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Flashcards in Ovarian Pathology Deck (49):

What is the most common disorder of the fallopian tubes?

inflammation (salpingitis), almost invariably occurring as a component of pelvic inflammatory disease. Less common abnormalities are ectopic pregnancy, endometriosis, and rarely primary tumors


Inflammation of the fallopian tubes mostly occurs due to what?

bacterial, now more due to nongonoccal organisms such as Chlamydia, Mycoplasma hominis, and streptococci in postpartum settings

NOTE: Nongonnocal infections can pentrate the tube walls and spread via blood and seed to the meninges, heart, and joints


How does salpingitis present?

fever, lower abdominal or pelvic pain, all of which are the result of distention of the tubes with debris or exudate


Describe tumors of the fallopain tubes

Primary adenocarcinomas are rare but are associated with BRCA mutations (usually occur in the fimbria)

NOTE: It is generally well accepted that serous carcinomas generally arise here and metastasize to the ovary and not the other way around


What are follicular ovarian cysts?

These are so commonplace that they are considered part of normal physiology and begin from unruptured graafian follicles. These cysts are often multiple, small, and filled with clear fluid. When small they are lined by grnaulosa or luteal cells (but when they grow larger, fluid accumulation may produce pressure that causes cellular atrophy). These usually spontanoeusly rupture and dissappear. 

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What is this?

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This is a corpus leuteal cyst- again mostly harmless but can cause ovarian torsion (20% in pregnancy). In these cases, pts. present with acute unilateral lower abdominal pain caused by venous congestion. 

Histologically, these cysts are lined by a rim of bright yellow tissue containing luteinized granulosa cells. They occasionally rupture and cause a peritoneal reaction.


What is Polycystic Ovarian Disease?

aka Stein-Leventhal disease, this is a disorder in which multiple cystic follicles in the ovaries produce excess androgens and estrgoens and typically comes to attention after menarche in teenage girls who present with oligomenorrhea, hirsutism, infertility, and obesity. 


Tumors of the ovaries arise from what three structures?

-surface epithelium

-germ cells

-sex cord-stroma

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Where do most ovarian tumors arise from?

The vast mjaorty originate in the surface epithelium 


How do epithelial tumors typically form?

Repeated cycles of ovulation and scarring causes the surface epithelium to become entrapped in the cortex of the ovary, forming small cysts that can become metaplastic or give rise to a number of tumors


What are the risk factors for ovarian cancer?

nulliparity and unmarried women

fam Hx

germline mutations in certain tumor suppressor genes like BRCA


T or F. Prolonged use of oral contraceptives lowers the risk of ovarian cancer



Describe serous ovarian epithelial tumors

These are the most common ovarian epithelial tumors, with the majority being benign (60%) and malignant versions typically being found in older pts. These typically present at an advanced age and cause a significant number of deaths 


What are the variants of serious epithelial ovarian tumors?

There are Type I (low grade) types that arise in the ovaries and produce borderline tumors that can progress to invasive carcinomas and then Type II (high grade) that probably arise in the fimbriae as STIC lesions fallopian tubes and are more strongly associated with BRCA and T53 mutations 


Are serous epithelial ovarian tumors bilateral?

Bilaterality is common, occurring in 20% of benign serous cystadenomas, 30% of serous borderline tumors, and approximately 66% of serous carcinomas.


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What is this?

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Borderline serous epithelial ovarian tumor showing increased architectural complexity and epithelial cell stratification. 


How can you distinguish low grade and high grade ovarian epithelial tumors histologically?

High-grade serous carcinomas are distinguished from low-grade tumors by having more complex growth patterns and widespread infiltration of the underlying stroma

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What is this?

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A mucinous tumor of the ovarian epithelium. The vast majority of these are benign, very large and commonly multicystic


What parts of a mucinous epithelial tumor of the ovary suggests malignancy?

•Serosal penetration and solid areas of growth are suggestive of malignancy

•Malignant tumors are characterized by the presence of architectural complexity, including solid areas of growth, cellular stratification, cytologic atypia, and stromal invasion. 


T or F. Mucinous tumors of the ovary are more likely to be bilateral than serous tumors



Mutation of the _________ is a consistent genetic alteration in mucinous tumors of the ovary

KRAS proto-oncogene


What is pseudomyxoma peritonei?

This is a clinical condition marked by extensive mucinous ascites, cystic epithelial implants on the peritoneal surfaces, adhesions, and frequent involvement of the ovaries

•Recent evidence points to the source being, in almost all cases, extraovarian (usually appendiceal) 

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What is this?

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An endometrioid adenocarcinoma, a tumor of the epithelium of the ovaries that often co-exist with endometriosis (15% to 20% of cases with endometrioid carcinoma coexist with endometriosis) and are marked bythe formation of tubular glands similar to those of the endometrium within the lining of cystic spaces


T or F. Endmedtrioid tumors are mostly benign

F. They are mostly malignant


What mutation is common in endometrioid carcinomas of the ovary?



Describe transitional cell (Brenner) tumors

These are uncommon, usually unilaterla ovarian tumors characterized by nests of transitional-type epithelium. Most of these are benign

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What are the main sources of secondary (met) tumors in the ovaries?

Metastatic tumors to the ovaries account for about 5% of all ovarian tumors

•The most common are derived from tumors of müllerian origin: the uterus, fallopian tube, contralateral ovary, or pelvic peritoneum.

•The most common extra-müllerian tumors are breast and gastrointestinal tract.

•Also included in this group are the rare cases of pseudomyxoma peritonei, derived from appendiceal tumors.


What is this?

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A Krukenberg tumor, a classic metastatic GI carcinoma that goes to the ovaries and is characterized by bilateral metastases composed of mucin-producing, signet-ring cancer cells, most often of gastric origin.


What are the ovarian tumors of sex cord stroma origin?

•Granulosa tumors

•Fibromas, Fibrothecomas, and Thecomas

•Sertoli-Leydig cell tumors


Describe granulosa tumors

Low grade sex cord tumors that can produce a large amount of estrogen (which can in turn cause endometrial hyperplasia and even carcinoma)

These primarily occur in postmenopausal women and are unilateral


How do granulosa tumors of the ovary appear histologically?

The tumor cells are arranged in sheets punctuated by small follicle-like structures (Call-Exner bodies).

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Grnaulosa tumors of the ovary stain strongly with an Ab to _____



What is this?

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This can either be a fibroma, a fibrothecoma, or a thecoma. 

These can present at any age and are usually unilateral


What are some ommon associations with fibromas and thecomas?

•Combination of findings (ovarian tumor, hydrothorax, and ascites) is designated Meigs syndrome. Its genesis is unknown.

•The second association is with the basal cell nevus syndrome


What is this?

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A Sertoli-Leydig cell tumor- these tumors are often functional and commonly produce masculinization or defeminization, but a few have estrogenic effects.

• less than 5% metastasize, and these can present at any age (unilateral)


What are some germ cell neoplasms of the ovary?



-Yolk sac tumor


How common are teratomas of the ovary?

they account for 15-20% of all ovarian tumors and commonly present within the first 20 yrs of life (and the younger the presentation, the greater the likelihood of malignancy. More than 90% of these are benign mature cystic teratomas however)


What are the types of ovarian teratomas?

-benign (mature) cystic teratoma

-immature malignant



Describe mature benign teratomas of the ovary

These are marked by the presence of tissue derived from all three germ layers (ecto, meso, and endo). Most are found in young women incidentally because they contain calcifications. The vast majority are unilateral


What else can be a very good tip of a mature cystic teratoma when excised?

it may contain hair, pieces of bone, cartilage, or even teeth

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T or F. Benign teratomas are likely to undergo torsion

T. AND they are very commonly associated with infertility


What is this?

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An immature malignant teratoma. These resemble embryonal and immature fetal tissue and are commonly found in prepubertal adolescents and young women

•An important risk for subsequent extraovarian spread is the histologic grade of tumor (I through III), which is based on the proportion of tissue containing immature neuroepithelium .


What is this?

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This is struma ovarii, a monodermal teratoma composed of normal ovarian tissue on the left and thyroid tissue on the right 


What are dysgerminomas?

The ovarian counterpart of testicular seminoma (Also present in mediastinum, pineal gland (germinoma), and retroperitoneum)

All are malignant but only about 1/3 are aggressive so there is an 8)% cure rate

Below: Fried egg appearance with lymphocytes

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Dysgerminomas commonly overexpress what gene? How can it be ID'd?

receptor tyrosine kinase KIT which can be ID'd using a CD117 stain (below) or a PLAP marker 

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_____is elevated in the sera of 75% to 90% of women with epithelial ovarian cancer. 

CA-125. However, CA-125 is undetectable in up to 50% of women with cancer limited to the ovary. it is primarily used to monitor therapy