Gyn - Ovary

Front 1

Most common category of ovarian primary tumors is ___

Back 1

- epithelial tumors (60% of all ovarian tumors belong to this category)
- 90% of malignant ovarian tumors belong to this category
- serous and mucinous make up half of the epithelial ovariant tumors

- three main categories: epithelial, sex cord-stromal, and germ cell
- other: soft tissue tumors, lymphomas, metastases

Front 2

most common malignant sex cord-stromal tumor of the ovary is __

Back 2

- granulosa cell tumor

Front 3

The single most common ovarian tumor is ___

Back 3

- benign cystic teratoma (germ cell tumor) 32% of ovarian tumors

Front 4

sex cord-stromal tumors make up __% of ovarian tumors

Back 4

9%

Front 5

Epithelial ovarian tumors are classified as mixed when at least __% of the second pattern is present

Back 5

10% or more

Front 6

Ovarian cancer rarely occurs during pregnancy, but when it does, it is most likely to be ___ or __

Back 6

- serous or mucinous carcinoma

Front 7

Ovarian tumors and ascites

Back 7

- ascites rarely occurs with a benign tumor
- it is suggestive of carcinoma

Front 8

CA-125 can be elevated in benign conditions such as ___

Back 8

- endometriosis
- pregnancy
- PID
- leiomyomas
- liver disease

Front 9

micropapillary borderline serous tumors are associated with __

Back 9

- high likelihood of extraovarian spread and invasive implants
- corrected for stage and implant type, there is no difference in survival compared to typical borderline serous tumor

Front 10

Restaging after inadequate staging of ovariant borderline serous tumors?

Back 10

- controversial
- 15% the stage is altered
- risk of recurrence appears the same for women undergoing restaging vs. those that do not

- may be more indicated if micropapillary borderline serous tumor (higher risk of having extraovarian spread and invasive implants)

Front 11

FIGO staging for ovarian cancer

Back 11

I - confined to ovaries
II - pelvic extension/implants
III - extension outside pelvis
IV - distant metastasis

Front 12

FIGO stage IA-B for ovarian cancer

Back 12

IA - tumor limited to ONE ovary (A ovary), intact capsule, no surface tumor, negative cytology

IB - tumor limited to Both ovaries, intact capsule, no surface tumor, negative cytology

IC - limit to one or both ovaries with any of the following: capsule rupture, surface tumor, positive cytology

Front 13

Does the size of the peritoneal metastases matter in ovarian cancer?

Back 13

Yes
- peritoneal metastases (mets beyond pelvis)= FIGO stage III
IIIA - microscopic mets
IIIB - macroscopic, but </= 2 cm
IIIC - macroscopic, but > 2cm and/or lymph node mets

Front 14

serous tumors make up __% of ovariant tumors

Back 14

- 30% of ovarian tumors
- 50% are benign, 15% borderline, and 35% malignant

Front 15

__% of benign serous tumors are bilateral

Back 15

20%

Front 16

__% of serous cystadenomas are actually monoclonal

Back 16

- 14%

Front 17

A otherwise benign appearing serous cystadenoma or cystadenofibroma with focal borderline features?

Back 17

- <5-10% of the tumor shows borderline features (mild to moderate nuclear atypia or branching papillary growth)

- serous cystadenoma, cystadenofibroma, or adenofibroma with focal low grade aytpia or proliferation

- requires further study

Front 18

Serous tumors: bilaterality

Back 18

- benign (20%)
- borderline (35-40%)
- malignant (often bilateral)

Front 19

serous borderline tumors, surface papillary excrescences are present in __

Back 19

40-50%

Front 20

serous borderline tumor, solid growth is __

Back 20

- uncommon (exception: borderline serous adenofibroma)
- necrosis and hemorrhage are also uncommon

Front 21

Papillary growth pattern in serous borderline tumors is __

Back 21

- branching (hierarchical)
- fibrovascular cores lined by proliferating columnar cells
- may see cilia
- tufts of cells leading to clusters and single cells detached into cyst lumen

Front 22

In serous borderline tumors, the nuclear atypia is typically __

Back 22

- low grade nuclear atypia
- scattered mitotic figures

Front 23

Serous borderline tumors - see scattered indifferent cells

Back 23

- aka metaplastic cells
- cells with abundant eosinophilic cytoplasm
- scattered among the columnar tumor cells, more often near tips of papillae
- indifferent cells are more common in cases with microinvasion and in pregnancy

Front 24

Autoimplants in serous borderline tumors

Back 24

- resemble desomplastic peritoneal implants, but occur within the tumor cyst wall
- plaque or nodule of loose fibrous tissue with glands and/or papillae
- no prognostic significance!!, but more often seen in high stage tumors

Front 25

Wall thickness in benign cystadenoma vs borderline cystadenoma

Back 25

benign - thin wall
borderline - thicker wall

Front 26

microinvasion in serous borderline tumors (two types)

Back 26

- invasive foci < 3mm
- when present it is often multifocal (when do you just call it invasive carcinoma??)

Two types:
1. (most common) - see cells with eosinophilic cytoplasm, vesicular nuclei, prominent nucleoli
- no stromal reaction
- occasionally seen in lymphatic spaces with uncertain clinical significance

2. tumor cells surrounded by stroml response (inflamed or myxoid fibrous stroma) or cells within clear spaces

Front 27

Serous borderline tumor wit implants

Back 27

- 15-30% cases have implants

3 types
- non-invasive epithelial type
- non-invasive desmplastic type
- invasive type

Front 28

Most significant adverse prognostic findings in serous borderline tumors

Back 28

- presence or absence of invasive implants AND advanced tumor stage

- non-invasive implants (epithelial and desmoplastic, are a/w favorable prognsosis)

Front 29

invasive vs desmoplastic implants

Back 29

- there is more epithelium present in the invasive implant compared to desmoplastic implants
- plus invasive implants show an infiltrative pattern of growth into surrounding subperitoneal tissues and omentum

Front 30

Lymph node metastases are seen in __% of serous borderline tumors

Back 30

up to 33%

Front 31

__ may mimic lymph node involvement by serous borderline tumor

Back 31

1. Mesothelial cell hyerplasia
- uncommon
- hyperplastic mesothelial cells
- a/w peritoneal mesothelial hyperplasia
- cells would be positive for calretinin, CK5/6

2. Benign epithelial inclusions (endosalpingiosis)
- lined by low columnar cells, many w/ cilia
- seen in pelvic and peri-aoritc LN in 5-25% pts undergoing surgery for UTERINE cancers
- controversy: some believe them to rep lymph node involvement by serous borderline tumor, while others disagree and believe them to be benign inclusions

Front 32

clinical significance of lymph node involvement by serous borderline tumor

Back 32

- believed NOT be a/w with adverse outcome
- However, recently suggested the tumor aggregates > 1mm may be a/w decreased survival

Front 33

the papillae seen in serous borderline tumor with micropapillary features

Back 33

- many are long, thin micropapillae and lack fibrovascular cores
- these micropapillae sprout from the surface of coarse papillary fronds
- micropapillae are 5 times as long as they are wide
- ciliated cells are less frequent than in typical borderline tumors

Front 34

serous borderline tumor with micropapillary features are a/w ___

Back 34

- bilaterality
- intracystic and surface papillary growth
- extraovarian disease
- invasive implants (in some studies)

Front 35

In order to qualify for serous borderline tumor with micropapillary features the focus of micropapillary architecture must be greater than __

Back 35

0.5 cm or more

Front 36

Serous surface papillary carcinoma of the ovary vs. primary peritoneal serous carcinoma with involvement of the ovaries

Back 36

- serous surface papillary carcinoma show predominantly surface growth with minimal parenchymal invasion and NO intracystic growth

Primary peritoneal serous carcinoma with ovarian involvement:
- extensive peritoneal serous carcinoma
- FOCAL (</= 0.5cm) of ovariant surface tumor present

Front 37

Why do "they" think most ovarian serous carcinomas start out as high grade tumors

Back 37

- a limited number of microscopic serous carcinomas have been reported
- most serous caricnomas are high grade tumors with marker cytologic atypia and frequent mitotic figures

- low grade serous carcinomas are "different" tumors, appear to arise from progression of serous borderline tumors

Front 38

IHC for ovarian serous carcinoma

Back 38

CK7+ CK20=
p53+
WT-1+ (endometrioid serous carcinomas are WT-1=)
CA-125+

Vimentin=
CEA=
CDX-2=


Clear cell carcinoma:
WT-1=
CA-125=

Front 39

Low grade serous carcinoma of the ovary

Back 39

- uncommon
- may be mixed with areas of borderline tumor
- appear to have a DIFFERENT histogenesis from high grade tumors
- some or all may arise by progression of serous borderline tumors

Front 40

Universal grading system for ovarian carcinomas proposed by __

Back 40

- Silverberg et al