Ovarian tumors
Tumor associated with hyper calcemia
Clear cell tumors
Tumor with highest association with pelvic endometrioisis
Clear cell tumors
Tumor that is almost always found as a high grade neoplasm
Clear cell tumors.
Karyotype of mature teratoma
Kayrotype is alway 46 XX Due to meioitic maternal chromosome. Like they're growing their own baby.
Endometrioid tumors
Look like endometrial glands Frequently bilateral and malignant. Up to 30% are associated with an endometrial carcinoma.
Serous tumors - malignant
Malignant variant (serous carcinoma) is malignant and has papillary structures, psammoma bodies, is invasive and is most common ovarian carcinoma. (older patients, 40-60 yrs.).
Defining feature of mature/immature teratoma
Mature teratoma does not contain immature neural elements.
Stuma ovarii
Monodermal teratoma with thyroid tissue. Growing a funcitoning thryoid in your ovaries that can make you hyperthyroid.
Sertoli Leydig Cell tumor
Most are androgenic Make the patient hirsuit, deep voiced. Leydig cells have characteristic Reinke crystals
Granulosa cell tumor
Most elaborate large amount of estrogen (endometrial hyperplasia/carcinoma). 5-25% are malignant Call-Exner bodies are present and are small hole that are full of a pink secretion. May rupture and hemorrhage
Mucinous (cystadeno) carcinoma
Mucinous carcinomas are defined by the presence of invasion of the surrounding tissue. Widespread invasion. Only thing that changed is they gained a mutation to allow invasion.
Mature teratoma cannot contain
immature neural epithelium
Age for serous carcinoma
40-60 years
Meigs Sydrome
A syndrome associated with fibroma-thecoma Can produce hydrothorax and ascites. They complain of difficulty breathing and ascites.
CA 125
Any ovarian cancer can secrete theis.
Most common cause pseudomyxoma pertonei
Appendiceal tumor, therefore the appendix is taken and evaluated in all cases where a patient has a mucinous tumor of the ovary. Ovary tumors are tough and rupture rarely.
If a woman has a mucinous tumor of the ovary, what other procedure is usually done?
Appendix removal
A 54 yo woman has weight loss accompanied by abdominal enlargement for 6 months. She is concerned because she has a family hisotry of cancer (mother and aunt). On PE there are no cervix lesions, uterus is normal in size, there is a left adnexal mass. US shows a 10 cm cystic mass with scattered 1 cm peritoneal nodules. Cytology of the fluid shows malignant cells consistent with carcinoma. Which of the following genes is mot likely a factor in the development of this lesion.? A. RAS B. BRAC1 C. EBB2 D. MYC E. RB1
B. Patient is 54. Not a germ cell tumor. Probably cervix epithelial Peritoneal nodules all over - serous carcinoma. Strong family history connection points to BRCA.
Benign/Borderline Mucinous tumors
Benign (80%) BL (10%) Mucinous cystadenomas are composed of cysts lined by mucinous cells. Can rupture.
Serous tumors - Benign
Benign variant cells look like fallopian tube and is the most common benign surface epithelial tumor (20-40 years). No invasion of the capsule or ovary is present. Usually have smooth surface and ver little solid area.
A 32 yo presents with cyclic abdominal pain. She has been attempting to become pregnant for 5 years. PE is normal. Laproscopic exam demonstrates numerous 2-5 mm hemorrhagic nodules coating the ovaries. What is the most likely diagnosis? A. Fibroma B. Brenner tumor C. Endometriosis D. Krukenberg tumor E. Mature cystic teratoma F. Mucinous adenocarcinoma
C Endometriosis. Explains why it is cyclic.
Mature Teratoma
Dermoid 20% of ovarian tumor and 90% of germ cell tumors. May be composed of any tissue found in the body. Usually skin, hair, teeth, lung, colon, etc. Young patientss in therir 20. Asymptomatic, or may feel a mass.
Tumor that is always malignant, but 80% cure rate.
Dysgerminoma
Tumor in phenotypic females with gonadal dysgenesis
Dysgerminoma.
A 31 yo woman has dull constant abodminal pain for 6 months. She has a 7 cm right adnexal mass involving the right adnexal mass involving the right ovary found on US. A CT demonstrates irregular calcifications. The gross appearance is very wrinkled. A hair appears to be growing from the ovary? What is the most likely diagnosis? A. Mucinous cystadeonoma B. Choriocarcinoma C. Dysgerminoma D. Serous cystadenoma E. Mature cystic teratoma
E. The calcifications are teeth and bones.
A 42 yo woman has menometorrhagia (prolonged excessive uterine bleeding) for 2 months. She has no history of AUB and has not reached menopause. She has no vaginal or cervical lesions on PE. A solid, 7 cm, right adnexal mass is seen on US. Endometrial biopsy results return for non-atypical hyperplasia. What is the most likely diagnosis? A. Mature cystic teratoma B. Endometrioma C. Corpus luteum D. Metastais E. Granulosa cell tumor F. Struma Ovarii
E. What makes endometrial hyperplasia - estrogen What makes estrogen - granulosa cells Granulosa cell tumors is the answer.
Yolk Sac tumor
Endodermal sinus tumor Predominantly in young patient (<10)
Primary sites for metastases to ovary
GI tract (Krukenberg tumor), appendix, breast and lung
Krukenberg tumor
GI tumor that like to metastasize to the ovary.
Ovarian tumor that can rupture and hemorrhage
Granulosa cell tumor
Shiller duval bodies
Histology of yolk sac tumor. This is evidenced by the prsence of shiller duval bodies as seen. A SD body is a papillary structure with a blood vessel in the core that is lined by the malignant cells.
Fibroma-Thecoma hormones
If a large theocoma component they can secrete estrogens (endometrial hyperplasia) and androgens.
A 19 yo has had pelvic discomfort for several months. On PE there is a 10 cm right adnexal mass. CT shows the mass to be solid and well circumscribed. On removal, the mass is solid and white with areas of necrosis. Microscopically, it contains mostly primitive mesenchymal cells and cartilage, muscle, and neuroepithleium. What is the most likely diagnosis?
Immature teratoma Got the mixed tissues and the neuroepithelium.
Monodermal teratoma
One tissue type teratoma. Most commonly this is thyroid. May be funcitonal and cause hyperthryoidism.
Brenner tumors
Over 95% are diagnosed between the ages of 30-70. Usually unilateral and benign Has a predominant stromal component with isalands of what looksl like bladder epeithelium.
Mutations in Serous tumors
P53 mutations or BRCA 1/2.
Malignant serous tumor histology
Psamomma bodies and papillae are seen. This is seen in the cervical serous tumors too.
Why are endoemtrioid tumors so commonly maignant?
Retrograde menstruation
Pseudomyxoma pertonei
Rupture of a mucinous tumor leading to mucinous extravasiation. Mucin pours throughout the abdomen.
Alpha fetoprotein
Seen in Yolk sac tumor: young female liver disease hepatocellular carcinoma: older men and women
Reinke crystals
Seen in Sertoli Leydig cell tumor
Inhibin
Seen with granulosa cell tumor
Most common ovarian carcinoma
Serous carcinoma
see psammoma bodies and papillae in histology
Serous tumors. Malignant
Broad hormone type that can happen at any age, and are usually identified if they secrete hormone
Sex cord stromal tumors
Call-Exner bodies
Small holes (follicle like spaces) that are full of a pink secretion. Found in granulosa cell tumors. Think of them as demented follicular cells that are trying to do what they remember their job as (forming antral follicle).
Fibroma-Thecoma
Solid, firm mass (fibroma)). If there are theca cells it's a fibroma-thecoma. Can produce hydrothorax and ascites (Meigs Syndrome). Theocoma component can secrete estrogens and androgens.
Spread of serous tumors
Spreads by tumor cell exfoliation and lymphatics.
Immature neural epithelium is found.
That is an immature teratoma
Monodermal teratoma most common type
Thyroid
Sex cord stromal tumors
Tumors that emerge from the stroma Rarest of all ovarian tumors (3-5%) Can happen at any age. Usually benign May secrete hormones
Endometrioid tumor association
Up to 30% are associated with an endometrial carcinoma.
Immature teratoma
Usually in young women (teens) Contains immature (neural) elements More solid than cystic On histology, you can see a rosetta. Can grow like crazy.
Elevated AFP in the tumor
Yolk Sac tumor
Ovarian tumor with a kid less than 10
Yolk sac tuor
Beta HCG
associated with choriocarcinoma
Tumor with transitional epithelium
brenner tumor.