Ovarian Pathology - Behmaram Flashcards Preview

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Flashcards in Ovarian Pathology - Behmaram Deck (20):
1

Recall the four sections of the oviduct.

What layers are found in the oviduct?

Infundibulum (fimbriated), ampulla, isthmus, and cornua.

Simple columnar epithelium (may be ciliated due to estrogenic effect), muscularis (inner circular, outer longitduinal)

2

What are the markers of chronic salpingitis?

What are the long-term risks it causes?

Like endometritis, the histologic hallmark is plasma cells in the plicae. This can cause them to be thickened or enlarged.

Scarring and disrupted ciliary motility increases the risk of ectopic pregnancy.

3

What is an ectopic pregnancy?

Where is it most often seen?

With what conditions is it associated?

Implantation of a zygote at a site besides the uterine body.

Most often found in the fallopian tube.

Endometriosis, as well as virtually any condition of the fallopian tubes.

4

Only one cancer of the fallopian tube was discussed. What was it?

It has two flavors, what are they?

Serous carcinoma.

May be invasive, or in-situ.

5

The normal ovary is anatomically divided into the capsule, medulla, hilum, and maybe capsule.

Name the three divisions of tissue which can form tumors.

Surface epithelium

Germ cells

Sex-cord & stroma

6

What do hilar cells secrete?

Are granulosa cells found in the cortex or medulla?

Where is the rete ovarii found?

What is the most obvious difference between a mature and young ovary?

Testosterone (analogous to testicular Leydig cells)

Cortex (anything follicular is related to the cortex)

In the medulla or hilum.

The number of eggs (primordial follicles)

7

The most common mass of the ovary is not a tumor, but a cyst. Name four discussed types.

Are they usually functional or non-functional?

Follicular

Luteal

Inclusion

Hemorrhagic

*Majority of cysts are functional.

8

The ovarian surface epithelium can give rise to many tissues. Which two are the most common? Why are they so named?

What are some uncommon tissues?

Serous and Mucinous, named for the appearance of fluid found in these cystic masses.

Transitional, Endometrioid.

9

What are some risk factors for surface epithelial tumors?

Risk reducers?

How many of these are malignant?

Anything estrogenic (obesity, estrogen usage), as well as family history (eg germ-line tumor suppressor mutations)

High parity, use of OCPs (presumably for progestin effect?)

About 20%.

10

Serous and mucinous tumors are both cystic when benign, and solid when malignant.

Which is more common?

Which can occasionally be bilateral?

Which can present with psammoma bodies?

Serous tumors are more common.

Serous tumors are also occasionally bilateral.

Serous again (not very confident on this point, but papillary serous endometrial carcinomas also have psammomas)

11

What factors might be expressed by a low-grade serous carcinoma?

High-grade?

What is the probable diagnosis for a bilateral mucinous cystadenocarcinoma?

Serous cystadenocarcinoma: KRAS/BRAF/ERBB2 if low-grade, p53 if high-grade.

A bilateral mucinous cystadenocarcinoma is probably metastatic. Recall: Krukenberg tumors are bilateral ovarian metastases of diffuse-type gastric adenocarcinomas.

12

Are endometrioid tumors generally benign or malignant?

Can they be bilateral?

What are their major associations?

MALIGNANT.

Yes, sometimes bilateral.

Associated with endometriosis; often concurs with (Type I) endometrial carcinoma. Even displays PTEN mutation!

13

What tissue type is found in a Brenner tumor?

Benign or malignant?

Bilateral?

Transitional-type epithelium (Urothelium!)

Benign, often incidentally found! Though nastier versions exist.

Usually unilateral.

14

Who generally gets germ-cell tumors?

How common are they?

Try to recall 4-5 types. (Hint: Think back to testicular pathology)

Younger patients; usually reproductive-age.

Comprise 15-20% of ovarian tumors.

Dysgerminoma (~seminoma), teratoma, yolk sac tumors, embryonal carcinoma, choriocarcinoma.

15

The most common germ-cell tumor is _____. It is usually (benign/malignant), unless expressing features such as ________. When benign, it may also be known as a ______.

Teratoma is most common. It is usually benign, but hallmarks such as neural elements or somatic malignancy (eg Squamous cell carcinoma inside the teratoma) can indicate malignancy. Benign teratomas may be called dermoid cysts (often rich in skin)

16

Here's some stuff from pathoma.

1. What is the prognosis for dysgerminoma? Why?

2. What serum and histological finding is characteristic of yolk-sac tumors?

3. Which germ-cell tumor spreads hematogenously?

4. Which germ-cell tumors are malignant?

1. Good; dysgerminomas, like seminomas, are radio-sensitive.

2. Elevated alpha-fetoprotein and schiller-duval bodies.

3. Choriocarcinoma!

4. Potentially, all of them.

17

Sex cord stromal-tumors may be functional or non-functional. Which secretes each of the following?

1. Estrogen

2. Testosterone

*Bonus: What histologic sign is shown in the answer to #1?

1. Estrogenic = Granulosa-theca cell tumors.

2. Testosterone = Sertoli-leydig cell tumors.

*Granulosa cell tumors feature Call-exner bodies which resemble follicles.

18

What is the most common ovarian metastasis?

Try to name 2 more.

Breast is mentioned in lecture. I would expect endometrial as well.

Sattar says: Gastric adenocarcinoma (Krukenberg) and Appendiceal mucinous adenocarcinoma (Pseudomyxoma Peritonei)

19

One category of sex-cord stromal tumors was not discussed in lecture. What is it?

CHALLENGE: What is Meigs syndrome?

Fibroma.

Meigs syndrome is fibroma associated with pleural effusions and ascites.

20

Which malignancies are most notably more common in those with hereditary BRCA1 mutations?

How can this knowledge guide their disease management?

Mostly mucinous & serous cystadenocarcinomas.

Prophylactic salpingo-oophorectomies are often sought (in additional to mastectomies)

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