L38- Ovarian Pathology II Flashcards
(35 cards)
Endometroid Tumors:
- (1) and (2) somewhat common associations with tumor development
- (3) are the genetic associations
- (4)% bilateral + 5yr survival
1- concomitant endometrial carcinomas (not metastasis), 15-30%
2- endometriosis, 15-20%
3- PTEN, KRAS, β-catenin, MSI
4-
40% bilateral
5yr survival = 4-50%
Endometroid Tumors:
- (1) gross appearance
- (2) microscopic appearance
1- solid and cystic, small, papillae, velvety surface
2- resembles endometrial cancer = not normal endometrium (like in endometriosis)
Clear Cell Adenocarcinoma:
- (1) prevalence, aggressiveness
- (2) developmental association
- (3) cells
- (4) pathogenesis
1- uncommon, aggressive
2- endometriosis
3- clear cells
4- unclear pathogenesis
Brenner Tumor:
- cancer of (1) cells
- (benign/malignant)
- (3) gross appearance
1- transitional epithelial cells (like bladder) + dense fibrous tissue
2- usually benign (malignant may appear transitional cell carcinoma)
3- solid, yellow
Germ Cell Tumors, describe distribution
(15-20% ovarian cancers)
95% benign cystic teratomas
5% malignant (children, young adults)
-teratoma, dysgerminoma, endodermal sinus tumor (yolk sac tumor), choriocarcinoma (non-gestational)
list the types of teratomas
- mature
- immature
- monodermal: struma ovarii, carcinoid
- malignant transformation (–> SCC usually, sometime thyroid, melanoma)
Mature Teratoma:
- aka (1)
- (2) most affected group
- mostly (uni/bi)-lateral
- (4) gross appearance and content
1- dermoid cyst
2- young women, active reproductive yrs
3- 90% unilateral
4: (all 3 layers are individually apparent)
- skin, adnexa, sebaceous glands = cheesy material
- hair, teeth, bone cartilage, thyroid, fat, mature brain tissue
Immature Teratoma:
- (1) most affected group
- (2) gross appearance and content
1- young women
2: (cannot distinguish 3 germ layers)
- bulky, solid, hemorrhage, necrosis
- wide embryonic tissue variety: primitive neuroectoderm / neuroepithelium
Immature Teratoma grading and prognosis
Low Grade:
I- rare foci of immature neural tissue
-<1 LPF (low power field)
-very good prognosis
High Grade: II- 2-3 LPF III- 4 LPF -prophylactic chemotherapy -no recurrence w/in 2 yrs --> excellent cure rate
list the specialized teratomas
(aka monodermal)
Struma ovarii- hyperthyroidism
Carcinoid tumor- carcinoid syndrome
Strumal carcinoid- combination
Yolk Sac tumor = (1):
- (2) incidence
- (3) most affected group
- mostly (benign/malignant)
1- endodermal sinus tumor
2- rare
3- children, young women
4- malignant (chemotherapy has improved prognosis from quickly fatal)
Endodermal Sinus tumor, aka (1):
- (2) are excellent markers
- (3) and (4) are the main microscopic features
1- yolk sac tumor
2- AFP, AAT
3- pink cytoplasmic inclusions w/ AFP
4- Schiller Duval bodies: epithelial layers surrounding vessels resembling glomeruli
Dysgerminoma:
- (1) incidence and most affected group
- associated with h/o (2)
- similar appearance to (3)
- (benign/malignant) tumor
- local tumor is treated by (5)
1- 2% ovarian cancers, children and young women
2- gonadal dysgenesis
3- seminoma testis, medullary carcinoma breast
4- malignant, 1/3 are aggressive
5- surgery and its very chemosensitive
Dysgerminoma:
- (1) gross appearance
- (2) microscopic appearance
1- unilateral solid tumor: homogenous gray-pink, soft fleshy tumor
2- large round uniform cells, clear cytoplasm, central regular nuclei, no stroma, lymphocyte infiltration
Choriocarcinoma (non-gestational):
- (benign/malignant) + aggressiveness
- similar to (2) tumors
- (3) are good markers
1- malignant, highly fatal, early and widespread metastasis to lung, liver, viscera
2- uterine / placental choriocarcinoma, except no chemotherapy response like these tumore
3- hCG (urine, blood)
Choriocarcinoma (non-gestational):
- (1) appearance
- (2) unique feature of spread
1- hemorrhage, necrosis; pleomorphisms, giant cells, multinucleation
2- primary tumor regresses as secondaries persist
list the rare germ cell tumors
- embryonal carcinoma
- polyembryoma
- mixed germ cell tumor
Sex Cord Stromal Tumor:
- (1) derivation tissue
- (2) most affected age group
- (3) is key microscopic feature
(5% ovarian tumors)
1- ovarian stroma
2- 2/3 postmenopausal
3- granulosa + theca w/ or w/o lutinisation = Exner bodies
Sex cord stromal tumors can cause an increase in (1) allowing for (2) to possibly result. Rarely (3) is produced instead of (1) causing (4).
1- estrogen
2- feminizing features –> precocious puberty, endometrial hyperplasia / carcinoma
3- androgens
4- masculinization
Granulosa Theca Cell Tumors:
- (large/small) tumor with (un-/predictable) behavior
- (3) unique recurrence property
1/2- small, unpredictable – 5-25% malignant
3- late, 10-20 yrs after primary, indolent growth
Fibroma/Thecomas:
- (benign/malignant)
- (2) content
- (3) appearance
1- benign
2- fibroblasts (fibroma) OR plump spindle cells with fat (thecomas)
3- solid white to yellow mass
Fibroma/Thecomas:
- strange associations with (1) and (2)
- occasional association with (3)
1- ascites, 40%
2- hydrothorax on R side (Meig’s syndrome)
3- basal cell nevus syndrome
Androblastoma = (1):
- (benign/malignant)
- (3) most affected group
1- sertoli leydig cell tumor
2- benign (5% recur, metastasis)
3- any age, peaks 20-40 y/o
describe the 2 types of effects from a Sertoli Leydig Cell tumor
(androblastoma)
Defeminization: breast atrophy, amenorrhea, sterility, hair loss
Masculinization: hirsutism, male hair distribution, clitoral hypertrophy, voice changes
