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Ovarian Pathology

Cysts lined with an inner layer of granulosa cells and outer layer of theca internal cells that form during ovulation that are under < 3 cm ? * cystic follicles
Over > 3 cm and over 3 cm WITH Luteinization ? * follicular cysts .... * + LH = Luteal Cyst
Polycystic Ovarian Disease ? * Numerous cystic follicles or follicle cyst, often associated with oligomenorrhea .... * women have anovulation, obesity, and hirsutism
Polycystic Ovarian Disease & Cortical Stromal Hyperplasia Gross Morphology ? * PCOS = see numerous clear, shiny cysts.... * Cortical = stromal prolif, with no cysts
Ovarian Tumors overview ? * mostly benign and usu in younger women..... * Malignant Ovarian Cancer = less incidence than vaginal/cerival, but when we get it, it is WAY more deadly
Surface Epithelial-Stromal Tumor types and basics ? * based on Differentiaion: Serous - Mucinous - endometrioid ....* and on extent of proliferation: Benign (adenoma), Borderline, and Malignant (adenocarcinoma)
Further classified based on cystic and/or fibrous features ? * cystadenoma /cystadenocarcinoma (with cystic structures) --- cystadenofibroma (cyst and fibrous areas)--- adenofibroma (predominantly fibrous areas)
Surface epithelial tumors theory ? * the derivation of mullerian epithelial tumors is the transformation of coelomic epithelium, which then incorporated into ovarian development and repro. development
Serous tumors = ? * Most common malignant ovarian tumor, BUT most are benign or borderline.... * This is a BILATERAL OVARIAN tumor
Malignant Serous Tumors = ? * Low grade = associated with serous borderline tumor mutations in KRAS and BRAF and RARE p53 mutation....... * High Grade = arise De Novo, mutations in BRCA1 and 2, with a COMMON p53 mutation
Reduces risk of Malignant Serous Tumors ? * women over 40 who have taken oral contraceptives and have undergone tubal ligation have reduced risk
Mucinous Tumors ? * Gross = looks like a dried sponge.... * UNILATERAL and are less common than serous, and happens in middle of life (NOT young).... * Have KRAS Mutations..... * gelatinous fluid... * Cysts are lined by tall, columnar epithelial cells with apical mucin
Pseudomyxoma peritonei = ? * Clinical condition defined by extensive mucinous ascites, cystic epithelial implants on the peritoneal surfaces, adhesions and frequently mucinous tumor involving the ovaries .... * thought to be cause by mucinous.... *
If bilat. presentaion of a mucinous tumor = ? * bilateral presentation of mucinous tumors always requires exclusion of a non-ovarian origin --> Pseudomyxoma Peritonei
Endometrioid Tumors ? * BILATERAL (40%) ...* benign and borderline endometrioid tumors.....* Gross = see solidand cystic areas.... * Histo = Tumor consists of tubular glands bearing a close resemblance to benign or malignant endo. –columnar cells secreting mucous onto surface
SUMMARY of Epithelial Cell Tumors ? * Bilateral = Serous and Endo..... * Uni. = Mucinous..... * Most common is Serous.... * Serous is the only cuboidal epi, the rest are Columnar... * Mucinous = LARGE/MASSIVE Tumor.... * Age Group for all = 20+ yr olds
If CA-125 is measured = ? * most common in serous and endometrioid, but not specific ot bs e Dx off of it, so use other tests..... * We use it once Dx is confirmed to check response to tmt and recurrences
Clear Cell Adenocarcinoma = ? * Rare, but see clear cells, and when we see clear cells = really aggressive.... * Only a 65% - 5-year survival rate..... * associated with endometrioid carcinoma
Cystadenofibroma = ? * Variants in which the fibrous stromal proliferation is more pronounced than that of the columnar lining epithelium ..... * Small and benign... * Can have Endo, Mucinous, and Serous
Brenner tumor = ? * Classified as adenofibroma..... * Epithelial components consists of nests of transitional –type epithelium (epithelial cells resembling those lining the urinary bladder)
Teratoma basics ? * Has a Mature Type = benign (has differentiated).... and Immature = is Malignant
Mature (Benign) Teratoma = ? * see in YOUNG women of reproductive age..... *associated with inflammatory limbic encephalitis ....... * Tumors arise from an ovum after the first meiotic division
Immature Malignant Teratomas = ? * Prepubertal adolescents and young women, mean age (18 yrs) ...... * The Tissue resembles embryonal and immature fetal tissue ..... * Can invade ovarian capsule and mets...* Grade based on % of immature epi found
Monodermal or Specialized Teratoma = ? * Rare & Always UNILATERAL - 2 types ..... * Struma ovarii (most common) = has mature thyroid tissue and can cause hyperthy....* Ovarian carcinoid = from intestinal epithelium in ovary (have serotonin syndrome).....* strumal carcinoid- combo of both
Dysgerminoma = ? * Ovarian counterpart of seminoma of the testis ..... * in 2nd and 3rd decades of womens life .... * Secretes HCG and may have syncitiotrophoblastic giant cells on histologic exam.... * 96% cure rate... * Common in Turners due to gonadal dysgenesis
Endodermal Sinus (Yolk Sac) Tumor = ? * 2nd most common germ cell tumor... * Occurs in KIDS (know this pic.)...... * The tumor is rich in α-fetoprotein and α1 antitrypsin ....* rapidly developing pelvic mass with abdominal pain in children or young women.... * See Schiller-Duval Bodies
Choriocarcinoma = ? * placental origin...* Most are mixed.... * See HIGH levels of HCG... * usu. unresponsive to radiation, and often fatal
The 3 Sex Cord-Stromal tumors ? * Granulosa-theca cell tumors --- Fibromas, thecomas and fibrothecomas --- Sertoli-leydig cell tumors (androblastomas)
Granulosa-Theca Cell tumors = ? * In adults we see more bleeding/spotting and even breast cysts..... *In girls, we see precocious puberty.... * Most occur Postmenopausal women....* SEs are from high estrogen production....* High incidence of recurrence...* Biomarker = High INHIBIN lvls
Morphology of Granulosa-Theca Cell Tumors = ? * Call-Exner Bodies seen in purple slide, which look like flower looking things
Tumors arising in the ovarian stroma that are composed of either ? * Fibroblasts- Fibromas ...... * plump spindle cells with lipid droplets- Thecomas ....... * or maybe Mixed- Fibrothecomas
Meigs syndrome = ? * See: ovarian tumor - pleural effusion - ascites .... * when tumor is removed, effusion and ascites goes away
Morphology of Fibroma and Thecoma ? * solid/spherical, with an intact ovarian serosa
Sertoli-Leydig Cell Tumors (Androblastoma) = ? * In 2nd & 3rd decades..... * Unilat. & may resemble granulosa-theca cell tumors.... * Produce musculinization (the Virulizing Tumor) .....* Gross: looks like a cross section of an orange....* see tubules w/sertoli cells or leydig cells mixed in stroma
Metastatic Tumors = ? * common metastatic tumors in the ovary are derived from tumors of the mullerian origin..... * Most common extramullerian tumors that metastasize to the ovary are carcinomas of breast and GI are pseudomyxoma peritonei and Krukenberg Tumor
Krukenberg Tumor and Pseudomyxoma Peritonei = ? * Pseudomyxoma Peritonei = from appendiceal tumors......... * Krukenberg Tumor = bilateral mets to ovary from GI origin, composed of signet-ring cancer cells (gastric cancer)
Created by: thamrick800