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Unit 5: Path - The Femal Reproductive System, the Peritoneum, and Pregnancy > Ovarian Tumors > Flashcards

Ovarian Tumors Flashcards

1
Q

How are ovarian tumors classified?

A

By cell of origin

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2
Q

What is the most common type of ovarian tumor?

A

Common epithelial tumors

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3
Q

What tumor accounts for over 90% of ovarian cancers?

A

Epithelial tumors

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4
Q

What are the three broad classifications of Epithelial tumors?

A
  1. Benign
  2. Borderline malignant
  3. Malignant
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5
Q

What are risk factors for ovarian cancer?

A
  • High pituitary gonadotropin levels
  • Cyclic (“incessant”) ovulation
  • FHx
  • BRCA1 or BRCA2 breast cancer
  • Hereditary Nonpolyposis Colon Cancer
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6
Q

What is the most common epithelial tumor and what does it histologically resemble?

A

Serous tumor; Fallopian tube epithelium

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7
Q

What are the typical types of benign epithelial tumors?

A

Serous or mucinous adenomas

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8
Q

A benign epithelial tumor is found to be cystic. What is the Dx?

A

Cystadenoma

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9
Q

A biopsy shows Ciliated tubal-type epithelium. What is the Dx?

A

Serous cystadenoma of the ovary

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10
Q

A benign mucinous cystadenoma of the ovary is shown. How is it different than its malignant counterpart?

A

Thin walls and lack solid areas (This goes for all benign ovarian epithelial tumors)

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11
Q

What is another name for a Brenner tumor?

A

Transitional Cell Tumor

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12
Q

What is the Px of a Brenner tumor?

A

Generally benign

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13
Q

A nest of transitional cells is shown. What is the Dx?

A

Brenner tumor

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14
Q

What is a Borderline tumor? Px?

A

Characterized by epithelial cell proliferation and nuclear atypia but not destructive stromal invasion; Generally good outcome.

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15
Q

A tumor is thought to be a borderline tumor, but it is found that there is presence of more than focal microinvasion (Discrete nests of epithelial cells <3 mm into the ovarian stroma). What is the Dx?

A

Low-grade invasive serous carcinoma

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16
Q

What is the Dx of a borderline tumor with lymph node metastase?

A

Borderline tumor

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17
Q

What is a major difference betwixt high grade and low grade serous adenocarcinomas?

A
  • Low-grade: Assc. w/ serous borderline tumors and KRAS or BRAF oncogenes
  • High-grade: Arise de novo, high frequency of p53 mutations
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18
Q

A papillary tumor shows hierarchical and complex branching w/o stromal invasion. What is the Dx?

A

Serous cystic borderline tumor

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19
Q

A low-grade serous carcinoma is shown. What is it characterized by?

A

Irregular invasion of the ovary by small, tight neests of tumor cells within variable desmoplasia

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20
Q

A laminated structure is seen within the low-grade serous carcinoma. What is it?

A

Psammoma Body

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21
Q

What is the principle criterion for distinguishing low- and high-grade serous carcinomas?

A

Uniformity of the nuclei

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22
Q

A large solid tumor shows multinodular masses w/ necrosis and hemorrhage. Histo shows psammoma bodies, high nuclear grade, and irregular bracnhing. What is the Dx?

A

High-grade serous carcinoma

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23
Q

What are the two subtypes of Mucinous adenocarcinoma?

A
  1. Expansile (Confluent glandular pattern)
  2. Infiltrative
24
Q

What is pseudomyxoma peritonei?

A

Clinical condition of abundant gelatinous or mucinous ascites in the peritoneum, fibrous adhesions, and frequently mucinous tumors involving ovaries

25
Q

Endometrioid adenocarcinoma is shown. Where is it believed to arise from?

A

Arise by malignant transformation of endometriosis, and not ovarian surface epithelium

26
Q

What are the typical mutations seen in sporadic endometrioid carcinoma of the ovary?

A

Beta-catenin (CTNNB1) and PTEN genes

27
Q

Clear cell adenocarcinoma of the ovary is shown. What are typical histo characteristics of this condition?

A
  • Sheets or tubules of malignant cells w/ clear cytoplasm
  • Tubular form: Bulbous nuclei that protrude into lumen of tubule (hobnail cell)
28
Q

What antigen can be ID’ed in 50% of ovarian epithelial tumors?

A

CA-125

29
Q

What is the most important prognostic index for ovarian tumors?

A

Surgical stage of the tumor at the time it is detected

30
Q

What is the Px of germ cell tumors in children? In adults?

A

Generally malignant; Generally Benign

31
Q

What is the most common cancer in children?

A

Germ cell tumors

32
Q

What is a dysgerminoma?

A

Germ cell tumor composed of neoplastic germ cells similar to oogonia of fetal ovaries

33
Q

The neoplastic germ cells are distributed in nests separated by delicate fibrous septa. Stroma contains lymphocytes. What is the Dx?

A

Dysgerminoma

34
Q

What is a teratoma?

A

A tumor of germ cell origin that differentiates toward somatic structures.

35
Q

A ovary appears to be sprouting hair. What is the likely Dx?

A

Mature cystic ovarian teratoma

36
Q

What is Struma ovarii?

A

Cystic lesion composed predominantly of thyroid tissue

37
Q

How are immature teratomas of the ovary different from mature teratomas of the ovary?

A

ITO contain embryonal tissue

38
Q

An immature teratoma of the ovary is shown. What histo morphologies that are clues to this Dx?

A

Rosettes with multilayered nuclei and Embryonal glia displaying densely packed, atypical nuclei

39
Q

Schiller-Duval bodies are shown. What are they characteristic of?

A

Characteristic of Yolk Sac Tumor

40
Q

IHC was performed and the tumor was found to be a Yolk Sac Tumor. What is it IHC positive for?

A

Alpha-fetoprotein

41
Q

A female patient is found to be hCG positive but is not pregnant. What is the possible Dx? Why?

A

Choriocarcinoma; CC secrete hCG

42
Q

What is gonadoblastoma associated with?

A

Gonadal dysgenesis especially in women who have a Y chromosome

43
Q

Fill in the blanks: Teratoma, Endodermal sinus (yolk sac) tumor, Embryonal carcinoma, Choriocarcinoma, Dysgerminoma

A
44
Q

What are the majority of stromal tumors?

A

Fibromas

45
Q

What is Meigs Syndrome?

A

Triad of ascites, pleural effusion, and benign ovarian tumor (most fibromas)

46
Q

An ovary is conspicuously enlarged by a firm, white, bosselated tumor. What is the likely Dx?

A

Ovarian Fibroma

47
Q

How do thecomas differ from fibromas?

A

Contain varying amounts of steroidogenic cells that in many cases produce estrogens or androgens

48
Q

A thecoma is shown. What are the typical cyto findings?

A

Oblong cells invested by collagen. The theca cells contain lipids.

49
Q

What function do Granulosa Cell Tumors posess?

A

Estrogen secretion

50
Q

A granulosa cell tumor of the ovary is shown. What is the characteristic morphology of such a tumor?

A

Call-Exner bodies where tumor cells are oriented about central degenerative spaces

51
Q

What is secreted by ovarian granulosa cell tumors?

A

Inhibin (suppresses pituitary release of FSH) and Calretinin

52
Q

What is the major clinical take-away of Granulosa cell tumors?

A

Many secrete ESTROGEN

53
Q

What is a common presenting sign of ovarian granulosa cell tumors?

A

Endometrial hyperplasia

54
Q

Sertoli and Leydig cells are found in a tumor in a female patient. What are typical clinical findings in such a patient?

A

Hirsutism, male estucheon, enlarged clitoris, deepend voice

55
Q

What is the steroid cell tumor that arises from Leydig cells and can cause virilization and masculination?

A

Hilus cell tumor

56
Q

What is a Krukenberg tumor? From where do most originate?

A

Metastases to the ovary composed of nests of mucin-filled “signet-ring” cells in a cellular stroma derived from the ovary; The stomach

Unit 5: Path - The Femal Reproductive System, the Peritoneum, and Pregnancy (25 decks)

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