OBG: Neoplasms

Question 1

Risk factors for Ovarian cancer

Answer 1

Old age 65+
Endometriosis

BRCA1/BRCA2 mutation
HNPCC syndrome (Lynch syndrome)
Family history

Elevated number of lifetime ovulations:
Infertility/low number of pregnancies
Early menarche
late menopause

Question 2

Ovarian cancer Protective factors

Answer 2

Bilateral salpingo-oophorectomy (BSO)
Breastfeeding
Oral contraceptives
Parity

B-BOP

Question 3

CA-125 is used as a tumor marker for epithelial ovarian cancer but can also be elevated in (3)

Answer 3

endometriosis
cirrhosis
malignancies (ex: uterine leiomyoma)

Question 4

___ should be the first step in evaluating women with suspicious ovarian masses.

Answer 4

Pelvic ultrasonography

TVUS

Question 5

___ ovarian tumor marker is CA-125

Premenopausal women: Elevated CA-125 points to a ___ process.

Postmenopausal women: Elevated CA-125 should raise concern for ___.

Answer 5

Epithelial

benign

malignancy

Question 6

Sex cord-stromal tumors

Granulosa cell tumor marker is ___

Answer 6

inhibin

Question 7

Dysgerminoma Germ cell tumor markers (2)

Answer 7

LDH

β-hCG

Question 8

Yolk sac tumor Germ cell tumor marker (1)

Answer 8

AFP

Question 9

Immature teratoma Germ cell tumor markers (3)

Answer 9

CA-125
AFP
LDH

(CAL is immature)

Question 10

Choriocarcinoma Germ cell tumor marker (1)

Answer 10

β-hCG (super elevated)

Also elevated in GTD, but not as much)

Question 11

Embryonal carcinoma Germ cell tumor markers (2)

Answer 11

AFP
β-hCG

(testicular cancer mostly in young and middle-aged men)

Question 12

___ is absolutely contraindicated in ovarian tumors because it may directly spread tumor cells to the peritoneum!

Answer 12

Fine needle aspiration

*Surgical evaluation
Recommended method for diagnosing ovarian cancer

Question 13

Ovarian mass workup (3)

Answer 13

1. Pelvic U/S
2. Tumor markers
3. Laparotomy/Laparoscopy

(NO Biopsy or fine needle aspiration b/c SEEDING risk)

Question 14

Treatment of ovarian cancer (2):

Answer 14

Surgical Resection

Chemotherapy (Carboplatin/paclitaxel)

Question 15

Ovarian cancer screening/prevention (3):

Answer 15

ONLY for high-risk individuals:

1st) do a Familial risk assessment
2nd) Genetic counseling/testing for (BRCA1, BRCA2, or Lynch)
3rd) If + genetic screen: consider ppx bilateral salpingo-oophorectomy (rrBSO) if no wish to conceive.

Question 16

Pregnancy luteoma

Rare, benign tumors 2/2 elevated hormone levels during pregnancy

May be Asymptomatic or cause _____

Diagnostics:
Pelvic u/s → SOLID adnexal mass
(Unilateral or Bilateral?) _____

Treatment:
________

Answer 16

Androgen hypersecretion and manifest with virilization of the mother or the fetus.

Can be unilateral or bilateral

Observation
Most regress spontaneously post partum.

Question 17

Types of epithelial ovarian tumors (7)

Answer 17

serous cystadenoma (benign)
mucinous cystadenoma (benign)
Brenner tumor (benign)
Serous Cystadenocarcinoma (Malignant)
Mucinous Cystadenocarcinoma (Malignant)
Endometrioid carcinoma (Malignant)
Endometriosis Clear cell tumors (Malignant)

Question 18

Cystadenocarcinomas are often (uni or bilateral?)

Answer 18

bilateral

Question 19

Psammoma bodies are a typical feature in these 2 ovarian epithelial cell tumors

Answer 19

serous cystadenoma (benign)
Serous Cystadenocarcinoma (Malignant)

Question 20

Endometriosis-associated tumors are filled with chocolate-colored fluid (2)

Answer 20

Endometrioma

Clear cell tumors

Question 21

On U/S
1. Unilocular cystic mass & Absent flow on Doppler

2. Multilocular cystic mass & Large

Answer 21

1. serous cystadenoma (benign)

2. mucinous cystadenoma (benign)

Question 22

Epithelial ovarian Tumor with:

mixed cystic/solid components and heterogeneous texture

May contain papillary projections and/or thick septations

Answer 22

Serous Cystadenocarcinoma (Malignant)

Question 23

Types of ovarian germ cell tumors (6)

Answer 23

Teratomas
-Dermoid cysts [mature cystic teratoma] (Benign)
-Struma ovarii [mature teratoma] (Benign)
-Immature teratoma (Malignant)
Yolk sac tumor [endodermal sinus tumor] (Malignant)
Dysgerminoma (Malignant)
Nongestational choriocarcinoma (Malignant)

Question 24

Types of sex cord-stromal tumors of the ovary (4)

Answer 24

Ovarian fibroma (Benign)
Theca cell tumor [Thecoma] (Benign)
Sertoli-Leydig cell tumor (Benign, usually)
Granulosa cell tumor (Malignant)

Question 25

Most common type of sex cord-stromal malignancy | ∼ 90%

Answer 25

Granulosa cell tumor (Malignant) Avg age: 50-55

Question 26

Clusters of spindle-shaped cells (fibroblasts) on histology of this tumor

Answer 26

Ovarian fibroma (Benign)

Question 27

Presents with lower abdominal discomfort and/or a pulling-sensation in the inguinal area May be associated with Meigs syndrome!

Answer 27

Ovarian fibroma (Benign) surgical removal of the tumor leads to complete resolution of symptoms.

Question 28

Which sex cord tumor presents with abnormal post-menpausal bleeding due to estrogen production. Ultrasound appearances include: Well-defined Hypoechoic, solid mass with clear margins & Visible endometrial thickening

Answer 28

Theca cell tumor [Thecoma] (Benign) ***Mass can be Echogenic or Anechoic too though

Question 29

Which sex cord tumor is associated with increased risk of endometrial cancer?

Answer 29

Granulosa cell tumor (Malignant)

Question 30

Most common of all germ cell tumors (90% of all cases) & Most common ovarian tumor in women < 30 years

Answer 30

Dermoid cysts [mature cystic teratoma] (Benign)

Question 31

Germ cell tumor with peak age: women < 20 years of age

Answer 31

Immature Teratoma (Malignant)

Question 32

Most common malignant ovarian germ cell tumor in adolescents and young women (but not most common over all)

Answer 32

Dysgerminoma (Malignant)

Question 33

``` Germ cell tumor on u/s with: Heterogeneous/ Hyperechoic mass Echogenic shadowing Absent internal vascularity and/or fluid-fluid levels ```

Answer 33

Dermoid cysts [mature cystic teratoma] (Benign)

Question 34

Germ cell tumor on u/s with: Large tumor with a solid component containing smaller, fluid-filled cysts and/or Small areas of calcification

Answer 34

Immature Teratoma (Malignant)

Question 35

Germ cell tumor on u/s with: | Large, solid, well- vascularized, multilobulated tumor that is well-defined relative to its surroundings

Answer 35

Dysgerminoma (Malignant)

Question 36

Germ cell tumor Macroscopic appearance: yellow, friable mass Schiller-Duval bodies (resemble glomeruli)

Answer 36

Yolk sac tumor [endodermal sinus tumor] (Malignant)

Question 37

Germ cell tumor with: | Cytotrophoblasts/syncytiotrophoblasts without chorionic villi

Answer 37

Nongestational Choriocarcinoma (Malignant)

Question 38

``` Germ cell tumor with: somatic tissue (hair, teeth, sebaceous glands) from any of the three embryonic germ layers. ```

Answer 38

Dermoid cysts [mature cystic teratoma] (Benign)

Question 39

Germ cell tumor composed of immature neuroectodermal tissue

Answer 39

Immature teratoma (Malignant)

Question 40

Fibroids (Leiomyomas) Treatment options that preserve fertility (4) Treatment options that will affect fertility (2)

Answer 40

First-line: 1. OCPs & progestin-only pill Second-line: 2. GnRH agonists*: (leuprolide, goserelin, nafarelin) reduce tumor size and vascularization * Optimal tx prior to surgery for no more than 6m 3. Androgenic agonists: (danazol): suppress growth 4. Myomectomy: surgical removal of fibroids - --------- 1. Uterine artery embolization 2. Hysterectomy