Pathology: Ovarian Neoplasms

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Questions and Answers

In ovarian physiology, which process directly facilitates the release of the oocyte, marking a critical step in female reproduction?

Folliculogenesis, initiating early follicle maturation.
Luteinization, converting the follicle into a corpus luteum.
Atresia, promoting follicle degeneration and hormone recycling.
Ovulation, involving the rupture of the Graafian follicle. (correct)

What distinguishes inclusion cysts from other benign cystic lesions in the ovary?

Their origin from germ cells following meiotic errors.
Their large size, typically exceeding 5 cm in diameter.
Their small size (less than 1 cm) and origin from peritoneal/Müllerian inclusions. (correct)
Their presence of endometrial-like tissue, causing pain.

What is the significance of ovarian torsion in the context of ovarian masses?

It involves malignant tumors undergoing rapid necrosis, preventing metastasis.
It is a condition that can occur with any ovarian mass and requires immediate intervention. (correct)
It exclusively occurs in benign neoplasms leading to spontaneous resolution.
It primarily affects postmenopausal women with small, atrophic ovaries.

What critical aspect differentiates the management of malignant ovarian neoplasms from benign ones, influencing prognosis and treatment strategies?

Malignant tumors, particularly high-grade serous carcinomas, often present at an advanced stage, impacting prognosis. (C) Signup and view all the answers

Which classification criterion is most crucial in distinguishing between benign, borderline, and malignant surface epithelial ovarian tumors?

The extent of nuclear atypia, architectural complexity, and the presence or absence of stromal invasion. (D) Signup and view all the answers

Which specific symptom would most strongly suggest a surface epithelial ovarian tumor, especially in women over 40?

Persistent, nonspecific pelvic or abdominal pain combined with gastrointestinal symptoms and abdominal distention. (A) Signup and view all the answers

What is the critical distinction between borderline and malignant epithelial ovarian tumors, affecting their clinical management and patient outcomes?

Malignant tumors show destructive stromal invasion, which is absent in borderline tumors. (A) Signup and view all the answers

Which molecular characteristic is most strongly associated with high-grade serous carcinoma (HGSC) of the ovary, potentially influencing targeted therapeutic strategies?

Mutations in the TP53 gene, detectable through immunohistochemistry. (B) Signup and view all the answers

Which factor significantly elevates the risk of developing ovarian cancer, particularly influencing screening and preventative strategies for at-risk individuals?

Presence of BRCA1 or BRCA2 mutations, necessitating genetic counseling and potentially prophylactic oophorectomy. (A) Signup and view all the answers

What microscopic feature is most diagnostic for endometrioid carcinoma?

Squamous morules. (D) Signup and view all the answers

In distinguishing mucinous from other ovarian carcinomas, which is the most crucial histopathological rule to exclude metastatic disease?

Demonstrating an intestinal phenotype and excluding microscopic features like infiltrative growth, bilaterality or pseudomyxoma peritonei. (A) Signup and view all the answers

What feature impacts upon the prognosis of clear cell carcinoma, influencing survival rates significantly?

The stage at diagnosis; early-stage tumors have ~90% 5-year survival, while advanced stage lesions have poor prognosis. (D) Signup and view all the answers

Which of the following ovarian tumor types is most strongly associated with underlying endometriosis?

Clear cell carcinoma. (D) Signup and view all the answers

When considering the staging of ovarian carcinomas, what distinction is critical in differentiating high-stage from low-stage disease and what does it indicate?

High-stage disease is defined by distant metastases; low-stage disease is confined to the ovaries with good prognosis. (A) Signup and view all the answers

Which specific histological feature is most indicative of an adult granulosa cell tumor?

Call-Exner bodies and coffee bean nuclei. (A) Signup and view all the answers

What is the primary clinical significance of fibroma-thecoma tumors of the ovary, impacting diagnostic and management strategies?

They are common benign tumors, often hormonally inactive but can cause virilization in some cases. (C) Signup and view all the answers

Which characteristic links ovarian germ cell tumors to those in the male testis?

Germ cell tumors in both ovaries and testes are very similar due to their origin from primordial germ cells that migrate to the gonads. (C) Signup and view all the answers

What specific clinical presentation differentiates germ cell tumors from surface epithelial tumors?

Germ cell tumors typically present in younger patients and is often associated with acute symptoms and isosexual precocity; surface epithelial tumors typically present in older women. (A) Signup and view all the answers

What underlying pathological process can be inferred from a mature cystic teratoma (dermoid cyst)?

The differentiation of germ cells along multiple lineages. (A) Signup and view all the answers

A malignant teratoma contains:

Mixtures of both mature and immature fetal tissue. (D) Signup and view all the answers

Which statement accurately characterizes dysgerminoma?

Male equivalent is seminoma of the testis. (C) Signup and view all the answers

What is the significance of Schiller-Duval bodies and elevated alpha-fetoprotein (AFP) in the context of ovarian neoplasms?

This suggests a Yolk sac tumor and a more aggressive clinical course. (D) Signup and view all the answers

How does the aggressive nature of choriocarcinoma typically manifest, affecting management and prognosis?

Early and widespread metastasis to lungs, liver, or brain, combined with elevated hCG levels. (C) Signup and view all the answers

Which critical factors distinguish metastatic tumors involving the ovary from primary ovarian neoplasms, specifically influencing diagnostic approaches?

Metastatic tumors involving the ovary often necessitate a comprehensive clinicopathological assessment. (A) Signup and view all the answers

Why is gross assessment so important in determining if a tumor is metastatic to the ovary?

It is important to correlate it with a history of mullerian primary malignancy. (B) Signup and view all the answers

Which gynecological malignancy arises from a probable Wolffian origin?

Tumour of probable Wolffian origin (FATWO). (D) Signup and view all the answers

Which genetic syndrome is linked with increased risk of ovarian cancer development?

Lynch syndrome. (D) Signup and view all the answers

What is the primary characteristic that distinguishes a serous ovarian tumor from other types of ovarian tumors?

Resemblance to fallopian tube epithelium and separation separate pathways into low grade versus high grade subtypes. (A) Signup and view all the answers

What is the importance of recurrence in borderline tumors?

Recurrence can be managed through cystectomy and oophorectomy, FIOG staging, etc. (B) Signup and view all the answers

Which of the following would be true about OCP (Oral Contraceptive Pill) use and hereditary cancer syndromes?

OCP/tubal ligation is protective against tumor development. (A) Signup and view all the answers

Which is generally characteristic of a Sertoli-Leydig cell tumor?

Virilization symptoms. (D) Signup and view all the answers

Which of the following symptoms is associated with granulosa cell ovarian tumors?

The granulosa cells secrete high volumes of the estrogen hormone. (D) Signup and view all the answers

Which are the primary sites of mucinous tumors that metastasize?

Appendix/colon and pancreas. (B) Signup and view all the answers

What histological component do you need to identify to classify a monodermal teratoma?

Struma ovarii, carcinoid, strumal carcinoid, neuroectodermal tumours. (B) Signup and view all the answers

Which is true of a Yolk Sac tumor?

The main diagnostic feature is Schiller-Duval bodies. (B) Signup and view all the answers

How does the presence of TP53 mutations, detectable via immunohistochemistry (IHC), contribute to the understanding and classification of high-grade serous carcinoma (HGSC)?

It supports its classification and is associated with defects in DNA repair mechanisms. (B) Signup and view all the answers

What key criterion differentiates a mature cystic teratoma from an immature teratoma and how does this distinction primarily influence clinical management?

The presence of exclusively mature tissues versus a mixture of mature and immature (fetal) tissues, affecting the risk of recurrence. (B) Signup and view all the answers

How can the histologic growth patterns of adult granulosa cell tumors be best used to differentiate it from other ovarian tumors?

Exhibiting coffee bean nuclei “grooves” and patterns like cords, sheets, and trabeculae. (C) Signup and view all the answers

What is the primary clinical significance of identifying 'coffee bean' nuclei and Call-Exner bodies in ovarian tumor pathology?

They confirm the diagnosis of an adult granulosa cell tumor, known for its late recurrences and hormonal activity. (C) Signup and view all the answers

In the evaluation of mucinous ovarian tumors, what is the most critical step in differentiating a primary ovarian tumor from a metastatic lesion, and what specific gross feature would raise suspicion for metastasis?

Excluding metastatic disease from the intestinal tract; bilaterality and nodular surface should raise suspicion for metastasis. (C) Signup and view all the answers

How does the relative chemoresistance of clear cell carcinoma influence treatment strategies, and what aspect of its prognosis is most affected by the tumor's stage at diagnosis?

It may warrant the inclusion of non-platinum-based regimens; the outcome is hugely stage-dependent, with stage 1 having ~90% 5-year survival, and advanced stages a poor prognosis. (B) Signup and view all the answers

How does the presence of specific architectural complexity and cytologic atypia in borderline ovarian tumors impact their clinical behavior, specifically concerning recurrence risks and overall survival?

It implies a risk of recurrence, especially with cystectomy or implants, but generally does not significantly diminish overall survival if managed appropriately. (A) Signup and view all the answers

A 25-year-old presents with a rapidly growing ovarian mass and elevated serum alpha-fetoprotein (AFP). Which of the following is the most likely diagnosis, and what histological feature would most strongly support this diagnosis?

Yolk sac tumor, supported by the presence of Schiller-Duval bodies. (A) Signup and view all the answers

In cases of suspected ovarian metastasis, what specific clinical data, beyond histological findings, is most crucial for distinguishing metastatic tumors from primary ovarian neoplasms and tailoring appropriate patient management?

A comprehensive history of extra-ovarian primary malignancies, guiding the diagnostic approach and treatment. (C) Signup and view all the answers

How does the differential diagnosis between a primary mucinous ovarian tumor and a metastatic mucinous tumor from a gastrointestinal (GI) source impact surgical staging and subsequent treatment strategies?

Excluding a GI primary influences the extent of surgical staging (e.g., lymphadenectomy) and directs postoperative surveillance for potential GI recurrence. (C) Signup and view all the answers

What are the implications of identifying a sex cord-stromal tumor of the ovary in a postmenopausal woman presenting with signs of virilization, and how does this influence further diagnostic and therapeutic steps?

It requires thorough investigation to rule out Sertoli-Leydig cell tumors which can cause virilization, guiding further hormone level assessments and imaging studies. (C) Signup and view all the answers

How does the cellular origin of dysgerminoma relate to its clinical behavior, and what is the significance of its histological similarity to specific testicular tumors?

Deriving from germ cells, dysgerminomas share a histological likeness to testicular seminomas and imply a sensitivity to radiation therapy. (B) Signup and view all the answers

What is the significance of identifying different tissue types (e.g., endoderm, ectoderm, mesoderm) within a mature cystic teratoma, and how does this impact the malignant potential and patient management strategies?

It confirms its classification as a benign lesion, since the presence of differentiated tissues from all three germ layers is a characteristic feature of mature teratomas. (C) Signup and view all the answers

When diagnosing a Sertoli-Leydig cell tumor, how would one interpret the presence or absence of androgenic symptoms in correlation with tumor morphology to guide further clinical investigation and management?

Presence of androgenic symptoms supports the diagnosis, warranting hormone level assessments (e.g., testosterone) and imaging to assess tumor extent and potential virilization. (B) Signup and view all the answers

Given that high-grade serous carcinoma (HGSC) is now often considered of tubal origin (STIC), what implications does this have for preventative strategies, particularly in women with BRCA mutations?

Salpingectomy with delayed oophorectomy becomes a viable option, reducing ovarian cancer risk while preserving fertility longer. (B) Signup and view all the answers

Which of the following is the most common type of ovarian neoplasm?

Benign (B) Signup and view all the answers

Which age range is most associated with benign ovarian neoplasms?

20-45 (B) Signup and view all the answers

What proportion of primary ovarian tumors are classified as surface epithelial tumors?

70% (A) Signup and view all the answers

What is the typical age of presentation for ovarian carcinomas, in general?

Over 40 years (A) Signup and view all the answers

Which of the following is a common, non-specific presenting symptom of surface epithelial ovarian tumors?

Pelvic or abdominal discomfort (C) Signup and view all the answers

Which of the following features is characteristic of borderline ovarian tumors?

Architectural complexity (D) Signup and view all the answers

Which genetic mutation is most frequently associated with high-grade serous carcinoma (HGSC) of the ovary?

TP53 (C) Signup and view all the answers

Which of the following is a risk factor for ovarian cancer?

Nulliparity (D) Signup and view all the answers

Which histological feature is commonly associated with endometrioid carcinoma?

Squamous morules (B) Signup and view all the answers

When evaluating mucinous tumors of the ovary, what is the most critical diagnostic step to exclude metastatic disease?

Exclusion of metastatic disease (C) Signup and view all the answers

What best describes the usual clinical behavior of adult granulosa cell tumors?

Indolent with late recurrences (B) Signup and view all the answers

What is a common presentation of fibroma-thecoma tumors of the ovary?

Torsion (C) Signup and view all the answers

Which ovarian tumor type is most similar to testicular tumors?

Germ cell tumors (A) Signup and view all the answers

Which tumor is most often associated with elevated alpha-fetoprotein (AFP)?

Yolk sac tumor (D) Signup and view all the answers

Which sites are more likely to be the primary origin of mucinous tumors that metastasize to the ovaries?

Appendix, colon, and pancreas (C) Signup and view all the answers

What conditions are tubal ligations and OCP's (Oral Contraceptive Pills) protective against?

Ovarian cancer (A) Signup and view all the answers

What percentage of high stage ovarian carcinomas are HGSC (High Grade Serous Carcinoma)?

90% (C) Signup and view all the answers

Presence of which type of tissue is required to classify a monodermal teratoma?

Specialized (B) Signup and view all the answers

What is the male equivalent to dysgerminoma?

seminoma (B) Signup and view all the answers

What symptoms are commonly associated with Sertoli-Leydig cell tumors?

Virilization (B) Signup and view all the answers

Flashcards

Ovarian Function

Reproduction, development of follicles, and hormone production (estrogen and progesterone).

Types of ovarian cystic lesions

Inclusion cysts, serous cystadenoma, mucinous cystadenoma, follicle cyst, corpus luteum cyst, and endometriotic cyst.

What is ovarian torsion?

Twisting of the ovary, which can occur with any ovarian mass

Are ovarian neoplasms benign or malignant?

Most are benign; malignant more common in older women and often present at a high stage with poor prognosis.