Pathology of the ovary

Question 1

how do ovarian disease manifest?

Answer 1

adnexal masses

Question 2

what is the incidence of gynecological cancers? prognosis?

Answer 2

incidence: endometrial > ovarian > cervical

worst prognosis: ovarian > cervical > endometrial

Question 3

what are the 7 types of ovarian cysts?

Answer 3

• follicular
• corpus luteum
• theca-lutein
• hemorrhagic
• dermoid
• endometrioid
• inflammatory

Question 4

what are the 7 benign ovarian tumors?

Answer 4

• serous cystadenoma
• mucinous cystadenoma
• endometrioma
• mature cystic teratoma (dermoid cyst)
• brenner tumor
• fibroma
• thecoma

Question 5

what are the 8 malignant ovarian tumors?

Answer 5

• serous cystadenocarcinoma
• mucinous cystadenocarcinoma
• granulosa cell tumor
• immature teratoma
• dysgerminoma
• choriocarcinoma
• yolk sac (endodermal sinus) tumor
• krukenberg tumor

Question 6

what is the most common ovarian mass in young women?

Answer 6

follicular cyst

Question 7

what is the cause / pathogenesis of follicular cyst?

Answer 7

distention of unruptured graafian follicle

Question 8

what is the pathogenesis of corpus luteum cyst?

Answer 8

cystic enlargement of corpus luteum with central hemorrhage, may rupture - peritoneal reaction with fibrosis and hemorrhage mimicking endometriosis

Question 9

diagnosis of endometriosis should have an exclusion of what type of ovarian cyst?

Answer 9

corpus luteum cyst

Question 10

theca-lutein cysts are due to what cause?

Answer 10

gonadotropin stimulation

Question 11

are theca-lutein cysts unilateral or bilateral? single or multiple?

Answer 11

often bilateral

often multiple

Question 12

theca-lutein cysts are associated with what conditions?

Answer 12

chroriocarcinoma

moles

Question 13

what is the cause of hemorrhagic cysts?

Answer 13

blood vessel rupture in cyst wall - cyst grows with increased blood retention

Question 14

what is the most common ovarian tumor in women 20-30 yo?

Answer 14

dermoid cyst

Question 15

what type of tumor is a dermoid cyst?

Answer 15

germ cell tumor (mature teratoma)

Question 16

why can dermoid cysts present as hyperthyroidism? what si the term for this?

Answer 16

could contain functional thyroid tissue

stuma ovarii

Question 17

how does an endometrioid cyst occur?

Answer 17

endometriosis within ovary with cyst formation (varies with menstrual cycle - chocolate cyst)

Question 18

how does nulliparity affect ovarian cancer risk?

Answer 18

increases risk

Question 19

what are the four classifications of ovarian neoplasms?

Answer 19

• surface epithelial 65-70%
• stromal 15-20%
• germ cell tumors 5-10%
• metastatic tumors 5%

Question 20

what is the most common ovarian tumor age 20-50?

Answer 20

serous cystadenoma (benign)

Question 21

serous cystadenomas are lined by what cell type? what is their gross morphology?

Answer 21

fallopian-like epithelium: tall, ciliated secretory columnar

smooth, thin walled, filled with serous fluid

Question 22

what is the gross morphology of mucinous cystadenoma?

Answer 22

• multiloculated

- often unilateral and large

Question 23

histogenetically, mucinous cystadenomas are linked to what structure? why?

Answer 23

cervix

epithelial lining consists of tall, mucus secreting columnar epithelium (but NOT ciliated)

Question 24

are most mucinous cystadenomas benign, borderline, or malignant?

Answer 24

benign (80%)

Question 25

where does an endometrioma arise?

Answer 25

from growth of ectopic endometrial tissue

Question 26

what is a brenner tumor? what is unique about it?

Answer 26

- adenofibroma with nodules of transitional type epithelial cells in a dense fibrous stroma - contains TRANSITIONAL epithelial cells

Question 27

what is the gross appearance of a brenner tumor? histologic?

Answer 27

- GROSS: solid tumor that is pale yellow-tan in color and appears encapsulated, unilateral - HISTOLOGIC: coffee bean nuclei on H&E

Question 28

brenner tumors are usually associated with what other type of tumor?

Answer 28

teratoma

Question 29

which type of ovarian tumor contains transitional type epithelium?

Answer 29

brenner tumor

Question 30

what type of tumor? - bundles of spindle-shaped fibroblasts - pulling sensation in groin - meigs syndrome - triad of ovarian fibroma + ascites + hyrothorax

Answer 30

fibroma

Question 31

what is meigs syndrome?

Answer 31

triad of - ovarian fibroma - ascites - hyrothorax

Question 32

how does a thecoma usually present?

Answer 32

abnormal uterine bleeding in a postmenopausal woman

Question 33

what may thecomas produce?

Answer 33

estrogen

Question 34

what is the most common ovarian malignancy? is it usually unilateral or bilateral?

Answer 34

serous cystadenocarcinoma usually bilateral

Question 35

in what type of ovarian cancer are psammoma bodies found?

Answer 35

serous cystadenocarcinoma

Question 36

what is the histology of serous cystadenocarcinoma?

Answer 36

- papillary growth - hyperchromatic cells - psammoma bodies (small concretions of dystrophic calcification)

Question 37

what are the three main features of mucinous cystadenocarcinoma?

Answer 37

- complex architecture - nuclear atypia - stromal invasion

Question 38

what is pseudomyxoma peritonei? in which ovarian tumor is it seen?

Answer 38

- intraperitoneal accumulation of mucinous material from ovarian or appendiceal tumor - mucinous cystadenocarcinoma

Question 39

an immature teratoma is most typically represented by what type of tissue?

Answer 39

immature / embryonic like neural tissue

Question 40

which is more likely to contain thyroid tissue - immature or mature teratoma?

Answer 40

mature

Question 41

are immature teratomas aggressive or non-aggressive?

Answer 41

aggressive

Question 42

what are call-exner bodies? where are they seen?

Answer 42

- small eosinophilic fluid-filled spaces between granulosa cells, resemble primordial follicles - granulosa cell tumor (malignant)

Question 43

what can granulosa cell tumors secrete?

Answer 43

estrogen and progesterone

Question 44

dysgerminomas are common in which age group?

Answer 44

adolescents

Question 45

what is the histological appearance of dysgerminoma?

Answer 45

fried egg cells

Question 46

"fried egg cells" is indicative of which tumor?

Answer 46

dysgerminoma

Question 47

dysgerminomas have which tumor markers? which transcription factors are expressed for diagnosis?

Answer 47

- hCG, LDH | - Oct3, Oct4, c-KIT

Question 48

choriocarcinoma is malignancy of what cell type?

Answer 48

trophoblastic tissue (cytotrophoblasts, syncytiotrophoblastic tissue)

Question 49

how do choriocarcinomas present?

Answer 49

- abnormal BHCG - SOB - hemoptysis

Question 50

are choriocarcinomas responsive to chemotherapy?

Answer 50

yes, very

Question 51

what are schiller-duval bodies? in which tumor type are they seen?

Answer 51

- resemble glomeruli | - yolk sac tumors

Question 52

what is the tumor marker for yolk sac tumors?

Answer 52

AFP

Question 53

what is a krukenberg tumor? what cell type is present?

Answer 53

- GI malignancy which metastasizes to the ovaries | - mucin secreting signet cell adenocarcinoma