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Pathology of the Ovaries Part II
Terms in this set (94)
Only 3% of neoplasm ovarian cysts less than ____ cm are malignant and those greater than ____ cm should be removed for risk of malignancy.
5 cm; 5 cm
In postmenopausal women, neoplasms cause the ovary to look ______________ and _______________.
enlarged, and heterogeneous
anechoic well defined lesions are usually ___________ while irregular walls, thick septations, and echogenic debris usually means _____________.
Ovarian Neoplasms show _______ resistance on a Doppler examination.
What are areas of metastases for ovarian neoplasms?
omentum, peritoneum, and liver
The 5-year survival rate is _________ for stages I through IV.
The 5-year survival rate for stage IV only is _________.
Ovarian Carcinoma is also known as _____________ ____________.
Unilocular = _______________; Multiocular = _____________.
In advanced stages of ovarian neoplasms, peritoneal ________________ with malignant ____________ and peritoneal ___________ can be seen.
carcinomatosis; ascites; implants
Change in ovarian ____________ or a volume of more than _______ ml should be considered suspicious.
echogenicity; 20 ml
Ovaries in postmenopausal women are ____________, meaning not having any follicles unless HRT is being used
kills more women than cancer of uterine cervix and body combined and is the fourth leading cause of cancer death in about 1 in 70 women
60% of ovarian malignancies occur in women between _____-______ years of age
Ovarian Carcinoma is usually not detected in the early stages but usually at stage II which is within the ____________ or stage III which is into the ____________.
Ovarian Carcinoma less than _________ is mostly likely benign and masses greater than _______ are more likely to be malignant.
5 cm; 10 cm
blood chemistry test; helpful in some patients; disappointing as screening test because of inability to detect many cases of ovarian cancer
CA 125 has many ________________________________ and ________________________________ results; elevated levels found in only 50% of patients with stage III ovarian cancer.
Ovarian Carcinoma can present as either __________, ___________, or __________ masses with 20% being bilateral
complex, cystic, solid
What is the most common presentation of ovarian carcinoma?
In long axis, masses less than ______ cm are likely begin and masses greater than _____ cm are likely malignant
5 cm; 10 cm
increasing age increases ...
risk for malignancy
Incidence of ovarian cancer greatly increased in women who had...
breast and colon cancer
Strongest risk factor is family history of _________________ or __________________ __________________.
ovarian; breast cancer
Ovarian cancer primarily arises from _______________ tumors (60-70%), including:
- serous cystadenocarcinoma (50%)
- endometrioid tumor similar to endometrial adenocarcinoma (15-30%)
- mucinous cystadenocarcinoma (15%)
- Clear cell carcinoma (5%)
- Brenner tumor (2.5%)
- Undifferentiated tumor (<5%)
________________ _______________ ________________ contribute to 15% to 30% of the (ovarian cancer) malignancies and are more common in girls and young women (4-27 y.o.); they include:
Germ cell tumors
- mature teratoma
- immature teratoma
- transdermal sinus tumor
- malignant mixed germ cell tumor
- embryonal carcinoma
________________ (5-10%) and stromal tumors are the remaining tumors that contribute to developing ovarian cancer.
Other risk factors for ovarian carcinoma include
- increasing age
Clinical symptoms of ovarian carcinoma include:
-weight change (ascites)
Stage I Ovarian Carcinoma is limited to :
the ovary; limited to one or two ovaries and possible ascites (positive peritoneal lavage)
Stage II of Ovarian Carcinoma is limited to:
the pelvis; involvement of uterus, fallopian tubes, pelvic tissue, and possible ascites
Stage III of Ovarian Carcinoma is limited to:
the abdomen; intraabdominal extension outside of pelvis to nodes, small bowel, and omentum
Stage IV of Ovarian Carcinoma is:
Hematogenous disease which spreads to liver parenchyma and beyond the abdomen
single layer of flat supporting cells that surround oocytes present in the cortex of the ovary; support and nourish oocyte
Follicular (stromal) cells
The stromal cells surrounding the follicle condense to form the __________________________.
TRUE or FALSE. Secondary follicles are similar to primary follicles in many ways and only dew primary follicles develop into secondary follicles.
Gynecologic tumors that arise from surface epithelium and cover ovary and underlying stroma; accounts for 65-75% of ovarian neoplasms and 80-90% of malignancies
surface epithelial-stromal tumors
Most common ovarian cancer group is
surface epithelial stromal tumors
The two most common types of epithelial tumors are :
serous and mucinous tumors
The two common serous type epithelial tumors common in older women:
___________ tumors are the most common type of epithelial tumor accounting for _____% of ovarian neoplasm
Epithelium of serous tumors are _________ in type; may be one or multiple cysts bilaterally
These tumors have more complex internal echo pattern; may become very large tumors
The benign/low malignancy form of epithelial tumor is called an ____________ and the malignant form is called a ____________.
______________ is a term used when a tumor is more than 50% fibrous
_____________ tumors usually spread intraperitoneal with direct extension to lymphatics later in the course of the disease.
type of epithelial tumor lined by mucinous elements of endocervix and bowel; can be very large and weighing over 100 pounds
Mucinous Cystadenoma are usually found in younger women ages ____-____ yrs old
13-45 yrs old
most common cystic tumor; usually unilateral with cystic material and spaces which are typically benign
In 75% of patients with mucinous tumors, ultrasound examination shows simple or septate thin-walled multilocular _________.
Mucinous Cystadenocarcinoma occur typically in women _____ to _____ years old
Mucinous Cystuadenocarcinoma are usually __________ when malignant and occur mostly in ____________ women; they are very large and associated with located ascites due to tendency to rupture
If a Mucinous Cystuadenocarcinoma ruptures, it is associated with:
Second most common benign tumor of ovary after dermoid cyst; usually unilocular, and irregular with thin separations and are smaller than mucinous cysts
TRUE or FALSE. External papillary mass adhesions and infection lead to bilateral involvement.
Serous ___________________________ include bilateral involvement, loss of capsular involvement, peritoneal implants, and metastases
tumors derived from primitive germ cells of embryonic gonad ; include dysgerminoma, embryonal cell carcinoma, choriocarcinoma, and transdermal sinus tumor
Germ Cell Tumors
Germ Cell Tumors include:
- embryonal cell carcinoma
- transdermal sinus tumor
95% of germ cell tumors are:
benign cystic teratomas
_______________________tumors occur as mixed tumors with elements of two or three varieties of germ cell tumors and are associated with elevated alpha-fetoprotein (AFP) and hCG levels
Germ Cell Tumors
____________________ are a type of germ cell tumor which have derivatives of all germ layers; 8-15% bilateral; ultrasound CHAMELEON of ovarian tumors; contain skin, hairs, sebaceous, and other body tissues
_____% of germ cell tumors are prone to calcify
tumors that range from small to 40 cm that contain fatty, sebaceous material, hair, cartilage, bone, and teeth
Teratoma: Dermoid Tumors
completely cystic mass; cystic mass with echgenic module along mural wall representing "dermoid plug"; fat-fluid level; high-amplitude echoes with shadowing (from teeth or bone), and internal septations
Sonographic appearance of Teratoma: Dermoid Tumors
uncommon teratoma; occur in girls and young women 10 to 20 years of age; AFP elevated in 50% of patients; unilateral and small in size but rapidly growing
Two most common ovarian neoplasms seen in pregnancy
rare (1-2%) malignant germ cell tumor that is bilateral and entirely solid ovarian mass in woman <30 years of age
Endodermal sinus tumors that are rare and rapidly growing tumors that occur in women less than 20 years of age and even men; unilateral; increased AFP may be seen
Yolk Sak Tumors
Second most common malignant ovarian germ cell neoplasm after dysgerminoma; has a poor prognosis
Endodermal sinus tumor
typically solid adnexal masses that arise from sex cords of embryonic gonadal and/or ovarian stroma
Sex cord-stromal tumors
Stromal Tumors include:
-granulosa cell tumor
-Sertoli-Leydig cell tumors (androblastoma and arrhenoblastoma)
a rare cancer of the ovaries prevalent in ages 20-25 where an androgen producing cancer cell will release male sex hormones
Sertoli-Leydig cell tumors
Both __________ and __________ tumors arise from ovarian stroma
Abundance of thecal cells = ______________ and abundance of fibrous tissue = __________________.
Fibromas are common in the _________________ women
What is Miegs' syndrome?
The triad of ascites, pleural effusion and benign ovarian tumor
usually unilateral; size ranges from small to melon size, with variable sonographic appearance; hypoechoic mass with posterior attenuation seen from homogeneous fibrous tissue; larger tumors pedunculated and prone to torsion, edema, and cystic degeneration
-Feminizing neoplasm composed of cells resembling graafian follicle
-Most common hormone-active estrogenic tumor of ovary
-common after menopause; also seen in reproductive age
__________________ have Clinical symptoms of estrogen production may include precocious puberty or vaginal bleeding and full breasts and are known to twist and cause torsion and rupture which leads to Meigs' syndrome
If rare malignancy occurs, granulosas spread through:
lymphatics and bloodstream
A 46-year-old woman was found to have a grapefruit-sized mass on pelvic examination. Sonography showed a well-defined, homogenous mass in the right ovary, which was surgically removed. What was likely her mass' diagnosis?
_____________ are more involved with metastatic disease than any other pelvic organ
______________ often mimic appearance of advanced stage II to III primary ovarian cancer
_________________ tumors "drop" metastases to ovaries from GI tract, primarily from stomach, but also from biliary tract, gallbladder, pancreas
_________________ disease to ovaries frequently bilateral and often associated with ascites and "moth-eaten" cystic patterns that occur when necrotic
involving ovary usually diffuse and disseminated and also frequently bilateral;
sonographically, mass appears as solid hypoechoic tumor
least common of all gynecologic malignancies; adenocarcinoma is the most common finding; occurs in postmenopausal women; usually involves the distal end
Carcinoma of the Fallopian Tube
Appears as sausage-shaped, complex mass, with cystic and solid components often with papillary projections
Sonographic appearance of carcinoma of the Fallopian tubes
Distinguish solid ovarian masses from pedunculated myomas by identifying ___________ connection and searching for __________.
In general the more the __________ the more neovascularity and the more likely the mass is _______________.
What is used to evaluate the relative amount of diastolic to systolic flow?
Pulsatile Index and Resistive Index
PI = (S-D/mean)
RI = (S-D/S)
A mass with complete ABSENCE of diastolic flow or HIGH RI and PI levels is almost always:
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