Ovarian Cancer and Pathology

Question 1

What symptoms may ovarian pathology cause?

Answer 1

Pain, swelling or endocrine effect

Question 2

What are some features of ovarian cysts?

Answer 2

Arise from any element

May be innate or acquired

Question 3

What are the types of ovarian cyst?

Answer 3

Follicular, luteal, endometriotic, epithelial, mesothelial

Question 4

How common are follicular ovarian cysts?

Answer 4

Very common = can form when ovulation doesn’t occur leading to polycystic ovaries

Question 5

What are some features of follicular ovarian cysts?

Answer 5

Follicle doesn’t rupture but grows to become a cyst
May be several cm in size
Thin walled and lined with granulosa cells
Usually resolve over a few months

Question 6

What is endometriosis?

Answer 6

Presence of endometrial glands and stroma outside the uterine body

Question 7

What can endometriosis present with?

Answer 7

Pelvic inflammation, pain and inflammation

Question 8

Where are some sites endometriosis can occur?

Answer 8

Ovaries, pouch of Douglas, peritoneal surfaces, cervix, vagina, vulva, bladder

Question 9

What is the pathogenesis of ovarian endometriosis?

Answer 9

Regurgitation, metaplasia, vascular or lymphatic dissemination

Question 10

What is the appearance of ovarian endometriosis?

Answer 10

Macroscopic = peritoneal spots/nodules, fibrous adhesions, chocolate cysts
Microscopic = endometrial glands and stroma, haemorrhage, inflammation, fibrosis

Question 11

What are some complications of endometriosis?

Answer 11

Pain, cyst formation, infertility, ectopic pregnancy, endometrial carcinoma

Question 12

What are the types of ovarian tumour?

Answer 12

Epithelial, germ cell, sex cord/stromal, metastatic, miscellaneous

Question 13

What are the types of epithelial ovarian tumour?

Answer 13

Serous, mucinous, endometrioid, clear cell, Brenner, undifferentiated carcinoma

Question 14

What are some features of epithelial ovarian tumours?

Answer 14

Cell of origin not entirely clear
Account for 65-70% of ovarian tumours
Categorised as benign, borderline or malignant

Question 15

What are some features of benign epithelial ovarian tumours?

Answer 15

No cytological abnormalities, proliferative activity absent/scant, no stromal invasion

Question 16

What are some features of borderline and malignant ovarian tumours?

Answer 16

Borderline = cytological abnormalities, proliferative, no stromal invasion
Malignant = stromal invasion

Question 17

How are serous epithelial ovarian tumours graded?

Answer 17

High grade = serous tubal intraepithelial carcinoma (STIC), most cases essentially tubal in origin
Low grade = serous borderline tumour

Question 18

What are endometrioid and clear cell epithelial ovarian tumours associated with?

Answer 18

Ovarian endometriosis and Lynch syndrome

Question 19

How are endometrioid epithelial ovarian tumours graded?

Answer 19

Graded the same as uterine tumours = most are low grade and early stage

Question 20

How common are germ cell ovarian tumours?

Answer 20

15-20% of all ovarian tumours

Question 21

What is the most common type of germ cell ovarian tumour?

Answer 21

Mature teratoma = benign dermoid cyst

95% of all germ cell tumours

Question 22

What are some features of mature teratomas?

Answer 22

Cystic = contain sebum and hair

Can rarely become malignant

Question 23

What are some common sites for mature teratomas to occur?

Answer 23

Skin, respiratory epithelium, gut, fat

Question 24

What are the other types of germ cell ovarian tumours?

Answer 24

Immature teratoma, dysgerminoma, yolk sac tumour, choriocarcinoma, mixed germ cell tumour

Question 25

What are some examples of sex chord/stromal ovarian tumours?

Answer 25

Fibroma/thecoma = benign, may produce oestrogen causing uterine bleeding Granulosa cell tumour = all potentially malignant, may be associated with oestrogenic manifestations Sertoli-Leydig tumours = rare, may produce androgens

Question 26

What are some features of metastatic ovarian tumours?

Answer 26

Consider when tumours are bilateral and small | Commonly from stomach, colon, breast or pancreas

Question 27

What is Figo stage 1 of ovarian cancer?

Answer 27

``` 1A = limited to one ovary 1B = limited to both ovaries 1C = cancer involving ovarian surface ```

Question 28

What is Figo stage 2 ovarian cancer?

Answer 28

``` 2A = extension or implants on uterus or fallopian tubes 2B = extension to pelvis (intraperitoneal) ```

Question 29

What is Figo stage 3 ovarian cancer?

Answer 29

``` 3A = retroperitoneal lymph node metastases or microscopic extrapelvic peritoneal involvement 3B = macroscopic peritoneal metastasis beyond pelvis up to 2cm in dimension 3C = macroscopic metastasis >2cm in dimension ```

Question 30

What is Figo stage 4 ovarian cancer?

Answer 30

Distant metastases

Question 31

What are some pathologies that can affect the fallopian tubes?

Answer 31

Inflammation = salpingitis Cysts and tumours Serous tubal intraepithelial carcinoma (STIC) Endometriosis or ectopic pregnancy

Question 32

What is an ectopic pregnancy?

Answer 32

Implantation of conceptus outside endometrial cavity = often rupture to cause haemorrhage

Question 33

Where can ectopic pregnancies occur?

Answer 33

Most commonly in fallopian tubes | Can also occur in ovary or peritoneum

Question 34

When should you suspect an ectopic pregnancy?

Answer 34

In any female of reproductive age with amenorrhoea and acute hypotension or acute abdomen