EXAM #1: OVARIAN DISEASE

Question 1

How do ovarian diseases present?

Answer 1

1) Abdominal pain and enlargement
2) Abnormal bleeding
3) Bowel or bladder symptoms

Question 2

What is the most common: endometrial, ovarian, or cervical cancer in the US? Worldwide?

Answer 2

US= endometrial
World= cervical is most common

Question 3

What has the worst prognosis: endometrial, ovarian, or cervical cancer?

Answer 3

Ovarian

Question 4

What is the most common ovarian mass in young women?

Answer 4

Follicular cyst

Question 5

What is a follicular cyst?

Answer 5

Distention of unruptured graafian follicle

Question 6

When are follicular cysts significant?

Answer 6

• If it lines granulosa cells and secretes estrogen

- Estrogen induces endometrial hyperplasia

Question 7

What is a corpus luteum cyst?

Answer 7

Cystic enlargement of the corpus luteum with central hemorrhage

Question 8

What condition may a corpus luteum cyst mimic?

Answer 8

Endometriosis

*If the cyst ruptures it may cause a peritoneal reaction with fibrosis and hemorrhage

Question 9

What is a theca-lutein cyst?

Answer 9

A BILATEARL/ MULTIPLE cyst induced by Gonadotropin stimulation

Question 10

What are theca-lutein cysts associated with?

Answer 10

Choriocarcinoma and moles

Question 11

What is a hemorrhagic cyst?

Answer 11

• Ovarian cyst with a blood vessel that ruptures

- Cyst may grow due to bleeding

Question 12

What is a dermoid cyst?

Answer 12

• Mature teratoma/ germ cell tumor

- Contains elements from all 3 germ layers i.e. teeth, hair, sebum, bone, cartilage…etc.

Question 13

What is the most common ovarian tumor in women between 20-30 y/o?

Answer 13

Dermoid cyst or “Cystic teratoma”

Question 14

When a dermoid cyst contains functional thyroid tissue, what is it called? How will this patient present?

Answer 14

Stuma ovarii

*This will cause HYPERTHYROIDISM

Question 15

How do dermoid cysts present clincally?

Answer 15

1) Abdominal pain

2) Ovarian torsion

Question 16

What is an endometrioid cyst?

Answer 16

Endometriosis in the ovary with cyst formation

Question 17

What description is pathognomonic for an endometrioid cyst that is filled with blood?

Answer 17

Chocolate cyst

Question 18

What age group is most affected by ovarian cancer?

Answer 18

Women older than 45-65

Question 19

What are the risk factors for ovarian cancer?

Answer 19

1) Family history
2) BRCA1/2 mutations
3) Nulliparity

Question 20

What is the most common ovarian tumor?

Answer 20

Serous cystadenoma

Question 21

What age range is most common for a serous cystadenoma?

Answer 21

20-50 y/o

Question 22

How are serous cystadenomas described? What are these tumors lined with? Are they unilateral or bilateral?

Answer 22

• Filled with serous fluid; not gel-like fluid
• Lined with fallopian-like epithelium
• Bilateral

Question 23

What is the fallopian-like epithelium?

Answer 23

Tall, ciliated, secretory columnar epithelium

Question 24

How are mucinous cystadenomas commonly described? What are these tumors lined with? Are they unilateral or bilateral?

Answer 24

• Unilateral
• Multilocuated
• Mucus-secreting epithelium (cervix-like)

Question 25

What type of epithelium is seen in a mucinous cystadenoma?

Answer 25

Tall-mucus secreting columnar epithelium (similar to the cervix)

Question 26

Which is more commonly malignant, serious or mucinous cystadenomas?

Answer 26

Serous

Question 27

What is an endometrioma?

Answer 27

Typically malignant mass arising from the growth of ectopic endometrial tissue

Question 28

How does an endometrioma present?

Answer 28

1) Pelvic pain 2) Dysmenorrhea 3) Dyspareunia

Question 29

What is a Brenner Tumor?

Answer 29

This is a surface epithelial tumor composed by a transitional type epitheliumn (bladder-like)

Question 30

How does a Brenner Tumor appear on gross evaluation?

Answer 30

Solid tumor that is - Pale- yellow/tan - Appears encapsulated

Question 31

What type of nuclei are seen in a Brenner Tumor?

Answer 31

"Coffee Bean"

Question 32

What other disease, aside from Brenner Tumors, has coffee bean nuclei?

Answer 32

Papillary Carcinoma of the Thyroid

Question 33

What are Brenner Tumors commonly associated with?

Answer 33

Terataomas

Question 34

What is a fibroma?

Answer 34

This is a benign tumor of fibroblasts that contains bundles of spindle-shaped fibroblasts *Can cause a "pulling" sensation in the groin

Question 35

What is Meigs Syndrome?

Answer 35

This is the triad of and ovarian fibroma, PLUS 1) Ascites 2) Hydrothorax/ pleural effusion

Question 36

What is a thecoma?

Answer 36

Benign tumor like a granulosa tumor that may produce estrogen

Question 37

How do Thecomas present?

Answer 37

Post-menopausal woman with abnormal uterine bleeding

Question 38

What is the most common ovarian malignancy?

Answer 38

Serous cystadenocarcinoma

Question 39

What histologic finding is seen in Serous cystadenocarcinomas? What other cancer has this feature?

Answer 39

Psammoma bodies (as seen in Papillary Carinoma of the Thyroid)

Question 40

What is the gross appearance of a Serous Cystadenocarcinomas?

Answer 40

Complex cyst with thick shaggy lining

Question 41

What is the histoliogc appearance of a Serous Cystadenocarcinomas?

Answer 41

- Papillary growth | - Hyperchromic cells

Question 42

What do psammoma bodies represent?

Answer 42

Dystrophic calcification

Question 43

How are mucunous cystadenocarcinomas described histologically?

Answer 43

1) Complex architecture 2) Nuclear atypia 3) Stromal invasion

Question 44

What is pseudomyxoma peritonei?

Answer 44

Intraperitoneal accumulation of mucinous material from ovarian or appendiceal tumor *Most commonly this represents a mucinous tumor of the appendix that metastesizes to the ovary

Question 45

What is an immature teratoma?

Answer 45

Very rare , solid tumor, most commonly containing neuroectoderm

Question 46

How do mature and immature teratomas differ in terms of the tissue that they most commonly contain?

Answer 46

``` Mature= thyroid tissue Immature= neuroectoderm ```

Question 47

What is the most common sex-cord stromal tumor?

Answer 47

Granulosa cell tumor

Question 48

When are Granulosa Cell Tumors most commonly seen?

Answer 48

Women in their 50s

Question 49

What is unique about Granuloas Cell Tumors?

Answer 49

Produce estrogen/or progesterone that causes - Abnormal uterine bleeding - Sexual precocity (young women) - Breast tenderness

Question 50

What is pathognomonic for a Granulosa Cell Tumor?

Answer 50

Call-Exner body

Question 51

What are Call-Exner bodies?

Answer 51

Small eosinophilic fluid-filled spaces between granulosa cells

Question 52

What is a dysgerminoma?

Answer 52

This is a tumor of large cells with a clear cytoplasm and central nuclei (cells resemble oocytes) *Most common tumor in adolescents (most common malignant germ cell tumor)

Question 53

What is pathognomonic for a dysgerminoma?

Answer 53

Sheets of uniform "fried egg cells"

Question 54

What are the tumor markers for dysgerminomas?

Answer 54

LDH* | HCG

Question 55

What is a chroiocarcinoma?

Answer 55

Malignant trophoblastic tissue (placenta)

Question 56

How do choriocarcinomas present?

Answer 56

1) Elevated B-HCG 2) Dyspnea 3) Hemoptysis

Question 57

What should you remember about choriocarcinomas?

Answer 57

Respond well to chemotherapy

Question 58

What is a Yolk sac tumor?

Answer 58

Malignant tumor that mimics the yolk sac; it is an aggressive tumor of the ovaries

Question 59

What is associated with Yolk Sac Tumors?

Answer 59

Schiller Duval Bodies, which are "glomerulus-like structures"

Question 60

What is the tumor marker for Yok Sac Tumors?

Answer 60

AFP

Question 61

What is a Krukenberg Tumor?

Answer 61

- GI malignancy that mets to the ovaries | - Causes mucin-secreting signet cell adenocarcinoma