ovarian pathology

Question 1

non-neoplastic cysts

Answer 1

follicular cysts
corpus luteum cyst
endometriosis

Question 2

follicular cysts

Answer 2

very common reach up to 5cm
forms when there is no LH surge and cyst doesn't rupture to release egg
usually harmless
resorb in 2-3 cycles
smooth walled unicameral/simple cysts

Question 3

corpus luteum cyst

Answer 3

if the opening from the released egg seals -> cyst
may spontaneously resolve or grow to 4cm
may hemorrhage or undergo torsion

Question 4

endometriosis

Answer 4

repeated cycles may form chocolate cyst

Question 5

ovarian torsion

Answer 5

sudden unilateral pain
occurs in young adult women typically with mass >5cm
must R/O ectopic by ultrasound
surgery

Question 6

PCOD

Answer 6

aka stein-leventhal syndrome
most common endocrine issue in repro age women
8-10% of all women worldwide

Question 7

PCOD symptoms

Answer 7

oligomenorrhea
hyperandrogenism (hirsutism etc)
polycystic ovareis
obesity, acanthrosis nigricans, DM, premature atherosclerosis

Question 8

features of PCOD

Answer 8

anovulation
MMR (amenorrhea)
infertility
acne, hirsuitism
insulin resistance and obesity 
high cholesterol

Question 9

stromal hyperthecosis

Answer 9

overlaps with PCOD
usually both ovaries enlarged with hormonally active ovarian stroma
most common in postmenopausal
virulization may be striking

Question 10

infertility

Answer 10

failure to conceive after 1 year of sex

Question 11

fecundity

Answer 11

likelihood of pregnancy over time

Question 12

serous tumors

Answer 12

47%
cystadenoma
borderline tumors
adenocarcinomas (type I and II)

Question 13

mucinous tumors

Answer 13

3%
cystadenoma
adenocarcinoma (only type I)

Question 14

endometrioid tumors

Answer 14

20%

adenocarcinomas (type I and II)

Question 15

sex-cord stromal tumors

Answer 15

granulosa tumors
fibrothecomas
sertoli-leydig tumors

Question 16

germ cell tumors

Answer 16

teratoma
dysgerminoma
endodermal
sinus (yolk sac)

Question 17

metastatic tumors

Answer 17

5%

Question 18

ovarian CA overview

Answer 18

asymptomatic until late
disease of older women (60s)
BRCA 1&2 mutations
lynch syndrome II (MSH 2 mutation)
prognosis dependent on stage
often b/l
NO effective screening
may arise from distal fallopian tube

Question 19

serous cystadenoma

Answer 19

common benign lined by single layer of epi which is ciliated

Question 20

serous borderline carcinoma

Answer 20

excrescences on cyst wall, more cytologic atypia, NO invasion
papillary
often seed peritonium
100% 5 yr survival

Question 21

serous adenocarcinoma type I

Answer 21

low grade slow progression

Question 22

serous adenocarcinoma type II

Answer 22

presents late

worse prognosis

Question 23

psammoma bodies

Answer 23

pathogmonic for serous adenocarcinoma (not specific for either type)

Question 24

mucinous tumors

Answer 24

least likely to be b/l (if it is R/O mets)
80% benign
KRAS mutation

Question 25

rupture of mucinous tumors

Answer 25

pseudomyxoma peritonei -mucinous ascites w/mets on peritoneal surfaces usually d/t appendix rupture

Question 26

endometrioid tumros

Answer 26

mostly carcinomas may arise in endometriosis 30% concurrent ovarian and endometrial endometrioid carcinomas

Question 27

type I endometrioid tumors

Answer 27

PTEN and KRAS

Question 28

type II endometrioid tumors

Answer 28

p53 CDH1 MI

Question 29

high-grade serous immunoprofile

Answer 29

``` p53+ WT1+ Pax8+ High Ki67 2/3s are ER+ ```

Question 30

high-grade serous mutation

Answer 30

tp53 | BRCA1,2

Question 31

low-grade serous immunoprofile

Answer 31

WT1+ Pax8+ p53- low Ki67

Question 32

low-grade serous mutations

Answer 32

BRAF | KRAS

Question 33

endometrioid carcinoma immunoprofile

Answer 33

``` ER+ Pax8+ Vimentin+ WT1- p53- ```

Question 34

clear cell immunoprofile

Answer 34

HNF beta+ WT1- ER-

Question 35

clear cell mutations

Answer 35

KRAS PTEN PIK3CA

Question 36

mucinous immunoprofile

Answer 36

``` CK20+ cdx+ CK7+ ER- WT1- ```

Question 37

mucinous mutations

Answer 37

KRAS

Question 38

peritoneal carcinomatosis

Answer 38

distinctive diffuse seeding of peritoneum small shallow implants cytology of ascites can aid Dx

Question 39

what can be used to follow course of surface epi tumors?

Answer 39

CA-125

Question 40

High albumin gradient

Answer 40

``` cirrhoiss alcoholic hepatitis heart failure/constrictive pericarditis massive hepatic mets budd-chiari syndrome portal v thrombosis idiopathic portal fibrosis ```

Question 41

low albumin graident

Answer 41

``` peritoneal carcinomatosis peritoneal TB pancreatits serositis nephrotic syndrome ```

Question 42

granulosa-thecal cell tumors

Answer 42

``` any age 2/3 in postmenopausal eomen hormonally active 75% produce E yellow inhibin + FOXL2 mutation callexner bodies can cause vaginal bleeding ```

Question 43

fibromas

Answer 43

``` very common solid white hard fibrous tumor usually u/l bening associated with meig syndrome ```

Question 44

meig syndrome

Answer 44

ascites pleural effusion ovarian fibroma resolves with resection of fibroma

Question 45

sertoli-leydig cell tumors

Answer 45

rare all ages 50% produce androgens

Question 46

germ cell tumors

Answer 46

``` teratomas dysgerinomas endodermal sinus (yolk sac) choriocarcinomas tend to be benign in adutls and malignant inkids ```

Question 47

dermoids

Answer 47

benign cystic teratoma 2-3 germ cell lines distinctive rokitanski nodule 1% develop CA (usually SCC)

Question 48

immature malignant tertatoma

Answer 48

girls and adolescents contain immature tissues (embryonal and fetal) rapid growth and spread

Question 49

monodermal (specialized teratomas)

Answer 49

single tissue predominates carcinoids or struma ovarii most common functional -> hyperthyrodism and carcinoid syndrome

Question 50

dysgerminoma

Answer 50

``` ALL MALIGNANT ovarian counterpart to seminoma highly sensitive to radiation only 1/3 aggressive fried egg appearance on histo ```

Question 51

endodermal sinus tumor

Answer 51

``` yolk sac very aggressive produces alpha fetoprotein and alpha 1 antitrypsin schiller-duval bodies kids/young adults chemo ```

Question 52

choriocarcinoma

Answer 52

``` usually w/in another germ cell tumor psudoplacental tissue aggressive produce beta-HCG high levels no sensitive to methotrexate ```

Question 53

krukenburg tumor

Answer 53

b/l mets of mucin producing signet CA cells, especially gastric origin