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19 Cards in this Set
- Front
- Back
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Benign Conditions in the Ovary/Fallopian Tube
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Close Tube/Ovary association so infection easily passes
a) Tubo-Ovarian Abscesses - PMNs liquefy tissue b) Tubo-Ovarian Adhesions - end result of previous infection, fibrosis with exudate making tube and ovary one big mass c) Cysts - enlarged, outer and inner surfaces SMOOTH (unlike carcinoma) d) Hemorrhagic Corpus Luteum - cyst filled with blood, patient report pain that can resemble appendicitis, inner space only has clotted blood e) Ovarian Torsion - Acute pain, small ovaries rarely twist. Usually from ones that already have cysts or teratomas. Infarcted tissue |
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Endometriosis definition, etiologies, presentation, sites, Treatment, Complications
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Def - Presence of endometrial glands in stroma in areas where it does not normally occur (outside endometrial cavity)
Etiologies a) Implantation (or post surgery like c-section) b) Coelomic metaplasia c) Hematogenous spread Presentation - Child bearing years. CYCLIC PAIN following menstrual cycle resulting from hemorrhage and edema in affected tissue. Foci respond to hormone stimulation Sites - surface of bladder, uterine serosa, in cervix, rectovaginal septum, surface of colonic tissue and abdominal wall Treatment - progesterone, may need surgical excision Complications - infertility can occur sometimes |
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Chocolate Cyst vs endometrioma
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Regular endometriosis is just a small amount
Endometriosis in the ovary can cause large blood filled cyst known as chocolate cyst If it looks malignant known as endometrioma (just called because larger and worse looking). Mass looking appearance |
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Ovarian Tumor tissue origin, malignancy chances, epidemiology, Symptoms, Cells of origin, Categories
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3rd most common cancer of female tract, 5th most common form of cancer in females. Causes 50% of all female repro deaths
ONLY 20% are MALIGNANT, seen in women 40-65. POSTMENOPAUSAL Symptoms - asymptomatic to constipation, pain, increasing abdominal girth from ascites and seeding of tumor cells. May find incidental mass. B/c symptoms are vague, may not present to advanced stage disease Cells - Covered by Capsule/surface epithelial tumors can cause surface epithelial cells. Stroma, sex cords making up matrix. Sex cord stromal tumors from here. Germ cell tumors from germ cells in ovary in middle. Ovary accepts many metastatic tumors and seen in 5% cases Categories: Surface Epithelial Tumors, Stromal Tumors, Germ Cell Tumors |
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Cancer Involvement and spread in ovarian cancer
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Can range from just one ovary to two to metastatic
Synchronous - limited to JUST OVARIES. Likely to be similar in size and involves stroma BUT NOT SURFACE METs - One tumor much larger than other, on surface of uterus and cervix. Can seed. Rarely spreads inside uterus and cervix Stage I is one ovary Stage II is SURFACE nodules on ovary, may have synchronous spread Stage III - METASTATIC, seen on Uterus and cervix SURFACE (not inside) Stage IV - distant mets outside repro system |
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Frequency, Proportion of malignant, group affected, Histology for ovarian tumors by origin
a) Surface Epithelial Tumors b) Germ Cell Tumors c) Sex Cord - Stromal Cells |
a) Surface Epithelial Tumors - 70% of tumors. 90% are malignant. Affects 20+ year olds. Serous, Mucinous usually. Rarely endometroid, clear cell
b) Germ Cell Tumors - 20% of tumors, Only 5% are malignant. Seen in Prepubertal usually or young age. Include Teratoma, Dysgerminoma, Yolk sac tumor, choriocarcinoma c) Sex Cord - Stromal Cells - 10% of all tumors, 3% malignant, Affect all ages. Types include Fibroma, Thecoma, Granulosa cell, Sertoli-Leydig 5% of tumors are metastatic origin |
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Serous Tumors, Types and distinguishing
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Surface Epithelial Origin
Types a) Benign Serous Cystadenoma - no atypia in architecture or nucleus. Simple cyst. Smooth surfaces, no nodules or proliferation b) Borderline Serous Tumor of Low Malignant Potential - some papillary growths in epithelial layer = ARCHITECTURE ATYPIA, NEVER have stromal invasion. c) Malignant Serous Adenocarcinoma - LOTS of atypia (nuclear and architecture), SPREAD INTO STROMA. Heavy destruction of ovaries and uterus = carcinoma. Psammoma bodies (calcified apoptotic cells) Evaluate based on architecture atypia and cytology atypia |
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Mucinous Tumors, Type and distinguishing
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Surface Epithelial Origin, VERY LARGE
Types a) Mucinous Cystadenoma (benign) - multiple, smooth cysts that are filled with mucin, confirmed with biopsy b) Mucinous Tumor of Low Malignant Potential - smooth surfaces and some proliferative areas that are small and do not cause too much damage - some CYTOLOGICAL ATYPIA. NO stromal invasion c) Mucinous Adenocarcinoma - hemorrhage, multiple cysts, atypical glands, mitosis. STROMAL INVASION. |
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Endometroid Adenocarcinoma and Clear Cell Carcinoma
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Both RARE surface epithelial origin ovary tumors
Endometroid Adenocarcinoma - ALMOST ALL MALIGNANT. Very destructive, crowded atypical glands. Grade 1 well differentiated with all glands, Grade 3 lots of atypia and cannot see glands Clear Cell Carcinoma - Rare in ovary, benign and borderline rare. Must make sure not endometriosis of ovary. HOBNAIL PATTERN |
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Ovarian Stroma and Sex Cord Origin % of all ovarian tumors or malignant ovarian tumors
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5-10% of all ovarian tumors
2-3% of all malignant ovarian tumors |
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Granulosa Cell Tumor Origin, Characteristics, Types and Patterns, IDs, Treatment, Complication
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Malignant tumor originating from granulosa ovarian cells
Characteristics - hemorrhagic, cystic tumor (can present as ovarian rupture with hemorrhage) Types: a) Adult Type - small, round granulosa cells without much cytologic atypia. Patterns include microfollicular (rosettes), Trabecular (cords), Insular (aggregates), Diffuse (sheets) b) Juvenile Type - cellular atypia, mitosis. LARGE CYSTS WITH EOSINOPHILIC SYTOPLASM. NO CALL-EXNER BODIES IDs 1) Call-Exner bodies - little rosettes with clear opening in microfollicular pattern. ONLY in adult type 2) Nuclear grooves - look like coffee beans in cells Treatment: USUALLY DX in STAGE I - must surgically remove but often recurrent or metastatic Complication - Granulosa Cell Tumors produce estrogen, hyperplasia of endometrium, can lead to carcinoma in 10% |
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Benign Ovarian Fibroma vs Benign Ovarian Thecoma
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Benign Ovarian Fibroma - white, firm tumor of fibrosis tissue. Looks like leiomyoma. Full of collagen and normal cells
Benign Ovarian Thecoma - yellow, fatty, soft tumor. Consists of benign-looking round cells. STAINS RED WITH OIL-RED O STAIN b/c cytoplasm filled with fat. More cellular than fibromas, SPINDLE CELLS. Produces estrogen (can lead to endometrial hyperplasia or carcinoma) Can have areas of both in a fibrothecoma Because both benign distinguishing shouldn't change prognosis |
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Germ Cell Tumors Prevalence, Theoretical Development, most common types
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Originate from germ cells. 20% ovarian tumors, only 5% are malignant
Development - original germ cell development disturbed and leads to tumor Common Types a) Mature cystic teratoma - consists of MATURE embryonic tissues, can present later in life and often can transform to malignant tissue b) Dysgerminoma - immature neoplastic development of original germ cell c) Immature teratoma d) yolk sac tumor e) Choriocarcinoma |
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Teratoma ovary vs testes
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BENIGN in ovary, MALIGNANT in testes
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Mature Teratoma Properties, Histology
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BENIGN in ovary clinically (not in testes) but can TRANSFORM to malignant if stay in body
Properties: usually cystic, with many tissue types. Skin, bone, teeth, sebum, HAIR are almost always DIAGNOSTIC. White foul-smelling proteinaceous material. Contains all 3 tissue types (endoderm, mesoderm, ectoderm). Histology - normal, mature tissue (normal glands, cartilage, epithelium, glial tissue, etc) |
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Stroma Ovarii
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Mature teratoma with only only 1-2 tissue types
Commonly THYROID TISSUE with colloid Usually benign, but can transform to malignant tumor Dark cystic nodules |
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Immature Teratomas Properties, Histology
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Occur in CHILDREN. MALIGNANT tumors
Aggressive and need chemoterapy. Histology - not very diagnostic. NO HAIR, TEETH or other mature structures. Look for neural tubes, spindle cell nuclei oriented in glands |
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Dysgerminoma Properties, Histology
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Seminoma equivalent in females
Considered malignant, but usually localized and removed. 1/3 are aggressive. Large brownish tumor with many nodules Histology: aggregates of round cells, typical nuclei, enlarged cytoplasm. FRIED EGG appearance. Fibrous bands and lymphocytes |
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Yolk Sac Tumor Properties, Presentation, Histology, Diagnosis
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Endodermal Sinus Tumor
VERY MALIGNANT, occurs in YOUNG pts. Very aggressive with metastases (often to lungs). Presentation: young girl with pain and rapidly enlarging pelvic mass Histology: a) Schiller-Duval Bodies - vesicle surrounded by atypical cells within a space b) Background of lacy, thin glands c) ALPHA FETOPROTEIN droplets (hormone produced by tumor) Diagnosis - Alpha fetoprotein hormone produced by tumor |
