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Pathology II Exam II > Female Genital 3 > Flashcards

Flashcards in Female Genital 3 Deck (49):
1

T/F- pelvic masses are usually sympotomatic

False, no symptoms is most common. Mass must be large, cause ascites, or tossed to cause symptoms

2

What are the three major categories of ovarian tumors?

-epithelial tumors
-sex cord/stromal tumors
-germ cell tumors

3

Metastasis accounts for ___% of all ovarian neoplasms

10

4

T/F- The surface epithelium of the ovary and fallopian tube arises from the same coelomic epithelium that gives rise to the endometrium and endocervix as well, so epithelial tumors in the ovary can have a variety of morphologies (e.g., serous, endometrioid, mucinous)

True

5

What type of ovarian tumor is most common in the ovaries (over 20 yrs of age)?

epithelial neoplasms (benign or malignant)

6

What type of ovarian tumor is most common in those under 20?

Germ cell tumors

7

In contrast to women, most gonadal neoplasms are of what origin?

germ cell (germ cells constantly undergo division in men)

8

Review the 5 sub-types of ovarian EPITHELIAL tumors

serous
mucinous
endometrioid
clear cell
brenner

9

If a tumor is derived from the fallopian tube epithelium you should think of what type of tumor?

serous (can be benign or malignant)

10

If a tumor is derived from the endocervic or intestinal epithelium it will be what?

mucinous (can be benign or malignant)

11

If a tumor is derived from the endometrial epithelium it will begin with the word ____

endometrioid (begign or malignant)

12

If a tumor is derived from the urothelium it will contain the word _____

Brenner tumor (can be benign or malignant)

13

Rank serous, mucinous and endometrioid tumors from most common to least common

1. serous (1/2 of ovarian neoplasms)
2. Mucinous tumors (1/3)
3. Endometrioid (10%)

14

Are serous tumors usually unilateral or bilateral?

Frequently bilateral (especially when malignant)

15

Are mucinous and endometrioid tumors usually unilateral or bilateral?

unilateral

16

many serous tumors will have a characteristic _____ epithelium and ____ bodies

-"hobnail"
-psammoma bodies (but not specific)

17

There is expanding literature that suggests high grade serous carcinoma of the ovary most likely originates in the ______rather than in the ovary itself.

distal fallopian tube (fimbriated end)

18

Benign mucinous tumors have a single layer of epthelium with apical mucin, nuclei are small and basally located. What features do borderline mucinous tumors have?

areas of papillary or velvety growth with piling up of nuclei

19

A ____mucinous tumor has areas of pseudo stratified nuclei whereas a _____tumor has basally oriented nuclei

1.borderline
2. benign

20

A mucinous carcinoma will have what type of growth pattern histologically?

an “expansile” growth pattern, marked by confluency of mucinous glandular structures with little intervening stroma.

21

A surgeon accidentally removes a tumor mass without following the proper staging procedures. What should they do next before initiating therapy?

Proper staging is required before therapy is initiated. If the tumor mass is removed without these staging procedures, then a second surgery will likely be required.

22

What sample is used for cytology in ovarian carcinoma staging?

free peritoneal fluid and/or washing of pelvis, paracolic gutters, and diaphragm

23

What histological samples should be taken when staging ovarian carcinoma?

-TAH-BSO (except in specific instances where unilateral salpingo-oophorectomy is appropriate)
-Resect infracolic mesentery and all visible lesions
-If no visible lesions, biopsies of cul de sac, R and L pelvic sidewalls and paracolic gutters, diaphragm
-Sample pelvic and para-aortic nodes

24

Review requirements for stage I ovarian carcinoma

Stage I: Limited to ovaries
A Limited to one ovary
B Limited to both ovaries
C Surface growth, ruptured capsule or positive peritoneal fluid

25

Review stage II ovarian carcinoma

Stage II: Pelvic extension
A Uterus/tubes
B Other pelvic organs
C IIA or IIB with positive peritoneal fluid

26

Mucinous borderline tumors are often stage ___ at presentation

I

27

Review stage III guidelines

Stage III: Extrapelvic disease
A Microscopic peritoneal disease
B Macroscopic peritoneal disease < 2 cm
C Macroscopic peritoneal disease > 2 cm, or + nodal metastasis

28

Serous malignant tumors are usually stage ___ at presentation

III

29

Stage IV criteria involves____

Distant disease (e.g. lung metastases)

30

Name 3 gene mutations that have highest risk for ovarian carcinoma

1. BRCA I
2. BRCA 2
3. Lynch (HNPCC)

31

T/F- p53, c-myc, H-ras, and K-ras are also implicated in some ovarian carcinoma

true

32

A woman has BRCA 1 and 2, what should she take to reduce her risk to that of the general population (1.6%)

oral contraceptives

33

Are there good screening tests for ovarian epithelial malignancy?

no, most women present at stage III (30-50% 5 yr survival)

34

Moving on to germ cell tumors, what is the most common germ cell tumor in women now?

teratomas (mature, immature, or malignant)

35

Name 5 types of germ cell tumors in women

-teratoma (resembles ecto, endo, or mesoderm)
-dysgerminoma (resembles germ cells)
-yolk sac tumor (resembles any endoderm structure)
-embryonal carcinoma (resembles embryonic disc)
-choriocarcinoma (resembles placenta)

36

A homogenous, tan tumor is discovered in a woman's ovary. What is this analogous to in a male?

This is a dysgerminoma, homologous to a seminoma of the testis

37

Is lymphoid infiltrate common in a dysgerminoma?

no

38

T/F- the prognosis is good for germ cell tumors

true

39

Name 3 types of ovarian sex cord-stromal tumors

Thecoma-fibromas
granulosa cell tumors
Sertoli-leydig cell tumors

40

Ovarian sex cord stromal tumors often produce what?

HORMONES

41

Granolas cell tumors are often yellow because of what? What hormone do they produce?

-large amounts of lipid
-produce estrogens

42

T/F- if a patient has a granulosa cell tumor removed she doesn't need long term follow up

False, They are known to recur many years after removal (e.g., ten or more years later), so patients must be followed up long-term.

43

Name the classic (but uncommon) feature of granulosa cell tumors (histologically)

-Call-exner bodies
-also will have nuclear grooves like coffee beans

44

Sertoli-leydig cell tumors are ______ (color) due to a large amount of ______ (tissue) and often produce _____ (hormone)

1. yellow
2. lipid
3. androgens (virilization)

45

______ tumors are notorious for late recurrences

granulosa cell tumors!

46

T/F- prognosis is poor for thecoma-fibroma tumors

False, 10 year survival is 100%

47

A tumor from the stomach metastasizes to the ovary and has signet ring cells. What is it called?

krukenberg tumor

48

Name sites of common metastasis to the ovary

-endometrium
-colon
-stomach
-breast
-melanoma
-lymphoma

49

What helps distinguish if a tumor is metastatic to the ovaries?

- Bilaterality
- Mets sometimes grossly smaller in size than primary disease
- “Outside-In” infiltration of tumor (mostly involving ovarian surface and cortex)
- Known history of other tumors (colon, gastric, breast, etc.)