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Questions and Answers
Which condition is associated with the presence of thickened fibrosed outer tunica and multiple cysts in the ovaries?
Which condition is associated with the presence of thickened fibrosed outer tunica and multiple cysts in the ovaries?
What histological structure is characteristic of endodermal sinus tumors?
What histological structure is characteristic of endodermal sinus tumors?
What is the common complication associated with oophoritis?
What is the common complication associated with oophoritis?
Which tumor is most commonly associated with producing human chorionic gonadotrophin?
Which tumor is most commonly associated with producing human chorionic gonadotrophin?
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Which tumor type is the most common malignant tumor of the ovary?
Which tumor type is the most common malignant tumor of the ovary?
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Which hormone levels are typically decreased in patients with Polycystic Ovary Syndrome?
Which hormone levels are typically decreased in patients with Polycystic Ovary Syndrome?
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What is a hallmark histological feature of granulosa cell tumors?
What is a hallmark histological feature of granulosa cell tumors?
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Which type of tumor generally presents during reproductive years as an abdominal mass?
Which type of tumor generally presents during reproductive years as an abdominal mass?
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What is a primary risk factor for developing ovarian tumors?
What is a primary risk factor for developing ovarian tumors?
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What are the typical signs and symptoms presented by Sertoli-Leydig cell tumors?
What are the typical signs and symptoms presented by Sertoli-Leydig cell tumors?
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Which characteristic is not typical of follicular cysts?
Which characteristic is not typical of follicular cysts?
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What condition can be a result of fallopian tube inflammation?
What condition can be a result of fallopian tube inflammation?
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What is a significant complication associated with larger fibromas?
What is a significant complication associated with larger fibromas?
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Which factor is NOT a risk for ovarian carcinoma?
Which factor is NOT a risk for ovarian carcinoma?
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What type of tumor primarily originates from gastric tissue and causes bilateral ovarian neoplasms?
What type of tumor primarily originates from gastric tissue and causes bilateral ovarian neoplasms?
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Which tumor type is described as being virtually always benign and occurs at all ages?
Which tumor type is described as being virtually always benign and occurs at all ages?
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What is a common characteristic distinguishing mucinous tumors from serous tumors?
What is a common characteristic distinguishing mucinous tumors from serous tumors?
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Which tumor is known for containing nests of transitional-like epithelium?
Which tumor is known for containing nests of transitional-like epithelium?
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Which statement is true regarding immature teratomas?
Which statement is true regarding immature teratomas?
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What is the primary histological characteristic of endometrioid tumors?
What is the primary histological characteristic of endometrioid tumors?
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Which tumor type is most commonly bilateral among teratomas?
Which tumor type is most commonly bilateral among teratomas?
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What is the prognosis of mucinous cystadenocarcinoma in comparison to serous tumors?
What is the prognosis of mucinous cystadenocarcinoma in comparison to serous tumors?
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What is a characteristic of a complete hydatidiform mole?
What is a characteristic of a complete hydatidiform mole?
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Which of the following best describes the typical presentation of dysgerminomas?
Which of the following best describes the typical presentation of dysgerminomas?
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What unique effect can rupture of a mucinous cyst cause?
What unique effect can rupture of a mucinous cyst cause?
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Which demographic is at the highest risk for developing a complete hydatidiform mole?
Which demographic is at the highest risk for developing a complete hydatidiform mole?
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What chromosomal complement is associated with a partial hydatidiform mole?
What chromosomal complement is associated with a partial hydatidiform mole?
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What is the likelihood of a complete hydatidiform mole transforming into choriocarcinoma?
What is the likelihood of a complete hydatidiform mole transforming into choriocarcinoma?
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What is a typical histological finding in choriocarcinoma?
What is a typical histological finding in choriocarcinoma?
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Which blood group combination presents the highest risk for developing choriocarcinoma?
Which blood group combination presents the highest risk for developing choriocarcinoma?
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What structural characteristic is commonly seen in the villi of a complete hydatidiform mole?
What structural characteristic is commonly seen in the villi of a complete hydatidiform mole?
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The trophoblast composition in a choriocarcinoma primarily includes which types of cells?
The trophoblast composition in a choriocarcinoma primarily includes which types of cells?
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Study Notes
Diseases of the Female Reproductive System (Ovary)
- Ovarian diseases encompass various conditions affecting the female reproductive system, specifically the ovaries.
Female Infertility - Ovarian Causes
- Gonadal dysgenesis (Turner's Syndrome): Characterized by the presence of 45XO or mosaics 46XX/45ΧO, impacting ovarian function.
- Testicular feminization: A condition affecting hormone receptors, potentially leading to infertility.
- Premature ovarian failure: A condition where the ovaries stop functioning before the typical age of menopause.
Oophoritis
- Inflammation of the ovary (oophoritis) can arise secondary to fallopian tube inflammation or peritonitis.
- Salpingo-oophoritis: Inflammation of both the fallopian tubes and ovaries, often linked to intrauterine contraceptive devices.
- Complications of oophoritis can include tuboovarian abscess, adhesions, peritonitis, and infertility due to extensive adhesions.
Follicular & Luteal Cysts
- Common, almost consider physiologic variants.
- Develop from un-ruptured or immediately sealed Graafian follicles.
- Typically small (2 cm diameter).
- Filled with clear serous fluid.
- Lined by granulosa or lutein cells.
- Rupture may trigger acute abdominal pain.
Polycystic Ovary Syndrome (Stein-Leventhal Syndrome)
- Symptoms include oligomenorrhea, hirsutism, infertility, and sometimes obesity.
- Biochemical characteristics: Increased estrogen and androgen levels, elevated luteinizing hormone (LH), and decreased follicle-stimulating hormone (FSH).
Gross & Histological Features of Polycystic Ovary
- Gross: Ovaries are enlarged (twice normal size), with subcortical cysts.
- Histology: Characterized by thickened fibrous outer tunica (Cortical Stromal Fibrosis), with numerous cysts lined by granulosa cells and hyperplastic luteinized theca interna cells. Corpus luteum is absent.
Ovarian Tumors - Risk Factors
- Nulliparity: Women who have never given birth.
- Persistent elevated pituitary gonadotropins after menopause.
- Exposure to irritants (e.g., talc, asbestos).
- Family history of ovarian carcinoma.
- BRCA-1, BRCA-2 gene mutations and HNPCC.
Ovarian Tumors - Types & Statistics
- Surface Epithelial Cells (Surface Epithelial/Stromal cell tumors): Largest proportion (65-70%). Include serous, mucinous, endometrioid, clear cell, brenner, and cystadenofibroma tumors.
- Germ Cell tumors: Representing 15-20% of ovarian tumors. Include mature cystic teratomas, immature teratomas, monodermal teratomas, dysgerminomas, endodermal sinus tumors, and choriocarcinomas.
- Sex Cord-Stromal tumors: 5-10% of ovarian tumors. Include granulosa cell tumors, thecomas, and fibromas.
- Metastatic tumors: 5% of ovarian tumors. Develop from extragenital primary sites such as stomach, colon, or breast. Krukenburg tumor is a common type.
- Ovarian cancer statistics vary, but ovarian cancer forms a significant portion of all malignant ovarian tumors. Survival rates vary and depend on stage of disease at diagnosis.
Surface Epithelial Tumors (specifically Serous Tumors)
- Most common type of epithelial ovarian tumor.
- Typically found in women aged 30-40.
- Often cystic, can be referred to as serous cystadenoma or serous cystadenocarcinoma.
- Serous cystadenocarcinoma: Is the most frequent malignant type comprising approximately 60% of all ovarian cancers.
- Benign tumors have a 25% bilateral occurrence rate.
Serous Tumors features
- Gross: Sizes range from 5–40 cm, usually cystic with clear serous fluid. Some papillary projections are evident in malignant forms.
- Histology: Variations noted in benign, borderline, and malignant types. Grading is based on microscopic examination. Malignant forms may spread to regional lymph nodes although distant metastases are uncommon.
Mucinous Tumors
- Differ from serous tumors in epithelium, are more likely to be benign.
- Typically more multilocular than serous tumors.
- Rupture can lead to mucinous deposits in the peritoneum (pseudomyxoma peritonei).
- Prognosis is generally better than that of serous cystadenocarcinoma
Endometrioid Tumor
- Can be solid or cystic, often arising from the wall of an endometriotic cyst.
- Microscopically, show tubular glands similar to endometrial glands.
- Typically malignant.
Brenner Tumor
- Uncommon, solid, encapsulated, and white or gray in appearance.
- Microscopically characterized by abundant stroma containing nests of transitional-like epithelium resembling urinary tract epithelium.
- Mostly benign, although malignant and borderline types also exist.
Germ Cell Tumors (Specifically Teratomas)
- Mature cystic teratomas (dermoid cysts): Commonest germ cell tumor.
- Cystic structure containing hair, sebaceous material, and teeth.
- Bilateral occurrence in 10-15% of cases.
- Common characteristics are usually benign.
Germ Cell Tumors (Specific details)
- Histology: Cysts lined by stratified squamous epithelium, with wide range of diverse tissues (sebaceous glands, nerves, respiratory/intestinal epithelium, cartilage, bone, muscle, and fibrous tissue).
- Malignant transformations, usually squamous cell carcinoma, are uncommon but can occur in elderly patients.
- Immature teratomas: Solid, malignant, arising early in life; consist of immature tissues (primitive neural tissue and immature mesenchyme). Highly proliferative and may metastasize to the peritoneum.
Germ Cell Tumors (Specific details)
- Monodermal (specialized) teratomas: Almost exclusively composed of tissue from one germ cell layer.
- Common germ cell layer is from the Stroma ovarii, often involving thyroid tissue, which can be benign or malignant.
Germ Cell Tumors (Specific details)
- Dysgerminoma: Malignant germ cell tumor; typically found in young women.
- Gross appearance: Solid and yellow-white.
- Microscopically: Round cells with large nuclei, separated by connective tissue containing infiltrated lymphocytes. Histologically similar to seminoma of the testicle.
Germ Cell Tumors (Specific details)
- Endodermal sinus tumor (yolk sac tumor): Typically solid and cystic; prone to hemorrhage.
- Histology: Shows characteristic Schiller-Duval bodies, which are crucial for diagnosis.
- Contains extracellular and intracellular hyaline droplets that react positively with alpha-fetoprotein (AFP), which serves as a tumor marker.
- High potential for intra-abdominal metastasis. Untreated cases have poor prognosis.
Germ Cell Tumors (Specific details)
- Choriocarcinoma: Highly malignant with early metastasis.
- Often associated with other germ cell tumors.
- Secretes human chorionic gonadotropin (hCG).
Sex-Cord Stromal Tumors
- Granulosa cell tumor: Potentially malignant, associated with estrogen-related precocious puberty, endometrial hyperplasia, and menorrhagia. Cells arranged in follicles, trabeculae, or sheets; central spaces possibly containing Call-Exner bodies.
Sex-Cord Stromal Tumors
- Thecoma: Commonest sex-cord stromal tumor; usually unilateral, well-circumscribed abdominal mass appearing in reproductive years. Cellular spindle cells containing abundant lipid content.
Sex-Cord Stromal Tumors
- Fibromas: Occur at all ages, peaking during perimenopause; always benign. Solid, firm, and white appearance. Cells resemble normal ovarian cortex stroma.
Sex-Cord Stromal Tumors
- Sertoli-Leydig cell tumors: Rare, composed of cell types typically found in testes. Present with signs and symptoms of androgen excess (hirsutism, virilization).
Metastatic Tumors
- Common metastatic sites, including stomach, colon, and breast.
- Krukenburg tumor: Bilateral ovarian metastasis composed of malignant mucin-secreting cells, primarily originating in the stomach.
Gestational Trophoblastic Disease & Types
- Spectrum of disorders involving trophoblast proliferation and maturation.
- Complete hydatidiform mole: Fertilization of an empty ovum lacking maternal DNA (23X) resulting in the absence of an embryo.
Complete Hydatidiform Mole: Risk Factors
- Maternal age: Risk increases progressively for individuals older than 40 years, showing a higher risk for those young than 15.
- Asian women show increased risk.
- Prior history of hydatidiform mole signifies a significantly higher risk of recurrence.
Complete Hydatidiform Mole: Pathology
- Gross: Marked swelling of the villi, resembling clusters of grapes.
- Microscopically: Numerous villi showing areas filled with central fluid-filled spaces, along with trophoblastic hyperplasia.
Partial Hydatidiform Mole
- Triploidy (69 chromosomes); one set maternal, two paternal, or vice versa.
- Results from fertilization of a normal ovum by two spermatozoa.
Gestational Choriocarcinoma: Risk Factors
- Complete hydatidiform mole: 2% chance of transformation.
- Blood Group A: Women with blood group A married to a man of the same blood group show higher risk.
Gestational Choriocarcinoma: Pathology
- Microscopic foci to large, necrotic, and hemorrhagic tumors.
- Lack intrinsic vasculature.
- Dimorphic populations of cytotrophoblasts and syncytiotrophoblasts with varying intermediate trophoblast degrees.
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Test your knowledge on various ovarian tumors and related conditions with this quiz. Explore topics such as histological features, complications, and hormonal changes associated with different types of ovarian tumors. Perfect for medical students and professionals looking to deepen their understanding of gynecological health.
