Female Genital Tract – Ovarian Pathology

Question-and-answer flashcards covering cysts, polycystic ovaries, tumor classifications, key genetic and clinical features, and specific tumor types of the ovary.

Which four broad disease categories affect the ovary?

Degenerative, inflammatory, cystic, and tumorous conditions.

Name the two most common functional ovarian cysts.

Follicular cysts and luteal cysts.

What clinical syndrome is characterized by oligomenorrhea, hirsutism, infertility, and sometimes obesity in young women?

Polycystic ovary disease (Stein-Leventhal syndrome).

Which biochemical abnormalities are typical in polycystic ovary disease?

Excessive androgen production, high LH, and low FSH levels.

What gross appearance is typical of polycystic ovaries?

Ovaries ~2× normal size with a thickened gray-white cortex studded with multiple subcortical cysts and absence of corpora lutea.

List the three principal cell origins of ovarian tumors.

Surface (coelomic) epithelium, germ cells, and sex-cord/stromal cells.

Approximately what percentage of ovarian cancers are of surface epithelial origin?

~90%.

Give two major epidemiologic risk factors for epithelial ovarian cancer.

Nulliparity and positive family history.

How does prolonged oral-contraceptive use affect ovarian-cancer risk?

It reduces the risk.

Mutations in which two tumor-suppressor genes account for many hereditary ovarian cancers?

BRCA1 and BRCA2.

Which tumor marker is most important for follow-up of epithelial ovarian cancer?

CA-125.

What is usually assumed when a woman presents with malignant ascites?

Ovarian carcinoma until proven otherwise.

Name the four main Müllerian (surface epithelial) tumor subtypes.

Serous, mucinous, endometrioid, and clear-cell tumors (plus Brenner and mixed Müllerian types).

Which ovarian tumor subtype is most common and most frequently malignant?

Serous tumors (serous cystadenocarcinoma).

At what ages are benign versus malignant serous tumors most often encountered?

Benign: 30–40 years; malignant: 45–65 years.

What percentage of ovarian cancers are mucinous tumors?

~10%.

State the benign–borderline–malignant distribution of mucinous tumors.

80 % benign, 10 % borderline (LMP), 10 % malignant.

What microscopic hallmark can be found in papillary serous carcinomas and some other papillary tumors?

Psammoma bodies.

Endometrioid ovarian carcinoma is commonly associated with mutations in which gene?

PTEN tumor-suppressor gene.

Approximately what proportion of women with endometrioid ovarian tumors also have an endometrial carcinoma?

15–30 %.

What benign ovarian tumor is composed of nests of transitional-type epithelium within a fibrous stroma?

Brenner tumor.

Which ovarian germ-cell tumor is the female analogue of seminoma?

Dysgerminoma.

Name four malignant germ-cell tumors of the ovary.

Immature teratoma, dysgerminoma, endodermal sinus (yolk-sac) tumor, and choriocarcinoma.

What percentage of ovarian teratomas are benign mature cystic teratomas?

90 %.

What classic gross finding inside a mature cystic teratoma can be seen on imaging?

A fully formed tooth or calcified bony structure.

Which malignant transformation is most often seen within a mature cystic teratoma?

Squamous cell carcinoma arising from the epidermal component (~1 %).

Why are mature cystic teratomas prone to cause surgical emergencies?

They can undergo torsion of the ovarian pedicle.

What specialized teratoma consists entirely of thyroid tissue and may cause hyperthyroidism?

Struma ovarii.

Which age group most commonly develops immature (malignant) teratomas?

Adolescents and young women; mean age ≈ 18 years.

What histologic feature predicts aggressive behavior in immature teratomas?

Foci of immature neuroepithelial tissue.

Name three major sex-cord/stromal tumors of the ovary.

Granulosa-theca cell tumor, fibroma-theca, and Sertoli-Leydig (androblastoma).

Are sex-cord/stromal tumors usually cystic or solid, and are they often hormone-producing?

Usually solid and often functional (hormone-producing).

Which hormone is typically produced in excess by granulosa-theca cell tumors?

Estrogen.

What microscopic structures, seen in granulosa cell tumors, consist of small gland-like spaces with eosinophilic material?

Call-Exner bodies.

Which oncogene is overexpressed in ~35 % of ovarian carcinomas and confers a poor prognosis?

HER2/NEU.

KRAS mutations are particularly common in which subtype of ovarian carcinoma?

Mucinous cystadenocarcinoma (up to 30 %).

P53 mutations are found in roughly what fraction of all ovarian cancers?

About 50 %.

A nulliparous 27-year-old woman with hirsutism, oligomenorrhea, and enlarged multicystic ovaries most likely has which condition?

Polycystic ovary disease (Stein-Leventhal syndrome).

A 32-year-old hyperthyroid woman is found to have an ovarian mass composed exclusively of thyroid tissue. What is the diagnosis?

Struma ovarii.

An ovarian mass that contains a well-developed molar tooth on imaging is most likely what tumor?

Mature cystic teratoma (dermoid cyst).