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.