Flashcards in Ovary Deck (83)
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1
Measure of cystic follicle
<2cm
2
Measure of follicular cyst
>2cm
3
Primary ovarian type %s
Surface- epithelial 90%
Germ cell 3-5%
Sex cord-stromal 2-3%
4
Surface epithelial ovary paths
Serous
Mucinous
Endometroid
Brenner
5
Germ cell ovary paths
Teratoma
Dysgerminome
Endodermal sinus (yold sac)
6
Stromal cell ovary path
Granulosa-Theca
Fibroma
Sertoli-Leydig
7
Ovary mets
Stomach
Colon
Endometrium
Breast
8
Cause of chocolate cysts
Endomertriosis
Repeated cyclical hemorrhage- chocolate color
9
What are chocolate cysts associated with
Infertility
10
Chocolate cysts induce
Fibrosis, adhesions, pain
Extends pelvic ligaments
11
Epidemiology of polycystic ovarian dz- Stein leventhal syndrome
Young women, post menarche, persistent anovulation
12
Signs/sx of PCOD
oligomenorrhea
Secondary amenorrhea
Hirsutism
Obesity (40%)
Infertility
13
Levels of androgen/LH/FSH in PCOD
INC androgen, LH
DEC FSH
14
Etiology of PCOD
Insulin resistance
Disregulation of enzymes involved in androgen biosynthesis, poorly regulated
15
PCOD pathogenesis
Excess androgens secreted
Androgens convert to estrogen by adipose tissue
Excess estrogen inhibits release of FSH by pituitary and stimulates release of GnRH by hypothalamus
GnRH releases LH
LH:FSH ratio greater than 3
Excess LH stimulates theca in ovary to produce excess androgens
16
PCOD excess estrogen causes
endometrial hyperplasia
Stimulates adipose cells in the body
17
PCOD excess androgens causes
Hirsutism, virilization
Androgens process through adipose and liver cause excess estrogen
18
Gross PCOD
Large capsuled multiple unruptured follicles as cysts lined by granulosa cells, Giving the pearls on a string look
19
How to Dx PCOD
Hormonal assay
Transvaginal ultrasound
20
Tx PCOD
Hormonal- break up cycle via clomiphene
In early years- wedge resection of ovary
Sx txs Hirsuitism: spirinolactone
DM (metformin) Obesity (wt loss)
21
Investigations in ovarian tumors
Large mass:
CA125 (not diagnostic)
ultrasound
CT scan
Estimation of hormones
FNAC
Biopsy
22
What is the most common fatal gynecological malignancy
Ovarian cancer
23
What reduces the risk of ovarian cancer
Pregnancy and OC
24
Epi of benign ovarian tumors
80% benign (20-45 yrs)
25
Age of malignant ovarian tumors
40 -65 yrs
26
Malignant ovarian tumors spread to
Peritoneum- ascites
LN- iliac, paraaortic
Blood- lungs, liver, git
27
Serous epithelial tumors epithelial differentiation
Fallopian tubes, columnar w. cillia
28
Mucinous epithelial tumors epithelial differentiation
Endocervix, tall mucin secreting cells
29
Endometroid epithelial tumors epithelial differentiation
Nonciliated columnar cell
30
Brenner epithelial tumors epithelial differentiation
Transitional epithileum
31
How common are serous tumors
30% of all ovarian tumors
32
Overview of serous tumor characteristics
60% benign, 15% borderline, 25% malignant
Benign- 20-50 years
Malignant >50yrs
20% benign bilateral
65% malignant bilateral
33
Risk factors of serous tumors
Nulliparity
Family hx
Mutations (BRCA1/BRCA2)
Low grade KRAS, BRAF
High grade p53
34
Charateristics of benign serous cystadenoma
Cysts filled with serous fluid
Smooth outer lining
Lined by single layer of tall columnar ciliated cells
35
Cystadenofibroma
Variant of benign serous cystadenoma
Has abundant fibrous tissue under epi
36
Borderline serous tumors
Papillae and polypoid changes seen in benign but more numerous in malignant
10 survival- borderline (75%), malignant (10-20%)
Borderline: multilayer, nuclear atypia, no stromal invasion
37
Malignant serous tumors
Multilayering, nuclear atypia, stromal invasion
38
General epi numbers for mucinous tumors
30% of all ovarian tumors
80% benign, 10-15% boarderline, 5-10% malignant
5% benign/5% carcinomas bilateral
39
Multiloculated cyst
Few locules
Largest ovarian masses known
Mucinous adenoma
40
Muliloculated
Lots of locules
Solid nodules
Malignant mucinous carcinoma
41
Papillae, polyps, psammoma bodies found in
Serous tumors
42
Histo-
Tall columnar cells w/ apical mucus vacuole, no cilia
Mucinous tumors
43
What has a better prognosis than serous carcinoma
mucinous tumors
44
Extensive mucinous ascites
Filling of peritoneal cavity with mucoid material
fatal at end
Pseudomyxoma peritonei- complication to mucinous tumors
45
Behave like carcinomas
Related to PTEN, KRAS, Beta-catenin, MSI
Endometroid tumors
46
General epi for endometroid tumors
20% of all ovarian carcinomas
15-30% associated with concomitant endometrial carcinoma
15-20% associated with endometroisis
47
Gross:
Solid/cystic
Small papillae
Velvety surface
Micro:
Resemble endometrial carcinoma
Not normal endometrium
Endometroid tumors
40% bilateral
5 year survival- 4-50%
48
Associated with endometriosis
Comprised of clear cells
Agressive
Clear cell adenocarcinoma
49
Gross:
Transitional epithelila cells
Solid/ yellow
Benign
Brenner tumor
50
CA 125
HMW glycoprotein
Screening tool
51
Characteristics of germ cell tumors
15-20% of all ovarian tumors
95% benign cystic teratoma
5% in children- malignant
52
Teratoma can turn malignant when
Immature
or
Transform to squamous cell carcinoma
53
Young women in reproductive years
Cyst contains skin, adnexa, sebaceous glands
Hair, teeth, cartilage, thyroid fat
Mature teratoma
90% are unilateral
54
Young women ~ 18 yrs
Cyst bulky, solid, hemorrhage, necrosis
Embryonic
Immature teratoma
55
Specialised teratomas
Struma ovarii- hyperthyroidism
Carcinoid tumor- carcinoid syndrome
Strumal carcinoid- combined
MONODERMAL
56
Clinic/Lab:
Young women, children
AFP, a1 antitrypsin
Enododermal sinus tumor (yolk sac tumor)
57
Schiller duval bodies
Layers of epi cells around blood vessels, recembles glomeruli
Enodermal sinus tumor
58
What is the cytoplasmic pink inclusion found in endodermal sinus tumors
alpha fetoprotein
59
CLinic
Child/ young female
Hx of gonadal dysgenesis (abnormal growth)
Gross:
Similar appearance to seminoma testis, medullary carcinoma beast
Dysgerminoma
60
General characteristics of dysgerminoma
Unilateral
Soft fleshy tumor
Large uniform round cells
Clear cytoplasm, regular nuclei, no stroma
Infiltration by lymphocytes
61
Choriocarcinoma prognosis
Highly fatal
62
How is choriocarcinoma different from placental and uterine choricarcinoma
Does not respond to ctx
63
Gross-
Hemorrhage, necrosis, pleomorphism, multi nucleated, giant cells
Secrete HCG (in blood/ urine)
Choriocarcinoma
64
Rare germ cell tumors
embryonal carcinoma
Polyembryoma
Mixed germ cell tumor
65
Characteristics of sex cord stromal tumors
5% of ovarian tumors
2/3 postmenopausal women
Granulosa/ Granulosa + theca cell tumors
Granulosa+ theca w/ or w/out luetinisation, cell exner bodies
Rarely produces androgens
66
Granulosa theca cell tumors
Small distinct hazard for malignancy
Difficult to predict behavior
Malignant 5-15%
Late recurrences
67
Basal cell nevus syndrome, ascites, and Meig's syndrome are associated with
Firbromas/ Thecomas
68
Characteristics of fibromas
Benign, fibroblast, fat
Solid white to yellow
69
Age epi of sertoli leydig cell tumors (androblastoma)
any age, peaks at 20-30
70
Recapitulate cell of testis
Benign
Defeminization, atrophy of breasts,
Masculization- hirsutisism
Sertoli leydig cell tumor
Androblastoma
71
Reinke crystalloids, masculization
Elevated 17 ketosteroid excretion, unresponsive to cortisone suppression
Pure leydig cell tumors
72
Germ cell tumor+ sex cord tumor
Gonadoblastoma
73
Bilateral
Signet ring cells
Gastric in nature
Krukenberg tumor
74
Prognosis of krukenberg
Poor prognosis
75
Most common form of ovarian metastatic carcinoma in young women
Krukenberg tumor
76
Most common ovarian malignancy
Serous adenocarcinoma
77
Most common bilateral tumor
Serous, adenocarcinoma, metastasis
78
Small solid tumors
Brenner, granulosa, endomertroid
79
Large solid tumors
Malignant epithelial malignancy, malignant teratoma, germ cell
80
Neoplastic ovarian lesions
Serous cystadenoma/ carcinoma
Mucinous sytadenoma/ carcinoma
Dermoid cyst
81
Nonneoplastic ovarian lesions
Follicular cyst
Corpus luteum cyst
Chocolate cyst
PCOD
82
Ovarian tumor that secretes excess Thyroxine
Struma ovarii
83
