Path Block 3 (Overy)

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Path Block 3 (Overy)
2010-11-05 21:18:37
Path Block Overy

Path Block 3 (Overy)
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  1. What is the most important cause of Primary Amenorrhea?
    Turners Syndrome
  2. What are the Types of Ovarian Non-neoplastic Cysts?

    What are the most common lesions of the overy? What are the different types?
    • •Follicular – pre-ovulatory
    • •Luteal – post-ovulatory

    Non-neolpastic lesions
  3. Follicular cysts verses Luteal cysts

    Which is more common?
    Where do they develope?
    • Follicular:
    • -Most common type
    • -Arise fro the ovarian cortex

    • Leuteal:
    • -arise from the corpus leuteum
    • -see fribin and fluid accumulation in the center of the Corpus leuteum
  4. What is this? How can you tell?
    • This is a Follicular Cyst.
    • In the second pic you can see the theca cells with the Granulosa cells on top
  5. What is PCOD?
    What do you see Elevated in PCOD?
    What does PCOD present with clinically?

    What do you see?
    poorly regulated enzymes involved in androgen synthesis

    • See:
    • High LH
    • HIGH testosterone
    • Low FSH

    • –Persistent anovulation – amenorrhea

    See hirsutism, Acne and alopecia
  6. This is PCOD
  7. What are the Four locations that Ovarian Neoplasias can be derived from?
    Which is the most common?
    • Surface epithelial cells (common 70%)
    • Germ cells
    • Sex cord stroma
    • and Metastasis
  8. What are the Major types of Surface epithelial tumors?
  9. •Serous
    • •Mucinous
    • •Endometrioid
    • •Other (Clear Cell, Brenner)

    What do they present like?
    Any markers for detection?
    • Malignant: weakness, weight loss, cachexia, ascites,
    • •G.I. complaints, dysuria, pelvic pressure

    CA-125= useful for following serous and endometrioid
  11. What are some ways to prevent Surface epithelial tumors?
  12. Tubal ligation reduces risk by 50+
    • -Oral contraception decrease by 50%
    • -Prophylatic bilateral salpingo-oophorectomy
  13. Ovarian Surface Epithelial Tumors

    What is the difference between the way the Benign, the border line and the malignant tumors present?
    • Benign
    • •Lined by single layer of bland epithelium


    • •Lined by stratified layers of epithelium
    • •Mild nuclear atypia and few mitoses

    • Malignant
    • •Highly atypical cells & high mitotic index
    • •Stromal invasion
  14. what is the most common malignant ovarian tumor?

    Is it bilateral? Age?

    What do you see Hystologically?
    The tumors may have ??
  15. •Serous Cystadenocarcinoma
    • -usually bilateral, Women over 50
    • - Psammoma bodies
    • •Cystic change
    • •Papillary projections
    • •Necrosis
  16. what are these? what are they associated with?
    psommoma bodies

    Serous Cystadenocarcinoma
  17. What does this patient have?
    Serous Cystadenocarcinoma
  18. Mucinous Surface Epithelial Tumors

  19. Uncommonly bilateral (< 5% - 10%)
    •Tend to be large, multilocular
  20. This is a Mucinous Cystadenoma

    Where is it from?
    What are its complications?
    appendix = usual source

    Intestinal obstruction
  22. This is a Pseudomyxoma Peritonei
  23. Endometrioid Carcinoma of the Ovary

    Where are they from?
    what are the mutations?
    What do you see inside?
    •Most are from surface epithelium; metaplasia

    Mutations= PTEN, KRAS, beta-catenin, microsatellite instability

    - See Chocolate and bloody material inside.
  24. Endometrioid Carcinoma of the Ovary
  25. Brenner Tumor

    What does it look like?
  26. •Uncommon, usually benign, unilateral and solid, yellow – consists of URETHRAL Nests..looks like a BEAN
  27. Brenner Tumor
  28. What is the Most Common Germ cell tumor in the overy?

    What can they contain?

    •May contain ectoderm, mesoderm or endodermal elements (MOST are ectodermal differentiation)
  29. Mature terotoma
  30. What is a monodermal teratoma?

    Give an example?
    •Specialized tissue overgrows all other tissue elements

    -Ex: Tyroid-- Struma ovarii
  31. Immature Teratoma

    What do you see?
    Can see 3 germ layers. NEURAL elemets common
  32. What is a Dysgerminoma?

    What is it associated with? In males it is..?
    What do you see in the stroma?
    •Most common malignant germ cell tumor

    • - Turners sundrome and congenital malformations
    • - Serminomas
    • - usually unilateral
    • -Lymphocutes in stroma
  33. Dysgerminoma
  34. Endodermal Sinus (Yolk Sac) Tumor

    - Seen in young girls


    -Schiller-Duval body (central blood vessel enveloped and lined by germ cells)
  35. What is this? How can you tell?
    It is a Endodermal Sinus (Yolk Sac) Tumor

    See Schiller-Duval body (central blood vessel enveloped and lined by germ cells)

    What do you see?
  37. Aggressive
    •High levels of human chorionic gonadotropin (B-hcg)
  38. Ovarian Sex Cord-Stromal Tumors

    What are they?
    Arise from specialized (sex cord) or non-specialized (stromal) cells

    • •Granulosa – Theca cell
    • •Thecoma - Fibroma
    • •Sertoli-Leydig cell (Androblastoma)
  39. Granulosa Cell Tumor

    What are the types?most common?
    What are produced?
    Clinical signs and symptoms?
    • 1.Juvenile type
    • 2.Adult type – majority (95%)15-80 years

    Production of •Estrogens and androgens

    • •Abnormal menses
    • Estrogen related complications including endometrial hyperplasia and carcinoma
    • •Vague abdominal pain
    • •Acute abdominal pain caused by tumor rupture or torsion
    • Clitoral enlargement
  40. What is this? How can you tell?
    This is Granulosa Cell Tumor Adult type

    See the Call-Exner bodies
  41. Thecoma-Fibroma Tumors

    Clinical Presentation?
    Are they
  42. •Mass, 90% unilateral
    •Ascites, Hydrothorax (Meigs Syndrome)
  43. Visually, what is the diffference between a Thecoma and a Fibroma?
    • Thecomas:
    • yellow
    • Cystic change occasionally present

    • Fibromas:
    • Grey-white, firm tumor
  44. Thecoma-Fibroma Tumors
  45. Sertoli-Leydig Cell Tumors(Androblastomas)

    What do you see?
    • Defeminization characteristics
    • -Oligomenorrhea or amenorrhea, atrophy of breast and uterus, hirsutism, clitoral hypertrophy, acne and temporal alopecia
  46. Sertoli-Leydig Cell Tumor (Androblastoma)
  47. Krukenberg tumor (Classic)

    What is it?
    What will you see?
    Metastatic Tumor of the Ovary

    See Metastatic signet-ring carcinoma involving both ovaries
  48. Krukenberg Tumor (Classic)
  49. What Ovarian Tumors are unilateral?????
  50. Unilateral:
    • 1.Mucinous Neoplasms
    • 2.Dysgerminoma
    • 3.Thecoma/Fibroma
    • 4.Brenner