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Obstetrics And Gynecology > Ovarian Tumors > Flashcards

Ovarian Tumors Flashcards

1
Q

Increased scars on ovary surface can be seen in cases of

A

Nulliparous
Ovulation induction
Early menarche
Late menopause
Perineal talc
Asbestosis
These all increases predisposition to epithelial injury

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2
Q

Increased scars on ovary can lead to

A

Epithelium of ovary tries to heal by itself - can lead to overhealing due to repeated injuries - Can eventually cause Epithelial Ovarian cancers

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3
Q

Which gene mutations increase predisposition to ovarian cancer

A

BRCA 1 - Chr 17
BRCA 2 - Chr 13

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4
Q

Chances of ovarian cancer If two 1st degree relatives with female specific cancers

A

35-40%

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5
Q

Chances of ovarian cancer if one 1st degree and one 2nd degree relatives with female specific cancers

A

2-10 times chances

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6
Q

Age group mostly affected in case of Ovarian cancers

A

Elderly (6th to 7th decade)

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7
Q

Ovarian cancer is associated with increase in which Prognostic marker

A

CA125

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8
Q

CA125 significant values in postmenopausal and premenopausal women

A

> 35 - postmenopausal
200 - in premenopausal

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9
Q

Which is the most common ovarian cancer

A

Epithelial Ovarian cancer - 70%

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10
Q

Which is the biggest tumor of mankind

A

Ovarian tumor

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11
Q

USG Features of Malignancy in case of Ovarian Cancers

A

Transvaginal > Transabdominal
Bilateral tumor
Multiloculated
Surface irregularities
Cystic + Solid areas in same tumor
A/w ascites
Metastasis

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12
Q

Risk of Malignancy index (RMI) Includes

A

Menopausal status
Ultrasound features
Sr CA 125

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13
Q

Which is specific marker for Ovarian cancer

A

Human epidydimis Protein 4 (HE-4) - 94% specificity
No effect with endometriosis

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14
Q

(Risk od Malignancy Algorithm) ROMA cutoff values for premenopausal and postmenopausal women

A

7.4% for premenopausal
25.3% for postmenopausal

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15
Q

Best treatment modality for Ovarian cancers

A

Staging Laparotomy + Optimal debulking

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16
Q

All cancers in Gyne are staged by and exception

A

Staged surgically except Ca Cervix (Staged clinically)

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17
Q

Steps for Staging Laparotomy and Optimal debulking

A

1) Vertical abdominal incision
2) If ascites/washings 50-100ml NS of pouch of Douglas,paracolic gutters
3) Assess the tumor and spread in clockwise manner (to check organ involvement)
4) Peritoneal biopsies
5) Scrape both hemidiaphragm
6) Supracolic omentectomy - send for pathology
7) Retroperitoneal LN sampling - Pelvic, Paraaortic LN

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18
Q

Optimal Debulking AKA

A

AKA Cytoreduction
Residual cancer is less than 1cm size
Post operative period - lesser morbidity

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19
Q

FIGO Staging for Ovarian cancers

A

Stage 1 - Stage 1A, Stage 1B , Stage 1C ( C1,C2,C3)
Stage 2 - Stage 2A, Stage 2B
Stage 3 - Stage 3A1, Stage 3A2, Stage 3B, Stage 3C
Stage 4 - Stage 4A, Stage 4B

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20
Q

Stage 1 of Ovarian cancer

A

Ovarian involvement
Stage 1A - one ovary involved
Stage 1B - Both ovary involved
Stage 1C - A or B + Surgical spill (C1), Surface growth (C2), Malignant ascites or washings (C3)

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21
Q

FIGO Stage 2 of Ovarian cancers

A

Involvement of Pelvis
Stage 2A - uterus, fallopian tubes
Stage 2B - other pelvic organs involvement

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22
Q

FIGO Stage 3 of ovarian cancer

A

Abdominal involvement
Stage 3A1 - Retroperitoneal LN involvement
Stage 3A2 - Microscopic Abdominal involvement
Stage 3Bb - Macroscopic Abdominal involvement <2cm
Stage 3C - Macroscopic Abdominal involvement >2cm
Liver and spleen superficial involvement

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23
Q

FIGO Stage 4 of ovarian cancer

A

Stage 4A - Malignant pleural effusion
Stage 4B - Deep liver and spleen deposits, Inguinal LN

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24
Q

Chemotherapy regimes used for Epithelial Ovarian cancer

A

CAP Regime - Cyclophosphamide, Adriamycin, Platins (Cisplatin, Carboplatin)
PT Regime - Platins, Taxol

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25
Q

Which Regime is best in case of Epithelial Ovarian cancers

A

PT Regime

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26
Q

Chemotherapy regimes for Germ cell Tumors

A

VBP - Vincristine, Bleomycin, Platins
BEP - Bleomycin, Etoposide, Platins : Better

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27
Q

Treatment for Sex cord tumors

A

Surgery is sufficient

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28
Q

Ovarian tumors are radioresistant or sensitive and exception

A

Ovarian tumors are Radioresistant except Dysgerminoma (Only Radiosensitive ovarian tumor)

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29
Q

Normal ovaries are Radioresistant or sensitive

A

Radiosensitive

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30
Q

Management of Early low risk Ovarian cancer

A

Low risk - Stage 1A, 1B
Surgical staging

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31
Q

Management of Early high risk Ovarian cancers

A

High risk - Stage 1C
Surgical Staging + Adjuvant Chemotherapy

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32
Q

Management of Advanced ovarian cancer

A

Stage 2,3 and 4
Maximal Cytoreduction ( Removal of entire pelvic tumor + resection of metastasis) + Adjuvant Chemotherapy

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33
Q

Fertility sparing surgery can be done in which stage of ovarian cancer

A

Stage 1A with low grade, Borderline tumors
U/L salpingo-oopherectomy

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34
Q

Neo adjuvant Chemotherapy is given in cases of

A

Stage 3 and 4 with massive ascites, pleural effusion or unresectable tumor

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35
Q

Types of Epithelial Ovarian tumor

A

Serous cyst adenoma
Mucinous cyst adenoma
Brenner tumor
Endometroid tumor
Clear cell carcinoma/Mesonephroid tumor

36
Q

Most common subtype of Epithelial Ovarian cancers

A

Serous cyst adenoma

37
Q

Bodies seen in case of Serous cyst adenoma

A

Psammoma bodies

38
Q

Serous cyst adenoma cells resembles like cells of which organ

A

Fallopian tubes

39
Q

Serous cyst adenoma Features

A

Unilocular Tumor
B/L in 50% cases
Mostly malignant
Surface growth can be seen

40
Q

In mucinous cyst adenoma, cells resembles like of

A

Cervical cells

41
Q

M/C cause of Pseudomyxoma peritonei in ovarian tumors and overall

A

In ovarian tumors - Mucinous cyst adenoma
Overall - Carcinoma of appendix

42
Q

Mucinous cyst adenoma features

A

Lesser malignant then Serous cyst adenoma
10% are B/L
Multilocular Tumor
Pseudomyxoma peritonei - Severe Hypoproteinemia

43
Q

In Brenner tumor, cells resembles like which organ

A

Bladder - made up of Transitional cells

44
Q

Nest of Transitional cells in Brenner tumor is termed as

A

Walthard inclusions (Puffed wheat type of cells)

45
Q

Brunner tumor consistency

A

Rubbery tumor
Benign

46
Q

Brenner tumor is associated with which Syndrome

A

Pseudomeig Syndrome
Post Menopausal bleeding

47
Q

Pseudomeig Syndrome and M/C seen in case of

A

Any ovarian tumor other than Fibroma with ascites and Pleural effusion
M/C bcz of Brenner tumor

48
Q

Meig Syndrome Triad

A

Fibroma
Ascites
Pleural effusion

49
Q

Endometroid tumor cells resembles to which organ

A

Endometrial type of cells
6-8% of all Ovarian cancers

50
Q

Which Epithelial Ovarian tumor is rare but very malignant

A

Clear cell carcinoma/Mesonephroid tumor

51
Q

Histological findings in case of Clear cell carcinoma/Mesonephroid tumor

A

Large cuboid cells, Clear cytoplasm
Hobnail cells - Cystic space lined by clear cells with protruding nucleus into lumen

52
Q

Germ cells tumors are usually seen in which age group

A

Younger women
Mostly unilateral

53
Q

Subtypes of Germ Cell Tumors and M/C

A

Teratoma - M/C
Dysgerminoma
Yolk sac tumor
Embryonal Tumor
Sex cord tumors - Granulosa cell tumors, Sertoli Leydig cell tumor

54
Q

Most common tumor of Pregnancy and Torsion

A

Teratoma

55
Q

Teratoma is benign or malignant?

A

10% Malignant
90% Dermoid/Benign cystic Teratoma

56
Q

Germ layers involved in Teratoma

A

Involves all germ layer derivatives - may have bone, teeth, sebaceous secretions, hairs in it

57
Q

Most common cause of Germ cell malignancy

A

Dysgerminoma (40-45%)
Only B/L germ cell malignancy (10-15%)

58
Q

Dysgerminoma is associated with

A

Dysgenic gonads

59
Q

Type of cells in Dysgerminoma

A

Have Seminoma type of cells - large polygonal cells, Clear cytoplasm and dark staining nuclei with back to back arrangement

60
Q

Dysgerminoma is associated with increase in which markers

A

LDH
Placental Alkaline phosphatase
AFP not increased

61
Q

Yolk sac tumor AKA

A

Endodermal sinus tumor

62
Q

Markers increased in case of Yolk sac tumor

A

AFP
Alpha 1 antitrypsin - more specific

63
Q

Bodies seen in case of Yolk sac tumor

A

Schiller duval bodies

64
Q

Yolk sac tumor and Embryonal tumors are usually seen in which age group and prognosis

A

Seen in young women, girls
Poor prognosis

65
Q

Markers increased in case of Embryonal tumor

A

AFP
HCG - more specific

66
Q

Subtypes of Sex cord tumors

A

Granulosa cell tumors
Sertoli/Leydig cell tumor

67
Q

Estrogen levels in Granulosa cell tumors and results in

A

Estrogen level increases - Precocious puberty, Menorrhagia, Predisposes to endometrial cancer

68
Q

Marker for Granulosa cell tumors

A

Inhibin

69
Q

Bodies seen in case of Granulosa cell tumors

A

Carlexner bodies

70
Q

Sertoli Leydig cell tumor AKA

A

Androgen producing Arrhenoblastoma

71
Q

Sertoli Leydig cell tumor C/F

A

Hirsutism/Virilization
Oligomenorrhea to Amenorrhea

72
Q

Difference between Hirsutism and Virilization

A

Hirsutism - Reversible
Virilization - Permanent changes (Hoarseness of voice, Breast changes,Clitromegaly)

73
Q

Causes of Rapid onset Hirsutism

A

Ovarian tumor
Adrenal Tumors

74
Q

Causes of Puberty Hirsutism

A

Congenital Adrenal hyperplasia

75
Q

Cause of Adult onset Hirsutism

A

Polycystic Ovarian Syndrome (PCOS)

76
Q

Overall M/C of Hirsutism

A

PCOS

77
Q

Non-Neoplastic Ovarian cysts includes

A

Follicular cyst
Corpus luteal cyst
Theca lutein cyst
Hemorrhagic cyst

78
Q

Theca lutein is seen due to increased

A

hCG
Can be seen in molar pregnancy or twins

79
Q

Most common ovarian tumor of Pregnancy

A

Dermoid then serous cyst

80
Q

Management in pregnancy If Tumor is small (<5cm) and asymptomatic

A

No treatment is required

81
Q

Management in pregnancy If Tumor is large (>10cm) and asymptomatic

A

Remove in 2nd trimester

82
Q

Management in pregnancy If Tumor is largev(>10cm) and diagnosed in 3rd trimester

A

Postnatal within 1-2 wks or along with a C section

83
Q

Most common tumor secondary to Ovary

A

Ca Stomach > Ca breast
Krukenberg tumor

84
Q

Histological finding in case of Krukenberg tumor

A

Signet ring cells

85
Q

Features of Borderline epithelial ovarian Tumors

A

Epithelial hyperplasia
Mitotic activity in cells, Nuclear atypia
Detached cell clusters
No destructive stromal inclusion

Obstetrics And Gynecology (2 decks)

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