Ovarian cancer Flashcards

1
Q

What are granulosa cell tumors?

A

Type of sex cord stromal tumor that secretes estrogen

low grade malignancy. bimodal (2 age groups)
- Present w/ large multicystic mass, abnormal bleeding, PRECOCIOUS PUBERTY, endometrial hyperplasia.
- Pathology w/ coffee-bean nuclei (Call Exner bodies).
- Tumor marker=inhibin.
Juvenile type=5%
Adult type: mild-age and older women.

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2
Q

What are germ cell tumors?

A

1/3 of all ovarian neoplasms. most common gyn malignancy in pre-adolescents.
- most are unilateral, do fertility sparing surgery
- Dermoid (mature cystic teratoma)=most common subtype.
- Malignant: dysgermimoma, yolk sac tumor, immature teratoma
Others: Choriocarcinoma, endodermal sinus, gonadoblastoma (malignant only if associated dysgermimoma elements)
- READ GYN WILLIAMS PAG 32541

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3
Q

What are protective factors for ovarian cancer?

A

OC use > 5 years, breastfeeding, full term pregnancy, multiparity, BTL, hysterectomy w/ oophorectomy.

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4
Q

What are immunohistochemical markers for serous ovarian tumors?

A

cytokeratin 7 (CK7), Ca-125, PAX8, WT1, KRT7

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5
Q

Risk factors for ovarian cancer?

A

1.3% lifetime risk (1 in 75)
- RF: family hx, uninterrupted ovulation (nulliparity, early menarche, late menopause, whites, person hx breast cancer, HRT, PID)
- Protective factors: breastfeeding, OCP use, BSO by age 40

  • median age diagnosis: 63!!
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6
Q

What are BRCA1/2?

A

AD genes. If BRCA1 (17q21), 40% chance of ovarian cancer.
- If BRCA2 (13q12), 20% chance.

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7
Q

What are low malignant potential tumors?

A

AKA Borderline (10-15% epithelial ovarian cancer)
- nuclear atypia, epithelial stratification, papillary projections, cellular pleomorphism, mitotic activity, microinvasion

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8
Q

What are serous tumors?

A

> 50% epithelial tumors
- path: psamomma bodies
- ciliated tubal epithelial
- not usually malignant

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9
Q

What are endometriosis tumors?

A

15-20% epithelial tumors
- good prognosis

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10
Q

What are mucinous tumors?

A

5-10% epithelial tumors.
- advanced stage are resistant to chemo, poor prognosis
- columnar endocervical epithelium
Pseudomyxoma peritonei, CEA=tumor marker

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11
Q

What is clear cell adenocarcinoma tumors?

A

5-10% epithelial tumors
- assoc w/ endometriosis
- Path: clear and “hobnail” cells
- mesonephric tissue histogenesis

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12
Q

What are sheets of lymphocytes associated with?

A

Dysgermimoma
- +B-HCG and LDH

“Distant germans betta have long distance”
- dysgerminoma, B-HCG, LDH

  • sensitive to radiation
  • cytoplasmic glycogen!
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13
Q

What are Schiller-Duval associated with?

A

Endodermal sinus tumor/yolk sac
- +AFP

“Egg Yolks can be AWESOME FRESH PICKS if you keep them in the CHILLER”
- Yolk sac, AFP, Schiller Duval

  • RAPID GROWTH
  • MALIGNANT
  • extraembryonic tissue
  • central capillary surrounded by connective tissue and peripheral columnar cells
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14
Q

What are Call-Exner bodies associated with?

A

Granulosa cell tumor
- micro follicular pattern with numerous small cavities - eosinophils present.

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15
Q

What are Psamomma bodies associated with?

A

serous tumor
- ciliated tubal epithelium

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16
Q

What are malignant cytotrophoblast associated with?

A

Choriocarcinoma

17
Q

What are signet cells associated with?

A

Krukenberg tumor

18
Q

What are tumor markers for ovarian cancer?

A

Ca-125
Human epidymis protein 4

19
Q

What are biomarkers for immature teratoma?

A

+AFP, LDH, CA-125

“Immature ladies are from pasadena California”
- immature teratoma, AFP, Ca-125
- fetal embryonic tissue
- MALIGNANT

20
Q

What are biomarkers for embryonal carcinoma?

A

B-HCG, AFP
“Embryos are betta AS FRESH PICKS”
- embryonal carcinoma, b-hcg, AFP
- malignant, embryonic tissue

21
Q

What ultrasound findings for adnexal masses suggest malignancy?

A

Cyst >10cm
papillary or solid components
Irregularity
Ascites
High color doppler flow

22
Q

What is ultrasound finding for endometrioma?

A

benign!
- homogenous appearing cyst with low-level echoes

23
Q

What is ultrasound finding for mature teratoma?

A

hypo echoic attenuating components with multiple small homogenous interfaces

24
Q

What is an immature teratoma?

A

most common variant of malignant germ cell tumors, account for 50%
- derive from 3 germ layers: ectoderm, mesoderm, endoderm
- more common than benign mature cystic teratoma (dermoid)
- tumor markers normal
- Large masses, go to peritoneum
- Neuroectoderm tissue predominant; GRADED by amount of immature NEURAL tissue they contain!!

25
Q

What is Meig’s syndrome?

A

triad of benign ovarian tumor with ascites and pleural effusion that resolves after resection of the tumor
- 1% tumors undergo malignant transformation

26
Q

What are random facts about ovary?

A

most common primary ovarian malignant: serous cystadenocarcinoma

most common ovarian neoplasm: mature cystic teratoma (dermoid)

Most common ovarian mass: functional cyst

27
Q

What are gonadal-stromal ovarian tumors?

A

3-5% of ovarian tumors
- Granulosa cell
- Fibroma (thecoma elements, w/ Meig syndrome)
- Thecoma (produce estrogen)
- Sertoli-Leydig (testicular gonad, crystal of Reinke, testosterone production)
- Lipid cells (testosterone)
- Gynandroblastoma (both ovarian + testicular, MALIGNANT

28
Q

What is a Brenner tumor?

A

type of epithelial ovarian cancer
- transitional urothelium
- Walthard cell rests

29
Q

What are Leydig cells associated with?

A

Hilus cell tumors

30
Q

What are pseudoxanthoma cells associated with?

A

Endometrioid cysts

31
Q

What are fibrous septa and lymphocytes associated with?

A

Dysgermimoma

32
Q

What are nesting tumors associated with

A

Brenners and granulosa

33
Q

What are bleomycin and adriamycin associated with?

A

Bleomycin: pulmonary fibrosis
Adriamycin: Cardiotoxic

34
Q

What is vincristine and vinblastine?

A

“Crist my nerves and Blast my bones”
Vincristine: neuro toxic
Vinblastine: Marrow toxic

35
Q

What are 5-FU and cytoxan associated with?

A

5-FU: cerebellar ataxis
Cytoxan: hemorrhagic cystitis, SIADH