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Details Title: ovarian cancer Description: 4.30.07 Total Flash Cards: 43 Created: 05/01/2007 09:49:57	To study from this set of flash cards, or to create your own your own study flash cards, register HERE. If you are already a registered user, CLICK HERE.
Cards Term This lecture is about Definition the different type of ovarian cancers: 1. surface epithelian, 2. germ cell, 3. sex cord stroma tissue Term where are 2 places that epithelial tumors arise from? Definition the surface epithelium of the ovary and/or the epithelial inclusion cysts Term How do cysts develop? Definition break in the ovary surface at the time of ovulation (as the corpus luteum resolves), the surface epithelium will invaginate, and the invagination will separate from the surface and form an inclusion cyst Term How do you classify surface epithelial tumors? Definition by differentiated cell type and by biologic malignancy. Term what are the possible cell types? Definition Serous; Mucinous; Endometrioid; Clear cell; Transitional cell; Squamous; Mixed; Undifferentiated Term what are the possible biological malignancies? Definition Benign, Low malignant potential (borderline) , Malignant Term What is Borderline/LMP? Definition not outright malignant, not benign. It depends upon the subtype, acts in between. Term can ovarian tumors get very large? Definition yes Term what do benign cystadenomas look like? Definition Benign cystadenomas are lined by a single layer of bland epithelial cells Term what do serous benign cystadenomas look like? Definition Ciliated epithelial cells (similar to lining of fallopian tube) Term what do mucinous benign cystadenomas look like? Definition Cells with intracytoplasmic mucin (similar to endocervical or intestinal cells) Term as oppose to benign cystadenomas Definition ovaria carcinomas have necrosis and hemorrhage as well as cystic areas and solid growth Term histologically, how do you differentiate benign vs. malignant? Definition Ovarian masses that are solid and cystic are most suspicious for malignancy Completely cystic masses are mostly benign Completely solid masses may be benign or malignant Term what do serous carcinomas look like? Definition Serous carcinoma: Papillae, slit-like spaces, solid areas Markedly atypical cells Necrosis, hemorrhage Many mitoses, including atypical forms Term what do mucinous carcinomas look like? Definition Mucinous carcinoma: Glands and solid areas Atypical, mucinous epithelial cells Term what do endometriod type look like? Definition Endometrioid carcinoma Resembles usual (type I) endometrial carcinomas Term How does ovarian cancer spread? Definition Typical spread of ovarian cancer along Peritoneal surfaces and involving the Omentum Term In the early stages, any signs or symptoms? Definition No signs or symptoms in early stage – most patients present with advanced disease Term How do you stage the tumors? Definition Staging Stage I - confined to ovaries Ia – one ovary Ib – both ovaries Ic – surface involvement, rupture or positive cytology Stage II – spread to tubes, uterus or other pelvic organs Stage III – lymph node metastasis, spread outside the pelvis or to omentum Stage IV – distant metastasis Term prognosis Definition Similar for different tumor types Term what is the most common prognostic factor? Definition Stage is the most important prognostic factor Early stage – 90% Late stage (most patients) – 20% five year survival Overall five year survival 30-50% Term Describe borderline tumors" Definition Clinical and pathologic features in between benign and frankly malignant tumors. Can be serous or mucous type. Term what are they associated with? Definition Much better prognosis than carcinomas More epithelial proliferation and atypia than in benign tumors May be associated with extraovarian lesions on peritoneal surfaces, omentum and lymph nodes NO INVASION! Term what is the gross appearance of a serous borderline tumor? Definition Cystic tumor with papillary growth on internal surface, Papillary growth on the surface of ovary, Combination of intracystic and surface growth Term can you distinguish the gross appearance of the mucinous borderline tumor from carcinoma? Definition not grossly Term what do you see histologically with a mucinous borderline tumor? Definition Cyst of variable sizes Lined by mucinous cells Small papillary proliferations, Small papillary proliferations Stratification of nuclei Mild to moderate nuclear atypia ! NO INVASION OF STROMA Term what are implants? Definition extraovarian tesions--Implants – not metastasis Some may represent independent primary peritoneal tumors Classification Non-invasive Invasive Classification of tumor is based on ovarian lesion irrespective of presence of invasion in implants BUT: Most important prognostic feature is whether implants are invasive or not If not invasive, practically benign If invasive, behave like low grade carcinoma Term what is pseudomyxoma peritonei? Definition Pseudomyxoma peritonei (PMP) is an uncommon tumor known for its production of mucus in the abdominal cavity.[1] The tumor is not harmful by itself, but the mucus has no place to go inside the abdominal cavity. If left untreated, it will eventually build up to the point where it compresses vital structures: the colon, the liver, kidneys, etc. Unlike most cancers, PMP does not spread through the lymphatic system or through the bloodstream. PMP is most commonly associated with cancer of the appendix; mucinous tumors of the ovary have also been implicated. Term Is Pseudomyxoma peritonei associated with mucinous ovarian tumors? Definition Previously thought to be of ovarian origin (high stage mucinous borderline tumors) Recent data indicates that it is almost never ovarian in origin Associated mucinous tumor of appendix or gastrointestinal tract Rupture of ovarian mucinous tumors are not associated with pseudomyxoma Term what are the prognosis of borderline ovarian tumors? Definition Stage I tumors (confined to ovary) and those with non-invasive implants have excellent prognosis (almost 100% survival) Tumors with invasive implants behave like low grade carcinoma, survival 30-60% Mucinous tumors with associated pseudomyxoma are NOT of ovarian origin Search for other primary site (appendix, GI tract) Term which tumors commonly metastatisize to the ovary? Definition Common primary sites: colon, pancreas, gallbladder, stomach, cervix Term what is a krukenberg tumor? Definition Krukenberg tumor Special form of metastasis to ovaries Bilateral ovarian mass Ovaries only mildly enlarged Solid tumor Term What are the histological features of a krukenberg tumor? Definition “Signet ring” tumor cells (cytoplasm filled with mucin pushing nucleus to side), Metastatic signet ring cell carcinoma Primary site: stomach, breast Term SWITCHING FROM surface epithelial tumors to germ cell tumors. what are germ cell tumors? Definition 30% of primary ovarian tumors > 95% are dermoid cysts/teratomas Most common malignant tumors in first two decades Most malignant tumors occur in pure form, 10% mixed Term what are marture cystic teratomas (dermoid cysts)? Definition Most common ovarian tumor 80% during reproductive years Rare familial cases Prone to complications Torsion (4-15%) Infection Perforation (granulomatous peritonitis) Rupture (acute abdomen) Malignant transformation (cancer of adult type, 1-2%) Term what will you find histologically? Definition Fat tissue, Skin adnexal structures , , Keratin debris and sebaceous material accumulating in cyst, Squamous epithelium, cyst Term in mature teratomas, you can also find Definition cartilage, hepatocytes, nucleated RBCs, pituitary, retina Term what is malignant transformation in a mature teratoma? Definition to a squamous cell carcinoma Term what is dysgerminoma? Definition Most common malignant germ cell tumor (50%) 20-30% of malignant ovarian tumors encountered in pregnancy 80% in 2nd and 3rd decades (rare under 5 and over 50 yrs) Bilateral in 20% (grossly 10%) Excellent prognosis (80-90% survival for high stage disease) Histology: similar to seminoma of testis Term SWITCHIGN FROM germ cell tumor to sex cord-stromal tumor. what are major types? Definition Granulosa cell tumor (12%) and Thecoma-fibroma group (87%) – most benign Term with a granulosa cell tumor, what do you see histologically? Definition grooved nuclei (coffee beans), Uniform tumor cells resembling granulosa cells Monotonous nuclei with grooves Follicle formation (Call-Exner body) Term what is pathomnemonic for granulosa cell tumors? Definition call-exner bodies Term what do you see histologically with thecomas? Definition Solid, bright yellow cut surface (tumor cells contain lipid)