestations (3).

A

Uterine bleeding.

Endometrial hyperplasia.

Endometrial carcinoma.

130
Q

Adult granulosa-cell tumor: Acute complication.

A

Rupture and bleeding into the peritoneum.

131
Q

Adult granulosa-cell tumor: Classic pattern.

A

Microfollicular.

132
Q

Adult granulosa-cell tumor: Variant appearances of granulosa cells (2).

A

Luteinized.

Large, dark nuclei; sometimes multinucleate.

133
Q

Adult granulosa-cell tumor: Features of diffuse and sarcomatoid patterns (5).

A

Less differentiation.

Few Call-Exner bodies.

More nuclear pleomorphism.

More mitotic activity.

Spindle cells.

134
Q

Adult granulosa-cell tumor: Other patterns (5).

A

Trabecular.

Insular.

Macrofollicular.

Watered-silk.

Gyriform.

135
Q

Adult granulosa-cell tumor: Immunohistochemistry (3,1).

A

Positive: Inhibin, calretinin, vimentin.

Often positive: CD56.

136
Q

Adult granulosa-cell tumor: Prognosis (2).

A

May recur decades later.

Stage I: Ten-year survival rate is 80-90%.

137
Q

Juvenile granulosa-cell tumor: Age group.

A

First three decades of life.

138
Q

Juvenile granulosa-cell tumor vs. adult granulosa-cell tumor: Cytology (3).

A

The cells of juvenile granulosa-cell tumor

− Lack nuclear grooves.
− Have more cytoplasm.
− Are often luteinized.

139
Q

Juvenile granulosa-cell tumor: Additional cytologic features (2).

A

There may be nuclear atypia.

There may be frequent mitotic figures.

140
Q

Juvenile granulosa-cell tumor vs. adult granulosa-cell tumor: Contents of follicles.

A

JGCT: Mucicarmine-positive secretions.

AGCT: Basement-membrane matter.

141
Q

Juvenile granulosa-cell tumor: Prognosis.

A

Usually good; excision cures some.

142
Q

Sclerosing stromal tumor of the ovary: Age of peak incidence.

A

Second decade.

143
Q

Sclerosing stromal tumor of the ovary: Histologic components.

A

Pseudo-lobules.

Thin-walled vessels.

144
Q

Sclerosing stromal tumor of the ovary: Cells of pseudo-lobules (2).

A

Fibroblasts.

Vacuolated, lipid-laden cells.

145
Q

Sclerosing stromal tumor of the ovary: Stroma of pseudo-lobules.

A

Edematous or densely collagenous (sclerosing).

146
Q

Sclerosing stromal tumor of the ovary: Immunohistochemistry (2).

A

Positive: Inhibin, vascular markers.

147
Q

Sertoli-cell tumor of the ovary: Age of peak incidence.

A

Second decade.

148
Q

Sertoli-cell tumor of the ovary: Function.

A

Usually nonfunctioning but can be androgenic or estrogenic.

149
Q

Sertoli-cell tumor of the ovary: Cytology (2).

A

Most tumors: Similar to benign Sertoli cells.

Some tumors: Large, lipid-rich Sertoli cells.

150
Q

Sertoli-cell tumor of the ovary: Architecture (3).

A

Tubules filled with neoplastic Sertoli cells.

Fibrous or hyalinized stroma.

No Leydig cells.

151
Q

Sertoli-cell tumor of the ovary: Immunohistochemistry (2,1).

A

Positive: Cytokeratin, inhibin.

Negative: EMA.

152
Q

Sertoli-cell tumor of the ovary: Prognosis.

A

Excellent if well differentiated.

Regarded as a low-grade malignancy.

153
Q

Sertoli-Leydig cell tumor of the ovary: Age group.

A

Any age, but especially in the second decade.

154
Q

Sertoli-cell tumor of the ovary: Endocrine effect.

A

Virilization or hirsutism due may be seen in half of patients.

155
Q

Sertoli-cell tumor of the ovary: Possible hematologic manifestation.

A

Erythrocytosis due to androgens.

156
Q

Juvenile granulosa-cell tumor: Histology (3).

A

Sheets of cells and immature follicles.

157
Q

Sertoli-cell tumor of the ovary: Histology of well-differentiated tumor.

A

Similar to that of Sertoli-cell tumor, but with clusters of Leydig cells in the stroma.

158
Q

Sertoli-cell tumor of the ovary: Histology of tumor of intermediate differentiation (4).

A

Cellular nodules in a fibrous or edematous stroma.

Sertoli cells form tubules, clusters, and cords.

Sertoli cells have darker nuclei and less cytoplasm than benign Sertoli cells.

Leydig cells form clusters.

159
Q

Sertoli-cell tumor of the ovary: Histology of poorly differentiated tumor (2).

A

Diffuse pattern of densely packed pleomorphic spindle cells.

Many mitotic figures.

160
Q

Sertoli-cell tumor of the ovary: Heterologous elements (3).

A

Not seen in well-differentiated SLCT.

Most common: Benign mucinous epithelium of gastrointestinal type.

Others: Immature skeletal muscle and/or immature cartilage.

161
Q

Retiform Sertoli-cell tumor of the ovary: Histology (3).

A

Similar to that of well-differentiated SLCT, with the addition of

− Tubules and cysts of rete testis−type epithelium.
− Other patterns of SLCT elsewhere in the tumor.

162
Q

Sertoli-cell tumor of the ovary: Immunohistochemistry.

A

Positive for inhibin.

163
Q

Sertoli-cell tumor of the ovary: Associated tumor.

A

Rare association with botryoid embryonal rhabdomyosarcoma of the cervix.

164
Q

Sex-cord tumor with annular tubules: Syndrome.

A

One third of tumors are associated with Peutz-Jeghers syndrome.

165
Q

Sex-cord tumor with annular tubules: Architecture.

A

Simple (ring-shaped) and complex (interconnecting rings) tubules surround hyaline matter.

166
Q

Sex-cord tumor with annular tubules: Cytology.

A

Cells lining the tubules have much pale cytoplasm; the nuclei face the periphery of the ring.

167
Q

Sex-cord tumor with annular tubules: Histologic feature associated with syndrome.

A

Peutz-Jeghers syndrome: Tubules may be calcified.

168
Q

Sex-cord tumor with annular tubules: Behavior.

A

One fourth of cases are malignant; lymphatic spread is typical.

169
Q

Sex-cord tumor with annular tubules: Classification.

A

Considered a sex cord−stromal tumor that can differentiate toward granulosa-cell tumors or Sertoli-cell tumors.

170
Q

Gynandroblastoma: Histology.

A

Contains at least 10% of each:

− Granulosa-cell component.
− Sertoli-cell component.

171
Q

Gynandroblastoma: Behavior.

A

Almost always benign.

172
Q

Stromal luteoma:

A. Classification.
B. Behavior.

A

A. Steroid-cell tumor.

B. Benign.

173
Q

Stromal luteoma: Architecture.

A

Nodules of lutein cells confined to the ovarian stroma.

174
Q

Stromal luteoma: Cytology.

A

Nucleus: Small, round, with prominent nucleolus.

Cytoplasm: Eosinophilic, lipid-poor.

175
Q

Leydig-cell tumor:

A. Synonym.
B. Presentation.

A

A. Hilus-cell tumor.

B. Classically androgenic but can be estrogenic.

176
Q

Leydig-cell tumor: Histology.

A

Variable arrangements of Leydig cells.

The cells contain the eosinophilic crystalloids of Reinke.

177
Q

Leydig-cell tumor: Immunohistochemistry.

A

Positive: Inhibin.

178
Q

Dermoid cyst: Rule of 15.

A

Bilateral in 15% of cases.

Usually less than 15 cm in diameter.

179
Q

Dermoid cyst: Histology.

A

All three germ layers are typically represented, i.e. not just skin.

180
Q

Malignant transformation of dermoid cyst:

A. Frequency.
B. Type of malignancy.
C. Typical patient.

A

A. Less than 3%.

B. Squamous-cell carcinoma.

C. Postmenopausal woman.

181
Q

Mature solid teratoma: Age group.

A

First and second decades.

182
Q

Mature solid teratoma: Histology.

A

Same as that of dermoid cyst except that it is solid.

183
Q

Dysgerminoma:

A. Frequency.
B. Associations.

A

A. Most common malignant germ-cell tumor of the ovary.

B. Ovarian dysgenesis; pregnancy.

184
Q

Dysgerminoma: Possible laboratory findings (2).

A

Elevated LDH.

Elevated hCG.

185
Q

Dysgerminoma: Histology.

A

Resembles seminoma.

186
Q

Dysgerminoma: Immunohistochemistry (2).

A

Positive: PLAP.

Negative: Cytokeratin (usually), EMA.

187
Q

Dysgerminoma: Metastasis.

A

Occurs late:

− Initially by the lymphatics.
− Later by the blood vessels to liver, lungs, bone.

188
Q

Yolk-sac tumor: Age of peak incidence.

A

Second and third decades.

189
Q

Yolk-sac tumor, glandular variant: Histology (2).

A

Intestinal and endometrioid types exist.

Hepatoid cells in the glandular lumens may mimic squamous morules.

190
Q

Yolk-sac tumor: Immunohistochemistry (3).

A

Positive: AFP, α₁-antitrypsin, creatine kinase.

191
Q

Yolk-sac tumor, hepatoid variant vs. hepatoid carcinoma (2).

A

Yolk-sac tumor, hepatoid variant:

− Less nuclear atypia.
− Accompanied by other types of YST.

192
Q

Embryonal carcinoma: Age of peak incidence.

A

First decade.

193
Q

Embryonal carcinoma: Laboratory finding.

A

Elevated hCG.

194
Q

Embryonal carcinoma: Histology (2).

A

Similar to that of testicular embryonal carcinoma.

Also contains syncytiotrophoblasts.

195
Q

Embryonal carcinoma: Immunohistochemistry (2,1).

A

Positive: PLAP (syncytiotrophoblasts), cytokeratin.

Negative: EMA.

196
Q

Polyembryoma:

A. Age group.
B. Possible laboratory findings (2).

A

A. Children, young adults.

B. Elevated AFP, elevated hCG.

197
Q

Polyembryoma: Histologic components (3).

A

Embryoid bodies representing various stages of development.

Syncytiotrophoblasts sometimes.

Fibrous or edematous stroma.

198
Q

Polyembryoma: Histology of mature embryoid body (4).

A

Embryonic disk:
− Columnar ectoderm.
− Cuboidal endoderm.

Amniotic cavity.

Yolk sac.

Extraembryonic mesenchyme.

199
Q

Polyembryoma: Most commonly associated germ-cell tumor.

A

Teratoma (mature or immature).

200
Q

Polyembryoma:

A. Behavior (2).
B. Treatment.

A

A. Invades locally and metastasizes distantly.

B. Excision and chemotherapy.

201
Q

Choriocarcinoma: Age group.

A

Children and young adults.

202
Q

Choriocarcinoma: Presentation (2).

A

Children: Isosexual precocious puberty.

Adults: Signs of ectopic pregnancy.

203
Q

Choriocarcinoma: Cytology.

A

Cytotrophoblasts: Distinct cells borders; single vesicular nucleus with large nucleus.

Syncytiotrophoblasts: Indistinct cell borders; many hyperchromatic nuclei.

204
Q

Choriocarcinoma: Locations of cells.

A

Cytotrophoblasts in the center, syncytiotrophoblasts surround it.

205
Q

Choriocarcinoma: Immunohistochemistry (4).

A

Positive: Cytokeratin, hCG, hPL, PLAP.

206
Q

Choriocarcinoma vs. other germ-cell tumors.

A

Other germ-cell tumors: No cytotrophoblasts.

207
Q

Choriocarcinoma: Spread.

A

Hematogenous, lymphatic, and local spread.

208
Q

Immature teratoma: Age at peak incidence.

A

Second and third decades.

209
Q

Immature teratoma: Intraoperative finding.

A

Half of cases show capsular perforation with adhesion to adjacent structures.

210
Q

Immature teratoma: Components.

A

Ectodermal: Primitive neural tissue, e.g. rosettes.

Mesodermal: Cartilage, muscle, mesenchyme.

Endodermal: Tubules lined by columnar epithelium.

211
Q

Immature teratoma: Grade 0.

A

All tissues are mature.

No mitotic activity.

212
Q

Immature teratoma: Grade 1.

A

Minor immature component.

Slight mitotic activity.

213
Q

Immature teratoma: Grade 2.

A

Moderate immature component.

Moderate mitotic activity.

214
Q

Immature teratoma: Grade 3.

A

Much immature tissue.

High mitotic activity.

215
Q

Immature teratoma: Grade 4.

A

The teratoma takes over the woman, converting her to a slimy, creeping mass of immature tissue.

216
Q

Immature teratoma: Spread.

A

Peritoneal implantation: Most common.

Lymphatic.

Hematogenous: Rare.

217
Q

Immature teratoma:

A. Prognosis.
B. Treatment.

A

A. Poor for grades 2 and 3.

B. Surgery and chemotherapy.

218
Q

Monodermal teratoma: Examples (2).

A

Struma ovarii.

Carcinoid tumor.

219
Q

Struma ovarii: Presentation (3).

A

Usually asymptomatic.

Can cause mass-related symptoms.

Can cause thyrotoxicosis.

220
Q

Struma ovarii:

A. Gross pathology.
B. Histology.

A

A. Green-brown cut surface; solid and/or cystic.

B. Mature thyroid tissue that can undergo oxyphilic and other benign changes.

221
Q

Carcinoid tumor of the ovary: Presentation.

A

The carcinoid syndrome happens occasionally.

222
Q

Carcinoid tumor of the ovary: Gross pathology.

A

Most carcinoids occur with other teratomatous elements:

− Dermoid cyst (most often).
− Mucinous cystic teratoma.
− Mature solid teratoma.

223
Q

Carcinoid tumor of the ovary: Histology.

A

The insular pattern is the most common.

224
Q

Gonadoblastoma:

A. Typical patient.
B. Presentation.

A

A. Phenotypic female with 46,XY or 45,X.

B. Virilization sometimes.

225
Q

Gonadoblastoma: Gonad.

A

May be ambiguous, e.g. abdominal or inguinal testis, streak gonad.

226
Q

Gonadoblastoma: Histology (3).

A

Nests consisting of seminoma-like germ-cell tumor with admixed Sertoli cells or granulosa cells.

Lutein or Leydig cells in the stroma between the nests.

May be calcified or hyalinized.

227
Q

Hypercalcemic small-cell carcinoma: Age at peak incidence.

A

Second decade.

228
Q

Hypercalcemic small-cell carcinoma: Cytology (4).

A

Small cells with fine chromatin and scant cytoplasm.

Large cells with hyperchromatic nucleus and much cytoplasm.

Necrosis and brisk mitotic activity.

May show focal mucinous differentiation.

229
Q

Hypercalcemic small-cell carcinoma: Architecture.

A

May form small follicle-like structures containing eosinophilic matter.

230
Q

Hypercalcemic small-cell carcinoma: Immunohistochemistry (3).

A

Negative: Neuroendocrine markers, inhibin, CEA.

231
Q

Metastasis to the ovary: Relative frequency.

A

Less than 10% of ovarian tumors.

232
Q

Metastasis to the ovary: Most common primary sites (4).

A

Gynecological tract (#1).

Intestine.

Stomach.

Breast.

233
Q

Krukenberg tumor: Definition.

A

Any metastatic signet-ring tumor to the ovary (not just gastric).

234
Q

Metastasis to the ovary: Frequency of bilaterality.

A

About 70%.

235
Q

Metastasis to the ovary: Most common locations within the ovary.

A

Cortex and hilum.

236
Q

Metastatic signet-ring tumor to the ovary vs. primary ovarian mucinous adenocarcinoma with signet rings (2).

A

Primary tumor:

− Typically unilateral.
− Signet rings are usually a minor component.

237
Q

Acute and chronic salpingitis: Leading causes (3).

A

Sexually transmitted infections: Chlamydia, Neisseria.

Curettage.

Placement of IUD.

238
Q

Granulomatous salpingitis: Causes (2).

A

Infectious agents: TB, parasites, Actinomyces.

Systemic diseases: Crohn’s, sarcoidosis.

239
Q

Chronic salpingitis: End stage.

A

Hydrosalpinx.

240
Q

Chlamydial salpingitis: Histologic clue.

A

Hyperplasia of lymphoid follicles.

241
Q

Tubal endometriosis vs. physiologic extension of endometrial tissue into the tube.

A

Endometriosis involves serosa and subserosa.

Physiologic extension involves the mucosa only.

242
Q

Endometrial colonization of the fallopian tube.

A

Physiologic extension with occlusion of the tubal lumen by endometrial tissue.

243
Q

Salpingitis isthmica nodosa:

A. Age group.
B. Significance.
C. Cause.

A

A. Third and fourth decades.

B. Can lead to ectopic pregnancy.

C. Unknown.

244
Q

Salpingitis isthmica nodosa: Gross pathology (2).

A

Nodules within the wall of the isthmus of the fallopian tube.

Often bilateral.

245
Q

Salpingitis isthmica nodosa: Histology (2).

A

Nests or cysts of tubal epithelium, surrounded by muscular layer.

Connections to the tubal lumen can be demonstrated.

246
Q

Tubal ectopic pregnancy: Risk factors (4).

A

Chronic salpingitis (#1).

Congenital abnormalities of the tube.

Salpingitis isthmica nodosa.

Endometriosis.

247
Q

Tubal ectopic pregnancy: Most common site.

A

Ampulla.

248
Q

Adenomatoid tumor of the fallopian tube: Patterns of growth (4).

A

Adenomatoid, glandular: Most common.

Solid.

Cystic.

249
Q

Adenomatoid tumor of the fallopian tube: Immunohistochemistry (5).

A

Positive: Cytokeratin, vimentin, EMA, calretinin, WT-1.

250
Q

Most common ___ tumor of the fallopian tube.

A. Epithelial.
B. Mesenchymal.

A

A. Papilloma.

B. Leiomyoma.

251
Q

Epithelial papilloma of the fallopian tube: Histology.

A

Branching fibrovascular stalk.

Single layer of nonciliated columnar or oncocytic epithelium.

252
Q

Epithelial papilloma of the fallopian tube vs. adenomatous hyperplasia.

A

In adenomatous hyperplasia the epithelium shows

− Stratification and disordered arrangement of cells.
− Cytologic atypia.
− Occasional mitotic figures.

253
Q

Most common malignancy of the fallopian tube.

A

Metastatic.

255
Q

Carcinoma of the fallopian tube: Age group.

A

Postmenopausal women.

257
Q

Carcinoma of the fallopian tube: Significance of serous tubal intraepithelial carcinoma.

A

It is a precursor of ovarian serous carcinoma.

258
Q

Carcinoma of the fallopian tube: Invasive types (4).

A

Serous (#1).

Mucinous, endometrioid, clear-cell.

259
Q

Carcinoma of the fallopian tube: Intraoperative findings (2).

A

Often bilateral.

Nearly always invasive.

Anatomic pathology (17 decks)

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