Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
40 Cards in this Set
- Front
- Back
Most common category of ovarian primary tumors is ___
|
- 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 |
|
most common malignant sex cord-stromal tumor of the ovary is __
|
- granulosa cell tumor
|
|
The single most common ovarian tumor is ___
|
- benign cystic teratoma (germ cell tumor) 32% of ovarian tumors
|
|
sex cord-stromal tumors make up __% of ovarian tumors
|
9%
|
|
Epithelial ovarian tumors are classified as mixed when at least __% of the second pattern is present
|
10% or more
|
|
Ovarian cancer rarely occurs during pregnancy, but when it does, it is most likely to be ___ or __
|
- serous or mucinous carcinoma
|
|
Ovarian tumors and ascites
|
- ascites rarely occurs with a benign tumor
- it is suggestive of carcinoma |
|
CA-125 can be elevated in benign conditions such as ___
|
- endometriosis
- pregnancy - PID - leiomyomas - liver disease |
|
micropapillary borderline serous tumors are associated with __
|
- 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 |
|
Restaging after inadequate staging of ovariant borderline serous tumors?
|
- 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) |
|
FIGO staging for ovarian cancer
|
I - confined to ovaries
II - pelvic extension/implants III - extension outside pelvis IV - distant metastasis |
|
FIGO stage IA-B for ovarian cancer
|
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 |
|
Does the size of the peritoneal metastases matter in ovarian cancer?
|
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 |
|
serous tumors make up __% of ovariant tumors
|
- 30% of ovarian tumors
- 50% are benign, 15% borderline, and 35% malignant |
|
__% of benign serous tumors are bilateral
|
20%
|
|
__% of serous cystadenomas are actually monoclonal
|
- 14%
|
|
A otherwise benign appearing serous cystadenoma or cystadenofibroma with focal borderline features?
|
- <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 |
|
Serous tumors: bilaterality
|
- benign (20%)
- borderline (35-40%) - malignant (often bilateral) |
|
serous borderline tumors, surface papillary excrescences are present in __
|
40-50%
|
|
serous borderline tumor, solid growth is __
|
- uncommon (exception: borderline serous adenofibroma)
- necrosis and hemorrhage are also uncommon |
|
Papillary growth pattern in serous borderline tumors is __
|
- 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 |
|
In serous borderline tumors, the nuclear atypia is typically __
|
- low grade nuclear atypia
- scattered mitotic figures |
|
Serous borderline tumors - see scattered indifferent cells
|
- 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 |
|
Autoimplants in serous borderline tumors
|
- 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 |
|
Wall thickness in benign cystadenoma vs borderline cystadenoma
|
benign - thin wall
borderline - thicker wall |
|
microinvasion in serous borderline tumors (two types)
|
- 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 |
|
Serous borderline tumor wit implants
|
- 15-30% cases have implants
3 types - non-invasive epithelial type - non-invasive desmplastic type - invasive type |
|
Most significant adverse prognostic findings in serous borderline tumors
|
- presence or absence of invasive implants AND advanced tumor stage
- non-invasive implants (epithelial and desmoplastic, are a/w favorable prognsosis) |
|
invasive vs desmoplastic implants
|
- 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 |
|
Lymph node metastases are seen in __% of serous borderline tumors
|
up to 33%
|
|
__ may mimic lymph node involvement by serous borderline tumor
|
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 |
|
clinical significance of lymph node involvement by serous borderline tumor
|
- believed NOT be a/w with adverse outcome
- However, recently suggested the tumor aggregates > 1mm may be a/w decreased survival |
|
the papillae seen in serous borderline tumor with micropapillary features
|
- 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 |
|
serous borderline tumor with micropapillary features are a/w ___
|
- bilaterality
- intracystic and surface papillary growth - extraovarian disease - invasive implants (in some studies) |
|
In order to qualify for serous borderline tumor with micropapillary features the focus of micropapillary architecture must be greater than __
|
0.5 cm or more
|
|
Serous surface papillary carcinoma of the ovary vs. primary peritoneal serous carcinoma with involvement of the ovaries
|
- 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 |
|
Why do "they" think most ovarian serous carcinomas start out as high grade tumors
|
- 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 |
|
IHC for ovarian serous carcinoma
|
CK7+ CK20=
p53+ WT-1+ (endometrioid serous carcinomas are WT-1=) CA-125+ Vimentin= CEA= CDX-2= Clear cell carcinoma: WT-1= CA-125= |
|
Low grade serous carcinoma of the ovary
|
- 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 |
|
Universal grading system for ovarian carcinomas proposed by __
|
- Silverberg et al
|