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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

Ovarian tumor that secretes excess 5HT

Carcinoid syndrome- dermoid cyst