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Flashcards in Ovarian Pathology Deck (62):
1

What type of ovarian cyst is due to non rupture of the dominant follicle?

Follicular

2

What blood marker would raise your suspicion of ovarian cancer?

CA125

3

A 34 year old lady present to a&e with sudden onset abdominal pain that came on when she was running and has been getting increasingly worse over the last 2 hours. She describes the pain as sharp and stabbing. She says she has had some episodes of stabbing pain in the past but they have resolved after 30 mins, unlike this.

Ovarian cyst torsion

4

Describe how a follicular ovarian cyst arises

Forms when ovulation doesn't occur
Follicle doesn't rupture but grows until it becomes a cyst.
Thin walled and lined by granulosa cells

5

Describe what you should so if you find a pelvic mass on examination of a 54 year old women.

1. Blood sample for tumour markers (CA 125)
2. US scan
3. Use age, menopausal status and US score to calculate risk of malignancy index

6

What three factors are taken into consideration when making a risk of malignancy index score?

CA125 value
Menopausal score
US score

7

How is the RMI in ovarian cancer calculated?

CA125 value x Menopausal score x US score

8

A score above what value on the RMI suggests high risk?

200

9

What is the name given to an ovarian metastatic tumour from gastric cancer?

Krukenberg tumour

10

On what chromosome is the mutation for the BRCA1 gene found?

17

11

On what chromosome is the mutation for the BRCA2 gene found?

13

12

What is the lifetime risk of someone with a BRCA 1 mutation developing ovarian cancer?

30 - 60%

13

What is the lifetime risk of someone with a BRCA 2 mutation developing ovarian cancer?

20%

14

What is the most common benign epithelial tumour of the ovary?

Serous cystadenoma

15

What are the three classifications of epithelial ovarian tumours?

Benign
Borderline
Malignant

16

On pathology of an ovarian cyst you see a simple cystic form with a smooth surface and smooth lining. there is no cytological abnormalities and no excess proliferation. Is this a benign, borderline or malignant epithelial tumour?

Benign

17

On pathology of an ovarian cyst you see cytological abnormalities and excess proliferation. There is no stromal invasion Is this a benign, borderline or malignant epithelial tumour?

Borderline

18

On pathology of an ovarian cyst you see cytological abnormalities, excess proliferation and stromal invasion Is this a benign, borderline or malignant epithelial tumour?

Malignant

19

Where does ovarian high grade serous cacrinoma usually originate?

Fallopian tubes

20

What is the precursor lesion for high grade serous cacrinoma?

Serous tubal carcinoma

21

What is the precursor for low grade serous carcinoma?

Serous borderline tumour

22

List the 5 types of epithelial ovarian tumours

Serous
Mucinous
Endometrioid
Clear cell
Brenner
(undifferentiated)

23

What 2 conditions are associated with endometrioid and clear cell carcinoma of the ovary?

Endometriosis of the ovary
Lynch sydrome

24

What is a brenner tumour?

Ovarian tumour of transitional type epithelium. Usually benign

25

Tumour of transitional type epithelium?

Brenner tumour

26

A tumour containing teeth, har and subum?

Germ cell tumour

27

List three types of ovarian sex cord/stromal tumours

Fibroma
Granulosa cell tumour
Sertilo Leydig cell tumour

28

What stage is ovarian cancer if it limited to one ovary only?

1A

29

What stage is ovarian cancer if it is in both ovaries only?

1B

30

What stage is ovarian cancer if it is in the ovarier and on the ovarian surface?

1C

31

What stage is ovarian cancer if it has extended into the fallopian tube?

2A

32

What stage is ovarian cancer if it has spread to other pelvic intraperitoneal organs?

2B

33

What stage is ovarian cancer if there is reteroperitoneal lymph node spread?

3A

34

What stage is ovarian cancer if there is microscopic extrapelvic peritoneal involvement?

3A

35

What stage is ovarian cancer if there is macroscopic peritoneal metastasis up to 2cm in dimension?

3B

36

What stage is ovarian cancer if there is macroscopic peritoneal metastasis over 2cm in dimension?

3C

37

What stage is ovarian cancer if there is distant metastasis

4

38

What kind of ovarian tumour caused defeminisation and then subsequent masculinisation with facial hair growth and clitoral enlargement

Sertoli leydig Cell tumour

39

What are the two most common chemotheraputic agents used in the treatment of ovarian cancer?

Paclotaxil
Carboplatin

40

What is the first lymph nodes that ovarian pathology will drain to?

Para aortic
Then pelvic and sometime inguinal

41

Does lymphatic or haematogenous spread usually come first in ovarian cancer?

Lymphatic

42

Above what stage and grade is chemotherapy recommened for?

Any ovarian cancer greater than Stage 1B grade 2

43

How does carboplatin work as a chemotheraputic agent?

Alkylating agent that forms DNA cross links that prevent cell replication

44

How does paclitaxel work as a chemotheraputic agent?

Prevents cell replication by interfering with cell microtubule formation

45

What is the inheritence pattern of lynch syndrome?

Autosomal dominant

46

What is the problem with the DNA in lynch syndrome? Why does it occur?

Defective DNA mismatch repair leading to microsatellite instability. Due to changes in the lengths of the dinucleotide repeats of cystonine and adenosine.

47

What cancers are you at increased risk of if you have lynch syndrome?

Colorectal cancer
Endometrial carcinoma
Digestive adenoma: Gastric adenoma, pyloric gland adenoma, duodenal adenoma, intestinal adenoma
Ovarian serous cystadenocarcinoma

48

What fertility treatment increases your risk of ovarian cancer?

Clomifine

49

Which malignant ovarian tumour is most common?

Serous cystadenocarcinoma

50

Which ovarian tumour causes a raised lactate dehydrogenase?

Dysgerminoma

51

Which ovarian tumour is most associated with streak ovaries as seen in Turners syndrome?

Gonadoblastoma

52

Which ovarian tumour produces AFP?

Yolk sac tumour

53

Describe how a follicular cysts arises?

Ovulation doesn't occur and the follicle doesn't rupture but grows until it becomes a cyst

54

How would you investigate a suspected follicular cyst?

US

55

A 23 year old women presents with a very sharp pain in her left iliac fossa. She is in the middle of her menstrual cycle

Ruptured follicular cyst

56

What are the two most commonly used chemotheraputic drugs in ovarian cancer?

Paclitaxel
Carboplatin

57

What is Meigs Syndrome?

Ascited and pleural effusuion/hydrothorax is association with a benign, usuallu solid ovarian tumour. In 80 - 90% of cases the tumour is an ovarian fibroma

58

What kind of ovarian tumour is most often associated with Meig's syndrome?

Ovarian fibroma

59

In which ovarian tumour would you most likely see a raised CEA?

Mucinous tumour

60

What is the main function of doing a blood test for CEA in someone with an ovarian tumour?

If it is raised it suggests that the tumour is a metastasis from a primary GI tumour

61

What is meant by optimal cytoreduction in debulking surgery?

No visible disease if left behind following laporotomy

62

What lymph nodes are removed in the debulking surgery done in early stage ovarian cancer?

Pelvic
Para aortic