Ovarian Path Flashcards by k k

What do serous bordeline tumors look like microscopically

HIERARCHICAL BRANCHING

Psammoma bodies- Laminated/targetoid calcifications

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Mature Cystic Teratoma

Germ cell tumor
All three types of germ layers
Commonest ovarian tumor 
Some have teeth!!
Most asymptomatic

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Anti-NMDA Encephalitis

Anti-N-methyl D-aspartate receptor (NMDAR) encephalitis affects young women

Presents with psychosis, memory deficits, seizures

Frequently associated with underlying neoplasm, most often teratoma

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Immature Teratoma

Grading based on amount of immature neural tissue (more is worse)

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Dysgerminoma

50% of malignant GCT

Female counterpart to seminoma

Excellent prognosis, even with widespread metastases

Sheets and nests of cells with large central nuclei and prominent nucleoli

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Yolk Sac Tumor

Usually 10-30 years old or perimenopausal women

Produces alpha-fetoprotein

Schiller-Duval body

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What the histologic feature to know about yolk sac tumors?

Schiller-Duval body- Glomeruloid structure with central blood vessel surrounded by neoplastic cells

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Sex Cord Stromal Tumors

Granulosa cell tumor (adult and juvenile)
Thecoma-fibroma
Sertoli-Leydig cell

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Adult Granulosa Cell Tumor

3% primary ovarian tumors
Associated with endometrial neoplasia
Serum inhibin is a great tumor marker
Late recurrance

Call-Exner bodies: resembles orimitive follicae; central space with secretions

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What’s the path buzz word for Adult Granulosa Cell Tumors?

Call-Exner bodies: resembles orimitive follicae; central space with secretions

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Fibroma/Thecoma

4% of all ovarian tumors

Almost all benign, but 1/5 have concurrent endometrial carcinoma

Hormone secreting in some cases can lead to abnormal bleeding as presenting symptom

Meig’s syndrome: Fibroma + Ascites + Hydrothorax

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Sertoli-Leydig Cell Tumor

Recapitulates developing testis

Clinical outcome dependent on stage & grade

12% clinically malignant

Well differentiated: rarely metastasizes

Moderately/poorly diff: ~10% metastasize

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General features of primary vs metastatic disease

Primary:
Unilateral
No surface growth
Absence of nodularity
Larger (>10 cm)

Metastatic
Bilateral
Surface and hilar involvement
Nodular growth pattern
Infiltrative growth with desmoplastic stroma
Smaller (

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Krukenberg Tumor

Metastatic gastric carcinoma

Signet ring morphology

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Pseudomyxoma Peritoneii

Metastatic from appendix

“Jelly belly”- mucin throughout abdomen

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Tubal Intraepithelial Carcinoma

Fimbriated end of fallopian tube

Putative precursor to most ovarian high grade serous carcinomas

p53

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Ectopic Pregnancy

Implantation other than intrauterine
90% in fallopian tube
35-50% with prior PID
Other tubal scarring
Most common cause of hematosalpinx
Rupture = Medical Emergency

Endometriosis

Extrauterine endometrial glands and stroma
Ovaries, uterine ligaments, pelvic peritoneum, bowel
6-10% women
Infertility, dysmenorrhea, pelvic pain
“chocolate cyst”

Polycystic Ovarian Disease

Young ♀ with infertility, oligomenorrhea, obesity (40%) and hirsutism (50%)

Pathophysiology:
Persistent anovulation due to asynchronous release of FSH and LH
Excess androgens with peripheral conversion to E2
Rx: Early intervention, metformin
Risk: unopposed E2 risk for Endometrial CA

Inherited Risk Factors for ovarian cancer

BRCA1: Ch 17q21 &amp; BRCA2: 13q12-13
DNA repair genes
Syndrome includes CA of breast and ovary
Patients frequently survive breast CA, mortality from ovarian CA
Typically high grade serous carcinoma

Presenting symptoms of ovarian cancer

Bloating
Pelvic/Abdominal pain
Early satiety
Urinary symptoms
Others: fatigue, dyspareunia, constipation, metrorrhagia

> 12 times/month or persistent symptoms new to patient visit doctor (gynecologist)

What are the major classifications of ovarian tumors?

Surface epithelial (stromal cell): 65-70%
Germ Cell: 15-20%
Sex cord-stroma: 5-10%
Metastasis to ovaries: 5%

What is the origin of most epithelial tumors believed to be?

fimbriated end of fallopian tube

Do low-grade serous carcinomas of the ovaries exist? What about low-grade serous carcinomas of the endometrium?

Ovaries: yes can exist
Endometrium: NO. By definition is high-grade

What percent of ovarian tumors are benign?

80%

Borderline tumors

Intermediate biologic phenotype “Low Malignant Potential” Often associated with long term survival Low proliferative rate ∴ not responsive to radiotherapy or chemotherapy

Characteristics of malignant ovarian tumors

``` Heterogeneous Solid & cystic Hemorrhage & necrosis +/- vaginal bleeding, ↑ abdominal girth High risk for dissemination ```

Serous Neoplasms

Hierarchical branching, cuboidal cells Most frequent subtype (30% ovarian tumors) Tubal-type epithelium: Ciliated columnar cells Survival: Benign (100%) Borderline (80%) Malignant (20%)

Histologic and gross findings of serous neoplasms (benign, borderline, malignant)

Epithelial tufting One or multiple thin-walled cysts Psammoma bodies: Laminated/targetoid calcifications (seen in benign and malignant settings) Benign: Broad papillae with fibrovascular cores No cytologic atypia or mitoses Borderline: Intracystic velvety papillary excrescences Complex papillae with epithelial tufting and HIERARCHICAL BRANCHING No stromal invasion +/- surface involvement; potential to spread Malignant (carcinoma): Solid, cystic, mixed Friable with hemorrhage and necrosis Cysts contain “straw-like” proteinaceous fluid Increasingly complex architectural patterns Stromal invasion present Marked cytologic atypia Pleomorphism (*) Mitoses (^) Glandular (bottom left) or solid (bottom right)

Treatment for malignant serous carcinoma of the ovary

Surgery + Chemo +/- Radiation

Mucinous Surface-Epithelial Tumors

Huge tumors, Intestinal vs Endocervical epithelium Benign, borderline, malignant Discrete dilated glands with simple shapes (no branching)

Types of Surface-Epithelial Tumors

``` Seers = Serous Make = Mucinous Everything = Endometrioid Clear = Clear cell ```

Cystadenoma

A type of Mucinous Surface-Epithelial Tumor Simple glandular epithelium with small basal nuclei and abundant blue (mucinous) apical cytoplasm

Mucinous Borderline Tumors

Stratified epithelium with atypia and scattered mitoses | 10 year survival: 80%

Mucinous Carcinoma

Rare compared to serous carcinomas Unilateral in 80% 10 year survival = 35% Stage is most important prognostic factor 2 types of invasion Destructive (25% recur) Expansile (

Endometrioid

Resembles uterine adenocarcinoma Always exclude metastasis from uterine tumor Same grading schema based on solid component Similar genetic alterations as low-grade endometrial Synchronous primary endometrial carcinoma in 15-30% 20% of all ovarian CA 40% bilateral 5 year survival for Stage 1 = 75%

Clear cell Carcinoma

Very rare, but may be aggressive Exclude metastases from other organs Many growth patterns Associated w endometriosis Tubulocystic growth pattern “Hobnail cells”: Nuclei bulging into cystic space without apparent cytoplasm (*)

What is clear cell carcinoma of the ovary associated with?

ENDOMETRIOSIS

What do mucinous tumors usually have?

GOBLET CELLS

What do endometrioid tumors usually resemble?

normal endometrial glands

What kinds of cells does clear cell carcinoma have?

Hobnail cells!

Call-Exner bodies

Granulosa Cell Tumor