Ovarian Tumors and Conditions Quiz

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.

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.