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139 Cards in this Set
- Front
- Back
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What tumors of ovaries are regarded as pseudotumors?
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Polycystic ovaries
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How to classify ovarian tumors according to origin?
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1. Epithelial tumors
2. Gonadostromal (stromal) tumors 3. Germ cell tumors 4. Secondary tumors |
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Epithelial tumors testis compared to ovaries?
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Testes: non-existing
Ovaries: most common! |
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Epithelial tumor of ovaries - what epithelium is it thought to be derived from?
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Ovarian coelomic mesothelium - since it can differentiate towards all parts of female genital system! (Müllerian system)
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Ovarian tumors - what tissue may the cells resemble?
Serous? Mucinous? Endometroid? Clear cell? Transitional? |
Serous = Fallopian
Mucinous = endocervical Endometroid = Endometrium Clear cell = Maybe vagina, but not sure Transitional = urothelium Nb! Tumors may be mixed! |
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How to classify ovarian epithelial tumors according to morphology?
BENIGN MALIGNANT STROMAL component |
Typically grow cystically
BENIGN - Adenomas - Cystadenomas (- And also papillary, but clinicians not used to this) MALIGNANT - Adenocarcinomas - Cystadenocarcinomas If STROMAL component: - Adenofibroma - Cystadenofibroma |
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3 typical biological behaviours of ovarian epithelial tumors?
1. Benign 2. Malignant 3. Borderline Examples of behaviour? |
1. Completely benign
- Adenomas, cystadenomas 2. Truly malignant - Adenocarcinomas, cystadenocarcinomas - Metastasize --> Peritoneum --> Ascites - Metastasize --> Retroperiton. ly-nodes 3. Borderline - Not invasive, but bizarre morphology. - Low malignant potential |
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Patient with suspected ovarian tumor with ascites means?
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Disseminated advanced disease
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2 common hereditary ovarian syndromes?
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1. Malignant breast syndrome (BRCA1,2)
2. Lynch syndrome |
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What is lynch syndrome?
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A syndrome caused by mutation in genes for DNA repair - most commonly manifested with HNPCC - but can also cause ovarian lesions
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Risk factors for epithelial ovarian tumors?
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Not identified - maybe positive family history and no kids (nulliparity)
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Most important late clinical sign of malignant ovarian epithelial tumors?
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Ascites
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Most important clinical sign for benign epithelial tumor of ovaries?
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Compression of other organs
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When does a ovarian epithelial tumor become cystadenoma?
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When there is retention of secretion
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What is most common of serous and mucinous cystadenomas?
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Serous - mucinous are very rare (although wikipedia say something else)
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Mucinous cystadenomas resemble what epithelium?
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Endocervical
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Earler many mucinous cystadenomas were diagnosed as primary ovarian, when they were really?
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Secondary, from somewhere else e.g. appendix - and associated with pseudomyxomatous peritonei - they found a lesion on ovary and concluded it must be the primary
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What is Brenner's tumor?
(this you MUST know) |
Transitional differentiation of ovarian epithelial tumor
Urothelium grow like epithelium |
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What are the most common germinal cell tumors of ovaries?
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1. Teratoma
2. Dysgerminoma 3. Choriocarcinoma ___ 4. Yolk sac tumor 5. Embryonal carcinoma |
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Most common germinal cell tumor of ovaries?
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Mature teratoma
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Definition mature teratoma of ovaries?
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Benign, bilateral tumor of totipotent stem cells (germ cells) - with potential to differentiate to all 3 germ layers
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How does mature teratoma present itself?
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As a 'dermoid cyst'
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Morphology of a dermoid cyst?
- Lining - Filling - Nodules - special name?? |
Lining
- Keratinizing squamous epithelium (may undergo malignant change!! - tumor of tumor) Filling - keratin and sebum Nodules - May protrude nodules called "Rokitansky nodules", may be present in structures of all 3 germ layers |
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How to know a dermoid cyst is benign?
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If all tissues are mature
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What is a teratoma called with only 1 component?
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Monodermal teratoma
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Immature teratoma is completely different from mature.
What is different? |
The tissues are immature - and it makes it malignant
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How do grade the immature teratoma from mature?
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You look at amount of immature neuroepithelial tissue, since it is very easy to recognize as immature
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What is a neuroepithelial cell?
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Stem cell of the CNS
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What is dysgerminoma?
What is it the same as? |
The same as seminoma in males:
- Malignant tumor with good prognosis, of the germ cells |
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What is a gonadostromal tumor?
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A tumor arising from the supportive gonadal stroma & sex chords
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What differentiation may the gonadostromal tumors show?
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In both genders:
- Theca - Granulosa - Leydig - Sertoli!! Endocrine active and produce estrogens/androgens |
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Most common gondaostromal tumor?
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Granulosa cell tumor
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Classification of granulosa cell tumor?
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1. Adult
2. Juvenile |
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Age, behaviour and morphology of adult granulosa cell tumor?
Malignancy? |
1. Older females
2. Produce estrogen (endometrial hyperplasia) (but should produce progesterone right???) 3. Look like granulosa cells of follicles 4. Sometimes malignant |
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In adult granulosa cell tumor the cells form some microcystic structures - what are they CALLed?
(CALL your EX) |
Call-Exner bodies
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Age and behaviour of juvenile granulosa cell tuomr?
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Young girls, potentially malignant
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Second most common gonadostromal tumor of ovaries?
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Thecoma / fibroma
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What are the thecoma / fibroma?
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Thecoma = producing estrogen
Fibroma = silent Small tumors of postmenopausal female |
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What is Meig's syndrome?
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Ascites and hydrothorax - in association with benign ovarian tumor !
Often granulosa cell / theca cell |
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What are the most common gonadostromal tumors of testis?
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Sertoli & leydig cell
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What is the most important secondary tumor of ovaries?
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Krukenberg's tumor
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What is Krukenberg's tumor?
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A metastasis of gastric poorly cohesive adenocarcinoma with signet cells (problem with E-cadherin)
Typically female operate away ovaries, and they discover poorly cohesive carcinoma w /signet |
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How is Krukenberg tumor spread from stomach?
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1. Hematogenously
2. Along peritoneum (also WITHOUT perforation!!!) :O |
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What feature will be seen grossly in Krukenberg tumor - which also gastric poorly cohesive adenocarcinoma exhibit?
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Desmoplasia - formation of fibrous tissue around tumor cells
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Which tumors have a tendency to grow into ovaries by invasion?
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- Colonic carcinoma (advanced)
- Spread of carcinoma from uterus (not unusual) |
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Which tumors typically spread hematogenously to ovaries?
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- Stomach
- Colon - Breast - Lymphomas |
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Gestational trophoblastic diseases are derived from what cells?
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Trophoblasts
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Which marker is used for diagnosis of trophoblastic disease?
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hCG
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3 classifications of trophoblastic gestational disease?
A specter |
1. Hydatiform mole
2. Invasive mole 3. Choriocarcinoma |
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What is a hydatiform mole?
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A hydropic change of chorionic villi = edematous
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2 forms of hydatiform mole?
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Complete (90%) - ALL villi edematous
Partial (10%) - only PART of villi edematous |
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How does a complete hydatiform mole develop?
Is there any fetus? What is the cytogenetics? |
Empty egg, fertilized by 1 diploid or 2 haploid sperms
No fetus Cytogenetics = 46, XX / XY |
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Partial hydatiform mole - how does it develop?
Fetus? Cytogenetics? |
Normal egg, fert. by 1 diploid or 2 haploid sperms
Often fetus, but mis-shaped (& often dead or die quickly) Cytogenetics = 69, XXY |
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Clinical presentation of hydatiform mole?
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1. Abnormal enlargement of uterus - compared to expected size at stage of pregnancy
2. Pathological bleeding, hCG above normal for stage of pregnancy |
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Malignancy of hydatiform mole?
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90% benign
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What is an invasive hydatiform mole?
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Complete hydatiform mole, invaded the myometrium & vessels!
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Risk of metastasis in invasive hydatiform mole?
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No, even though there may be found chorionic villi in vessels, there is no implantation of them due to regression of them!
So they are "false metastases" - normally to lung |
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What is the only risk in invasive hydatiform mole?
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The higher risk of choriocarcinoma - so a hysterectomy is considered
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What is the worst form for gestational trophoblastic disease?
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Choriocarcinoma
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Choriocarcinoma:
- Arise from? - Malignancy? - Grossly? - LM? - Treatment? |
- Arise from a complete/partial invasive mole
- Very maligant - lethal in past! GROSS - Look soft & necrotic hemorrhagic mass LM - Atypical trophoblasts - no chorionic villi! Treatment - Chemotherapy - very good! Even with metastases. And become pregnant as well afterwards |
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What are the 3 typical benign proliferative lesions of breast?
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1. Fibrocystic changes
2. Adenosis 3. Epithelial hyperplasia |
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What was fibrocystic changes of breast used to be called?
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Fibrocystic disease - but was changed since it usually do not cause any problems
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What happens in fibrocystic changes of breast?
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There is a slightly unsuccessful involution of the gland - so gland is replaced by
- Fibrous tissue - which compress ducts and become dilated, forming: - Cysts (usually gland should be quite homogenous) |
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Is fibrocystic changes painful?
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No - only if inflamed or bleeding
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Does fibrocystic changes resemble precancerous risk?
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No - they are entirely benign - as long as there is no epithelial proliferations.
But lesions are hard - so they may HIDE carcinomas inside in the initial stages |
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How does fibrocystic changes look in LM?
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- Fibrous tissue areas
- Dilated ducts - usually 5mm --> 2cm - Secretions in cysts sometimes - Calcifications -- > May be seen on mammogram! |
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Calcifications on mammogram (X-ray) means what?
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1. Fibrocystic changes
2. Adenosis 3. Carcinoma That is why they are always removed |
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How is epithelia changes in fibrocystic changes of breast?
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From cuboidal cylindrical --> Apocrine (like in axilla!)
Proves that mammary gland is a modified apocrine gland - and that aplasia of the epithelia is a reverse differentiation…. insane in the membrane! |
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What is adenosis?
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An abnormal proliferation of normal glandular tissue - here in breast - leading to deformed glands
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What is the clinical issue with adenosis of breast?
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There is microcalcifications - so it may mimick carcinoma on X-ray
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What is the pathological issue with adenosis of breast?
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The LM picture is veeery similar to carcinoma!
So it is "normal" that pathologists may misdiagnose adenosis & carcinoma |
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How not to misdiagnose carcinoma for adenosis?
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By immunohistochemistry - we stain for myoepithelial cells only seen in adenosis :)
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How does adenosis look in LM?
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1. Deformed ducts
2. Calcium lumps maybe |
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Fibrocystic changes may also contain some proliferation of epithelium. What are these changes called, according to location?
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1. Ductal hyperplasia
2. Lobular hyperplasia |
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Ductal/lobular hyperplasia without atypia looks like?
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Many uniform cells
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Ductal / lobular hyperplasia with atypia looks like?
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Many atypical cells :)
Grow in a cribriform pattern |
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Cancer risk adenosis?
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None
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Cancer risk fibrocystic changes?
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None
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Cancer risk hyperplasia without atypia?
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Small
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Cancer risk atypical hyperplasia?
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Real precancerous!
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What are the benign tumors of breast? (6 stk)
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1. Fibroadenoma
2. Tubular adenoma 3. Lactating adenoma 4. Intraductal adenoma 6. Phyllodes tumor |
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What are the 2 components of fibroadenoma?
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1. Fibro - mesenchymal
2. Adenoma - epithelial |
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Fibroadenoma occur in which age?
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2-3rd decade
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Fibroadenoma more frequent in which rase?
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Afroamerican
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How do we know that fibroadenoma is hormonally dependent?
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Since when hormonal stimuli is gone - (menopause) - the tumor shrinks --> Fibrous --> calcified
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Gross appearance of fibroadenoma?
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Sharply circumscribed, freely movable
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Malignant potential of fibroadenoma?
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None - only removed for cosmetic causes or exclusion of something worse
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2 growth patterns of fibroadenoma in LM?
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1. Intracanicular
2. Pericanicular But this is just for hobby :D No clinical importance, wohooo! Since both are benign |
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What is tubular adenoma?
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A variant of fibroadenoma - clinically the same
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What is a lactating adenoma?
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Clinical term.
A benign tumor appearing at beginning of pregnancy, due to strong hormonal stimulation. There is NOT higher chance of developing cancer in pregnancy, but these hormonal dependent grow faster then - so it is very worrysome :) |
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How to diagnose a lactating adenoma?
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FNAC - diagnosis in 10 mins :)
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What is an intraductal papilloma?
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A cauli-flower tumor with fibrovascular core, covered by neoplastic epithelium - growing into lumen
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How come there may be bloody discharge from intraductal papillloma?
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Since they are fragile, may be twisted and break and bleed
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How may we diagnose a intraductal papilloma?
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By ductography x-ray!! Very interesting :)
1. Open duct by canyle 2. Inject contrast medium 3. Take the dirty picture baby |
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What is a phyllodes tumor?
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A rare, fibroadenoma like tumor - but can get huge (up to 15-20 cm!)
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The fibro / mesenchymal part of phyllodes tumor - what is special with it?
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It has potential to differentiate into real sarcomas!
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Anything special about adenoma part of Phyllodes tumor?
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Nothing - looks just like fibroadenoma
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How to classify the Phyllodes tumors?
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1. Benign
2. Low-grade malignant 3. High grade malignant |
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When removing a Phyllodes - do you remove axillary lymph nodes too?
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No - since sarcomas only spread hematogenously!
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What is the #1 tumor among women?
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Breast carcinoma
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What is the #1 killing tumor among women?
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Lung cancer! - Since breast has quite good prognosis
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Why is it thought that the number of breast carcinomas are increasing?
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Hormonal level changes:
1. Menstruation start at 10 2. Only 2 kids usually - so estrogen stimulation is much higher than when mothers had 3-7 kids (since you are not menstruating then - and no estrogen) 3. Menopause is much later & there is hormone replacement therapy (HRT) for prevention of flushes |
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Why does NOT hormonal contraceptives increase change of breast carcinoma?
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1. Doses are very low
2. They are always applied with progesterone, so balanced 3. Used in the fertile period anyway - so not much addition to existing levels |
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What are the genetic predispositions to breast carcinoma?
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1. BRCA1 & 2
Genes responsible for cell cycle - and mutation leads to accumulation of mutations and early tumor 2. Some other genetic factors, since some tumors does not have BRCA |
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2 reasons why mortality of breast cancer is decreasing?
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1. Early diagnosis with screening mammography
2. Improved therapeutic options |
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How big must a breast tumor be to be palpable?
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1cm - while mammography can detect tiiny calcifications and precancerous lesions
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Survival of t1 tumors?
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85%
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Survival of T4 tumors?
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5% :/
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What is the new improved therapeutic options for breast cancer? (last 15 years)
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1. Targeted therapy - especially epidermal growth factor is increased - and antibody selectively sit on these receptors, blocking activity and immune system starts to destroy the cells
2. Or antibody is connected to aggressive chemotherapy - which in systemic dose would kill the patient - but since only delivered to tumor cells - is enough to get rid of it! |
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Targeted therapy for colorectal cancers?
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Anti-EGFr antibodies
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Targeted therapy for gastric cancers?
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Anti-Her-2 treatment - prolong lifetime with 10-15y
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Most typical location of breast carcinoma?
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Upper right quadrant - draining to axillary lymph nodes - and removal only of sentinel :)
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How is prognosis of breast carcinoma dependent on things?
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Very bad if it grows into chest wall - since then it has reached vascularized tissue - and has disseminated
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What are the 2 main classifications of breast cancer?
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1. In situ / invasive
2. Ductal / lobular so: - Ductal in situ - Lobular in istu - Ductal invasive - Lobular invasive |
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What is comido necrosis?
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A central necrosis of tumors - since they grow so fast.
Typically for some types of breast carcinomas - also undergo dystrophic calcifications, seen on X-ray |
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What is a breast carcinoma in situ?
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Carcinoma which has not yet reached the BM or blood vessels - and are only locally dangerous.
But also very difficult to detect - must be calcifications :( |
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All carcinomas of breast arise from?
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Carcinoma in situ (lobular/ductal)
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What are the 2 most common carcinomas of breast?
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- Ductal invasive carcinoma
- Lobular invasive carcinoma |
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Gross morphology of ductal invasive carcinoma?
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Poorly circumscribed nodule
Stellate shaped and palpable Sometimes dark rim around due to shrinking of adipose tissue & beta caroten deposition (??) |
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Gross morphology of lobular invasive carcinoma?
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Infiltrative growth pattern - and due to loss of E-cadherin (cell-glue), the cells are spread anywhere - which is very difficult for surgeons!
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LM image of lobular invasive carcinoma?
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Indian file / goose-lines
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What is the most common type of breast cancer?
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Ductal carcinoma -90%
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How does the antihormonal drugs, in treatment of breast cancer, work?
How to get the optimal effect? |
They sit on the hormone receptor without activating it. The better differentiation - the better effect
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How was it discovered that the breast cancer was hormone dependent?
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Someone removed the ovaries and the tumor regressed.
But effect is lower, since some estrogen production in: - Adrenal glands - Stored in fat tissue |
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Most common spread of breast cancer via lymphatic?
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Axillary lymph nodes
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What is it called when the lymphatic vessel infiltration is so big that it blocks the outflow?
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Inflammatory carcinoma (not inflamm - but looks like it!) - Whole arm is swollen.
And also called Peau d'orange - the breast looks like orange peel |
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Where are the most common hematogenous metastases of breast cancer?
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- Lungs
- Liver - Bone marrow (osteolytic) - Brain |
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What is the treatment of breast cancer?
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1. Surgery
2. Radiotherapy 3. Targeted therapy (last 15 y) 4. Hormonal therapy 5. Chemotherapy |
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3 other rare types of breast carcinomas?
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- Tubular carcinoma
- Mucinous carcinoma - Medullary carcinoma |
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Special with tubular carcinoma?
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Excellent prognosis
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Special with mucinous carcinoma?
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Hormonal dependent cancer cells float in a sea of mucin - rarely metastasize
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Special with medullary carcinoma?
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Typically necrotizing due to its rapid growth (comedo)
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What is Paget's disease of Nipple?
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Misleading name - its a rare manifestatino of ductal carcinoma (most common type)
Ducts underlying nipple are colonized by ductal in situ carcinoma - which grow through the duct to epidermis & proliferate! |
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Clinical aspect of Paget's disease of nipple?
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Looks like eczema - visit dermatologist and get antieczema cream - and it recurs
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LM of Paget's disease of nipple?
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"Bulls-eye cells"
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When tumor spread to epidermis it is called?
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Epidermal spread - like any glandular growth growing out the duct to epidermis
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What is the only treatment for Paget's disease of breast?
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Removal of nipple with the underlying ducts.
Only nipple helps for nothing. |
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Rate of carcinoma of male breast?
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Less than 1%
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Prognosis of male breast carcinoma compared to female?
Why? |
Much worse due to:
1. Male do not go to doctor for breast growth :P 2. Tumor hormone independent, so more aggressive 3. Most men have small breast - so invade chest wall quickly and already have T4 grade |
