Ovarian Pathology Part 2

What are the 3 types of ovarian tumors

1. Epithelial ovarian tumors 2. Germ cell ovarian tumors  3. Sex cord stromal ovarian tumors

— Are derived from the cells on the surface of the ovary

Epithelial ovarian tumors

Epithelial ovarian tumors are the most common form of ovarian cancer and occur primarily in children. T/F

False

— Are derived from the egg producing cells within the body of the ovary

Germ cell ovarian tumors

Germ cell ovarian tumors are ovarian cancers that occur primarily in adults. T/F

False

— Are derived from the supporting cells of germ cells

Sex cord stromal ovarian tumors

Most sex cord stromal ovarian tumors produce

Hormones

Identify 3 epithelial benign tumors

1. Serous cystadenoma 2. Mucinous cystadenoma 3. Brenner tumor

— is the most common of the 3 epithelial benign tumors

Serous cystadenoma

Serous cystadenoma contains — fluid

Serous cystadenoma

Clinical features for serous cystadenoma are

Pelvic fullness, bloating

U/S appearance of serous cystadenoma is

Cystic lesion, fewer septation than mucinous cystadenoma, unilocular or multilocular

Mucinous cystadanoma contains — fluid

Fluid filled with thick gel or mucin

When a large mass is identified in the ovary or adnexal region the next are to check is

Kidneys should also be evaluated for obstruction 

Clinical features of mucinous cystadenoma are

Pressure, pain, increased abdominal girth

U/S appearance of mucinous cystadenoma is

Multilocular, more numerous septations, fine, gravity dependent echoes

Brenner tumor is commonly seen

Post-menopausal patient

U/S appearance of Brenner tumor is

Solid hypoechoic or echogenic mass with anechoic spaces

— are the most common benign germ cell ovarian tumors

Teratomas

Teratomas are common in what age group

Women of childbearing age

Most common complication of germ cell tumors is

Ovarian torsion

Teretomas that contains tissue from ecto, meso & endoderm are called

Benign cystic teratomas

Teretomas that contains tissue from ectoderm are called

Dermoid cyst

Teretomas are commonly seen in association with

Seen with pregnancy, commonly seen superior and anterior to the fundus

U/S appearance of teretomas includes

Dermoid plug, cystic mass with an echogenic mural nodule, tip of the iceberg: only the tip of the mass is seen, behind that shadowing, dermoid mesh

The best modality to evaluate teretaomas is

CT scan 

Sex cord stromal ovarian tumors originate from

Supporting cells of germ cells

What are the 4 types of stromal tumors

81. Thecoma, granulosa cell tumor, Sertoli- Leydig’s cell tumors, fibroma

Which one of the stromal tumors does not produce any kind of hormone

Fibroma

Thecoma is also known as

Theca cell tumor

Theca cell tumor and granulosa cell tumors produces which type of hormone

Estrogen

Thecoma and granulosa is common in younger age group. T/F

False

Clinical features of theca cell tumor are

Excessive estrogen, enlarged uterus, irregular bleeding, enlargement & tenderness of breast

U/S appearance of sex cord stromal ovarian tumors is

Hypoechoic mass possibly an abnormally thick endometrium (endometrial hyperplasia) secondary to hormonal stimulation

In children granulosa cell tumors could cause

Precocious puberty (in children) 

In postmenopausal women granulosa cell tumors could cause

Vaginal bleeding (hyperplasia) and full breasts 

Sertoli - leydig tumors is also known as

Androblastoma or arrhenoblastoma

Arrhenoblastoma tumors produce what kind of hormones

Androgen (male hormones, testosterone)

Sertoli - leydig tumors are common at what age group

Under 30years

Signs and symptoms for Sertoli - leydig tumors includes

Masculinization-absent menstrual periods (amenorrhea), lack of breast development or breast shrinkage, excess hair growth on the face and chest, deepening of the voice, infertility

What is unique about fibroma

No hormone production and it is Associated with Meig’s syndrome

What the triads (3) criteria’s of Meig’s syndrome

1. Presence of benign ovarian tumor (fibroma) 2. Ascites 3. Pleural effusion that resolves after resection of the tumor

What is the flow pattern of benign and malignant tumor

Benign adnexal masses have a high-resistance Doppler flow pattern and malignant ovarian masses have a low -resistance Doppler flow pattern

What are the 4 classifications of ovarian cancers

1. Stage I: Limited to ovary 2. Stage II: Limited to pelvis, Involvement of uterus/ fallopian tubes 3. Stage III: Limited to abdomen 4. Stage IV- Beyond abdomen

What are the 2 common epithelial ovarian cancers

1. Serous cystadenocarcinoma (50%) 2. Mucinous cystadenocarcinoma (15%)

Which one is common between serous cystadenocarcinoma and mucinous cystadenocarcinoma

Serous cystadenocarcinoma

What will help us to differentiate between the benign and malignant epithelial cancers

Epithelial cancer usually present with ascites and plural effusion and will have increased blood flow (hyperemia)

What is pseudomyxoma peritoneii

Is when large ovarian tumors usually malignant ones rupture within the peritoneal cavity and it appears as loculated pockets of fluid in the abdomen & pelvis

Immature teratomas is a benign germ cell tumor/ T/F

False, it is a malignant germ cell tumor 

What lab value will increase in case of immature teratomas

AFP

U/s appearance of immature teratomas is

Variable because they are driver from ecto, meso and endoderm.

Which one is the most common malignant germ cell tumor between, immature teratomas dysgerminoma and endodermal sinus tumor

Dysgerminomas

What lab value will increase in case of immature dysgerminomas

Increase human chorionic gonadotropin (hCG) levels and lactate dehydrogenase (LDH)

The counterpart of dysgerminomas that can be seen testicles is called

Seminoma

Dysgerminomas highly radiosensitive (can responded to treatment). T/F

True

U/s appearance of dysgerminoma is

Solid echogenic, it may show calcifications

Endodermal sinus tumor is also known as

Yolk sac tumor

Endodermal sinus tumor is the 2nd most common malignant tumor after dysgerminoma. T/F

True

What lab value will increase in case of endodermal sinus tumor

AFP level

Endodermal sinus tumor outcome is good or bad

Bad, because does not respond to treatment

What are the primaries sites those metastases to the ovarie

Bowel (krukenberg tumor), breast, and endometrium, as well as from melanoma and lymphoma

Malignant tumors of the ovaries and metastasis to the ovaries usually present with —

Ascites

Malignant tumor from the GI to the ovary is called

krukenberg tumor

The outcome for the krukenberg tumor is

Poor

Any time where is large ovarian or adnexal tumor the other area we need to scan is-----------and why

The kidney to R/O hydronehrosis 

Is krukenberg tumor usually uni or bilateral

Bilateral

What are the two types of ascites

1.transudative ascites - Benign ascites 2. Exudative ascites- Malignant ascites

The u/s appearance of transudative ascites is

Clear fluid- Bowel is freely moving

The u/s appearance of exudative ascites is

Has internal echoes-Bowel is tethered in a fixed location

What are the 2 causes of exudative ascites

Infection and malignancy