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Pathology - Dysplasia, Carcinoma in Situ, and Squamous Cell Carcinoma of the Cervix
Linked to HPV types 16, 18, 31, and 33, early sexual debut, multiple sexual partners, HIV infection, and smoking.
Cervical dysplasia (CD): Concerns the squamocolumnar junction; identified by cells with hyperchromatic nuclei, irregular nuclear shapes, and minimal cytoplasm; epithelial proliferation starts at the basal layer and spreads outward; categorized as cervical intraepithelial neoplasia (CIN) grades I-III; CIN I displays abnormal undifferentiated cells solely in the lower third of the epithelium, while CIN III exhibits atypical cells throughout more than two-thirds of the epithelium.
Cervical carcinoma in situ (CIS) is characterized by dysplastic cells that spread over the whole epithelium but do not invade the basement membrane.
Symptoms and signs
Cervical cancer that has invaded surrounding tissues/ invasive cervical carcinoma (ICC). Gross: may present as exophytic, ulcerating, or infiltrating mass.
The microscopic findings typically show squamous cell carcinoma (SCC) with big cells and keratinization. It can also present as adenocarcinoma or undifferentiated carcinoma. The cancer originates from preexisting cervical intraepithelial neoplasia (CIN) at the squamocolumnar junction. Non-neoplastic epithelial cells generally exhibit koilocytosis, which is linked to HPV infection.
Therapies
Clinical ICC symptoms include irregular vaginal bleeding, postcoital spotting, pelvic pain, cervical ulceration and discharge, dysuria, and potential ureter obstruction causing renal failure.
Treatment: For CIN I, consider either expectant management or excision as 75% regress spontaneously. Treat CIN II-III by excision.
ICC: Hysterectomy, chemotherapy, and radiation for treatment; HPV vaccine for prevention.
Linked to HPV types 16, 18, 31, and 33, early sexual debut, multiple sexual partners, HIV infection, and smoking.
Cervical dysplasia (CD): Concerns the squamocolumnar junction; identified by cells with hyperchromatic nuclei, irregular nuclear shapes, and minimal cytoplasm; epithelial proliferation starts at the basal layer and spreads outward; categorized as cervical intraepithelial neoplasia (CIN) grades I-III; CIN I displays abnormal undifferentiated cells solely in the lower third of the epithelium, while CIN III exhibits atypical cells throughout more than two-thirds of the epithelium.
Cervical carcinoma in situ (CIS) is characterized by dysplastic cells that spread over the whole epithelium but do not invade the basement membrane.
Symptoms and signs
Cervical cancer that has invaded surrounding tissues/ invasive cervical carcinoma (ICC). Gross: may present as exophytic, ulcerating, or infiltrating mass.
The microscopic findings typically show squamous cell carcinoma (SCC) with big cells and keratinization. It can also present as adenocarcinoma or undifferentiated carcinoma. The cancer originates from preexisting cervical intraepithelial neoplasia (CIN) at the squamocolumnar junction. Non-neoplastic epithelial cells generally exhibit koilocytosis, which is linked to HPV infection.
Therapies
Clinical ICC symptoms include irregular vaginal bleeding, postcoital spotting, pelvic pain, cervical ulceration and discharge, dysuria, and potential ureter obstruction causing renal failure.
Treatment: For CIN I, consider either expectant management or excision as 75% regress spontaneously. Treat CIN II-III by excision.
ICC: Hysterectomy, chemotherapy, and radiation for treatment; HPV vaccine for prevention.
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Pathology - Zollinger-Ellison Syndrome
Gastrinoma is typically caused by a pancreatic islet cell tumor. While most gastrinomas occur sporadically, 25% are linked to Multiple Endocrine Neoplasia Type I (MEN I).
Gastrinoma can originate in the pancreas, duodenum, or adjacent tissues. They are frequently malignant and tend to spread to the liver, although they typically do not exhibit anaplasia histologically.
Gastrinomas release gastrin, which results in acid hypersecretion, leading to peptic ulcers and inactivation of pancreatic enzymes.
Peptic ulcer disease in the duodenum can lead to ulcer perforation, along with symptoms such as diarrhea, steatorrhea, and weight loss due to pancreatic enzyme inactivation.
Laboratory results: Elevated gastrin levels, reduced stomach acidity.
Excision of gastrinoma; regulation of stomach acid production with proton pump inhibitors.
Insulinoma is a pancreatic tumor that results in excessive release of insulin and elevated levels of C-peptide, a chemical produced during insulin manufacture. It is linked to the Whipple triad, which consists of episodic hyperinsulinemia and hypoglycemia, hypoglycemic CNS impairment, and the reversal of CNS dysfunction when hypoglycemia is resolved.
Gastrinoma is typically caused by a pancreatic islet cell tumor. While most gastrinomas occur sporadically, 25% are linked to Multiple Endocrine Neoplasia Type I (MEN I).
Gastrinoma can originate in the pancreas, duodenum, or adjacent tissues. They are frequently malignant and tend to spread to the liver, although they typically do not exhibit anaplasia histologically.
Gastrinomas release gastrin, which results in acid hypersecretion, leading to peptic ulcers and inactivation of pancreatic enzymes.
Peptic ulcer disease in the duodenum can lead to ulcer perforation, along with symptoms such as diarrhea, steatorrhea, and weight loss due to pancreatic enzyme inactivation.
Laboratory results: Elevated gastrin levels, reduced stomach acidity.
Excision of gastrinoma; regulation of stomach acid production with proton pump inhibitors.
Insulinoma is a pancreatic tumor that results in excessive release of insulin and elevated levels of C-peptide, a chemical produced during insulin manufacture. It is linked to the Whipple triad, which consists of episodic hyperinsulinemia and hypoglycemia, hypoglycemic CNS impairment, and the reversal of CNS dysfunction when hypoglycemia is resolved.
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Pathology - Fibrocystic Breast Disease
Resulting from a hormonal imbalance characterized by elevated estrogens and/or reduced progesterones.
The highest occurrence is often observed between the ages of 25 and 50.
Multiple histological variations: (1) Cystic lesions: numerous fluid-filled cysts are observed as blue (referred to as blue-dome cysts). The cysts are bordered by polygonal cells with eosinophilic granular cytoplasm resembling apocrine epithelium (known as apocrine metaplasia). Papillary projections of cystic epithelium may also be present.
Epithelial hyperplasia of the breast duct refers to a rise in the number of epithelial layers in the terminal duct lobules, leading to uneven lumens. Stromal fibrosis involves hyperplasia and fibrosis of the breast stroma.
Sclerosing adenosis is characterized by an elevated quantity of acini and fibrosis in the stromal tissue.
Clinical Symptoms and Signs
Manifests as diffuse breast pain, most severe during the premenstrual phase, with many palpable lesions that are often felt on both sides. There are no changes in the skin or nipple, and the masses tend to rapidly alter in size.
Perform biopsy to rule out malignancy. Once the disease is established, address symptoms by controlling pain with NSAIDs, oral contraceptives, and a supportive brassiere.
Fibrocystic disease is the predominant breast illness. Cystic fibrosis and stromal fibrosis do not pose a higher risk for cancer, although epithelial hyperplasia and sclerosing adenosis do have a slightly elevated risk.
Resulting from a hormonal imbalance characterized by elevated estrogens and/or reduced progesterones.
The highest occurrence is often observed between the ages of 25 and 50.
Multiple histological variations: (1) Cystic lesions: numerous fluid-filled cysts are observed as blue (referred to as blue-dome cysts). The cysts are bordered by polygonal cells with eosinophilic granular cytoplasm resembling apocrine epithelium (known as apocrine metaplasia). Papillary projections of cystic epithelium may also be present.
Epithelial hyperplasia of the breast duct refers to a rise in the number of epithelial layers in the terminal duct lobules, leading to uneven lumens. Stromal fibrosis involves hyperplasia and fibrosis of the breast stroma.
Sclerosing adenosis is characterized by an elevated quantity of acini and fibrosis in the stromal tissue.
Clinical Symptoms and Signs
Manifests as diffuse breast pain, most severe during the premenstrual phase, with many palpable lesions that are often felt on both sides. There are no changes in the skin or nipple, and the masses tend to rapidly alter in size.
Perform biopsy to rule out malignancy. Once the disease is established, address symptoms by controlling pain with NSAIDs, oral contraceptives, and a supportive brassiere.
Fibrocystic disease is the predominant breast illness. Cystic fibrosis and stromal fibrosis do not pose a higher risk for cancer, although epithelial hyperplasia and sclerosing adenosis do have a slightly elevated risk.
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Pathology - Benign Tumors of the Breast
Fibroadenoma (FA): Common in women under 40, more prevalent in African American women at a younger age.
Phyllodes tumor (PT) typically develops in individuals over the age of 50.
Intraductal papilloma (IP) typically affects women in their middle age.
FA: Gross: tiny, mobile, springy, hard mass with distinct, well-defined edges.
Microscopic description: fibroblastic stroma surrounds cystic and glandular areas; may decrease in size after menopause and show calcifications.
PT: Gross: substantial, bulky accumulation of connective tissue and cysts. Microscopic examination reveals cystic areas on the cut piece of stroma including leaflike extensions from cyst walls, resulting in a leaflike appearance on the breast surface. Approximately 5%-10% of these cases progress malignant transformation with atypia, known as cystosarcoma phyllodes.
IP: Gross: originating from significant lactiferous ducts. Microscopic description: increased development of ductal epithelial tissue in a papillary pattern; presence of apocrine metaplasia.
FA and PT: Enlarged mass becomes more sensitive during pregnancy or menstrual cycle; no changes in skin appearance; no swollen lymph nodes; no nipple retraction.
IP: Exhibits nipple discharge.
FA: No intervention or basic removal.
PT: Local excision with broad margin; may return post-resection. IP: Basic removal.
PT and IP are associated with a slightly elevated risk of breast cancer.
Fibroadenoma (FA): Common in women under 40, more prevalent in African American women at a younger age.
Phyllodes tumor (PT) typically develops in individuals over the age of 50.
Intraductal papilloma (IP) typically affects women in their middle age.
FA: Gross: tiny, mobile, springy, hard mass with distinct, well-defined edges.
Microscopic description: fibroblastic stroma surrounds cystic and glandular areas; may decrease in size after menopause and show calcifications.
PT: Gross: substantial, bulky accumulation of connective tissue and cysts. Microscopic examination reveals cystic areas on the cut piece of stroma including leaflike extensions from cyst walls, resulting in a leaflike appearance on the breast surface. Approximately 5%-10% of these cases progress malignant transformation with atypia, known as cystosarcoma phyllodes.
IP: Gross: originating from significant lactiferous ducts. Microscopic description: increased development of ductal epithelial tissue in a papillary pattern; presence of apocrine metaplasia.
FA and PT: Enlarged mass becomes more sensitive during pregnancy or menstrual cycle; no changes in skin appearance; no swollen lymph nodes; no nipple retraction.
IP: Exhibits nipple discharge.
FA: No intervention or basic removal.
PT: Local excision with broad margin; may return post-resection. IP: Basic removal.
PT and IP are associated with a slightly elevated risk of breast cancer.
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Pathology - Breast Cancer
Risk factors for breast cancer include a family history of first-degree relative with breast cancer at a young age, autosomal dominant inheritance of mutations in BRCA1 or BRCA2 gene, female gender, increased age, early first menarche, delayed first pregnancy, nulliparity, late menopause, radiation exposure, and exogenous estrogen use.
Incidence rises with advancing age.
Pathology
Infiltrating ductal carcinoma is characterized by tumor cells organized in cords, islands, or glands inside a dense fibrous stroma. It may develop from ductal carcinoma in situ (DCIS).
Intraductal comedocarcinoma is characterized by a cluster of tumor cells enclosed within a duct, with central necrosis, periductal fibrosis, and inflammation.
Inflammation: Lymphatic system affecting the skin above.
Paget disease is characterized by the invasion of giant cells with a visible halo of pale cytoplasm from ducts into the epidermis of the nipple. This condition always involves underlying ductal adenocarcinoma inside subareolar excretory channels.
Lobular infiltration: Frequently found in multiple and bilateral locations; cells align in a single file pattern with tumor cells surrounding the lobule in a target-like manner; presence of signet ring cells; may develop from lobular carcinoma in situ (LCIS) over an extended period.
Medullary: Dense cell sheets with prominent nucleoli in minimal connective tissue; presence of lymphocytic infiltration.
A painless, typically immobile, firm lump commonly located in the upper outer quadrant of the breast; skin and nipple changes; detectable axillary lymph nodes; bone discomfort if metastasis to bones occurs.
Treatment Notes
Infiltrating ductal carcinoma: Dense, immovable, fibrous lump.
Characterized by redness, swelling, heat, agony upon touch, and skin resembling an orange peel.
Paget's disease presents as pruritic, scaly, and painless eczematous lesions on the nipple.
Medullary: Soft mass with a fleshy consistency.
Lab results indicate that a paraneoplastic illness causing the release of PTH-related peptide can result in high levels of calcium in the blood.
Imaging: Mammogram showing microcalcifications or a spiculated, growing tumor.
Treatment options include surgery, radiation treatment, chemotherapy, hormonal therapy (tamoxifen or aromatase inhibitors) for patients with estrogen receptor-positive cancer cells, and monoclonal antibody therapy (trastuzumab) for individuals with HER2/neu expression.
Metastasis spreads to lymph nodes, lungs, liver, central nervous system (CNS), and bones.
Mucinous (colloid) refers to pools of extracellular mucin around tumor cell clusters with a gelatinous nature.
Among women, breast carcinoma ranks as the second leading cause of cancer-related mortality.
Clinical Symptoms
A painless, typically immobile, firm lump commonly located in the upper outer quadrant of the breast; skin and nipple retraction; detectable axillary lymph nodes; bone discomfort if metastasis to the bone occurs.
Infiltrating ductal cancer presents as a firm, fixed, fibrous mass.
Characterized by redness, swelling, heat, agony upon touch, and a skin texture like an orange peel.
Paget's disease presents as pruritic, scaly, and painless eczematous lesions on the nipple.
Medullary: Soft mass with a fleshy consistency.
Lab results indicate that a paraneoplastic condition causing the release of PTH-related peptide can result in hypercalcemia.
Imaging: Mammogram showing microcalcifications or spiculated, growing mass.
Therapies
Treatment options include surgery, radiation treatment, chemotherapy, hormonal therapy (tamoxifen or aromatase inhibitors) for patients with estrogen receptor-positive cancer cells, and monoclonal antibody therapy (trastuzumab) for individuals with HER2/neu expression.
Metastasis can spread to lymph nodes, lungs, liver, central nervous system (CNS), and bones.
Risk factors for breast cancer include a family history of first-degree relative with breast cancer at a young age, autosomal dominant inheritance of mutations in BRCA1 or BRCA2 gene, female gender, increased age, early first menarche, delayed first pregnancy, nulliparity, late menopause, radiation exposure, and exogenous estrogen use.
Incidence rises with advancing age.
Pathology
Infiltrating ductal carcinoma is characterized by tumor cells organized in cords, islands, or glands inside a dense fibrous stroma. It may develop from ductal carcinoma in situ (DCIS).
Intraductal comedocarcinoma is characterized by a cluster of tumor cells enclosed within a duct, with central necrosis, periductal fibrosis, and inflammation.
Inflammation: Lymphatic system affecting the skin above.
Paget disease is characterized by the invasion of giant cells with a visible halo of pale cytoplasm from ducts into the epidermis of the nipple. This condition always involves underlying ductal adenocarcinoma inside subareolar excretory channels.
Lobular infiltration: Frequently found in multiple and bilateral locations; cells align in a single file pattern with tumor cells surrounding the lobule in a target-like manner; presence of signet ring cells; may develop from lobular carcinoma in situ (LCIS) over an extended period.
Medullary: Dense cell sheets with prominent nucleoli in minimal connective tissue; presence of lymphocytic infiltration.
A painless, typically immobile, firm lump commonly located in the upper outer quadrant of the breast; skin and nipple changes; detectable axillary lymph nodes; bone discomfort if metastasis to bones occurs.
Treatment Notes
Infiltrating ductal carcinoma: Dense, immovable, fibrous lump.
Characterized by redness, swelling, heat, agony upon touch, and skin resembling an orange peel.
Paget's disease presents as pruritic, scaly, and painless eczematous lesions on the nipple.
Medullary: Soft mass with a fleshy consistency.
Lab results indicate that a paraneoplastic illness causing the release of PTH-related peptide can result in high levels of calcium in the blood.
Imaging: Mammogram showing microcalcifications or a spiculated, growing tumor.
Treatment options include surgery, radiation treatment, chemotherapy, hormonal therapy (tamoxifen or aromatase inhibitors) for patients with estrogen receptor-positive cancer cells, and monoclonal antibody therapy (trastuzumab) for individuals with HER2/neu expression.
Metastasis spreads to lymph nodes, lungs, liver, central nervous system (CNS), and bones.
Mucinous (colloid) refers to pools of extracellular mucin around tumor cell clusters with a gelatinous nature.
Among women, breast carcinoma ranks as the second leading cause of cancer-related mortality.
Clinical Symptoms
A painless, typically immobile, firm lump commonly located in the upper outer quadrant of the breast; skin and nipple retraction; detectable axillary lymph nodes; bone discomfort if metastasis to the bone occurs.
Infiltrating ductal cancer presents as a firm, fixed, fibrous mass.
Characterized by redness, swelling, heat, agony upon touch, and a skin texture like an orange peel.
Paget's disease presents as pruritic, scaly, and painless eczematous lesions on the nipple.
Medullary: Soft mass with a fleshy consistency.
Lab results indicate that a paraneoplastic condition causing the release of PTH-related peptide can result in hypercalcemia.
Imaging: Mammogram showing microcalcifications or spiculated, growing mass.
Therapies
Treatment options include surgery, radiation treatment, chemotherapy, hormonal therapy (tamoxifen or aromatase inhibitors) for patients with estrogen receptor-positive cancer cells, and monoclonal antibody therapy (trastuzumab) for individuals with HER2/neu expression.
Metastasis can spread to lymph nodes, lungs, liver, central nervous system (CNS), and bones.
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Pathology - Ovarian Cysts
Follicular (F) cyst linked to hyperestrinism and endometrial hyperplasia, commonly causing ovarian enlargement, typically detected during menstrual years.
Corpus luteum (CL) cysts are typically identified during the reproductive years.
Theca-lutein (TL) cyst is linked to choriocarcinoma, hydatidiform moles, and clomiphene treatment.
Follicle distention is frequently bilateral and involves an unruptured Graafian follicle bordered by granulosa cells.
CL: Typically one-sided; filled with transparent fluid; surrounded by yellow luteal cells containing lipid droplets in the cytoplasm; may experience bleeding into an existing mature corpus luteum.
TL: Frequently occurring on both sides and in several locations; surrounded by luteinized theca cells.
Symptoms may vary from being asymptomatic to experiencing pelvic pressure/pain or nonspecific gastrointestinal discomfort.
F: Non-menstrual pain.
CL: Menstrual cycle delay.
TL: Absence of menstruation.
Lab results show higher levels of hCG due to trophoblastic proliferation.
Frequently resolves after a 2-month course of oral contraceptives; monitor with repeated ultrasounds and consider surgical removal if it persists.
CL and TL: Cyst excision or unilateral oophorectomy.
Follicular (F) cyst linked to hyperestrinism and endometrial hyperplasia, commonly causing ovarian enlargement, typically detected during menstrual years.
Corpus luteum (CL) cysts are typically identified during the reproductive years.
Theca-lutein (TL) cyst is linked to choriocarcinoma, hydatidiform moles, and clomiphene treatment.
Follicle distention is frequently bilateral and involves an unruptured Graafian follicle bordered by granulosa cells.
CL: Typically one-sided; filled with transparent fluid; surrounded by yellow luteal cells containing lipid droplets in the cytoplasm; may experience bleeding into an existing mature corpus luteum.
TL: Frequently occurring on both sides and in several locations; surrounded by luteinized theca cells.
Symptoms may vary from being asymptomatic to experiencing pelvic pressure/pain or nonspecific gastrointestinal discomfort.
F: Non-menstrual pain.
CL: Menstrual cycle delay.
TL: Absence of menstruation.
Lab results show higher levels of hCG due to trophoblastic proliferation.
Frequently resolves after a 2-month course of oral contraceptives; monitor with repeated ultrasounds and consider surgical removal if it persists.
CL and TL: Cyst excision or unilateral oophorectomy.
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Pathology: Polycystic Ovarian Syndrome (Stein-Leventhal Syndrome)
The cause is uncertain, but it is thought that an imbalance of enzymes in androgen production may be triggered by elevated LH secretion, leading to an overproduction of androgens. This condition is linked to obesity, Cushing syndrome, congenital adrenal hyperplasia, genetic predisposition, and adrenal tumors that secrete androgens.
Prevalent endocrine condition that impacts 2%-5% of women in their reproductive years.
Pathophysiology: Elevated androgen levels lead to anovulation, the formation of numerous follicular cysts, and the proliferation of theca cells.
Ovaries are swollen with a thicker pearly white capsule and numerous cysts.
The cysts have a granulosa cell layer, luteinized theca cells, and cortical stromal fibrosis at a microscopic level.
Clinical Symptoms and Signs
Symptoms include amenorrhea or irregular menstruation, infertility, acne, obesity, hirsutism (in 70% of cases), insulin resistance leading to a higher risk of diabetes, virilism, and an increased risk of breast and endometrial cancer.
Laboratory results show elevated LH, reduced FSH, elevated testosterone levels, and signs of insulin resistance.
Treatment includes weight loss, oral contraceptives for cycle regulation in non-conceiving patients, metformin for insulin resistance, gonadotropin analogs, and ovulation induction with clomiphene.
The cause is uncertain, but it is thought that an imbalance of enzymes in androgen production may be triggered by elevated LH secretion, leading to an overproduction of androgens. This condition is linked to obesity, Cushing syndrome, congenital adrenal hyperplasia, genetic predisposition, and adrenal tumors that secrete androgens.
Prevalent endocrine condition that impacts 2%-5% of women in their reproductive years.
Pathophysiology: Elevated androgen levels lead to anovulation, the formation of numerous follicular cysts, and the proliferation of theca cells.
Ovaries are swollen with a thicker pearly white capsule and numerous cysts.
The cysts have a granulosa cell layer, luteinized theca cells, and cortical stromal fibrosis at a microscopic level.
Clinical Symptoms and Signs
Symptoms include amenorrhea or irregular menstruation, infertility, acne, obesity, hirsutism (in 70% of cases), insulin resistance leading to a higher risk of diabetes, virilism, and an increased risk of breast and endometrial cancer.
Laboratory results show elevated LH, reduced FSH, elevated testosterone levels, and signs of insulin resistance.
Treatment includes weight loss, oral contraceptives for cycle regulation in non-conceiving patients, metformin for insulin resistance, gonadotropin analogs, and ovulation induction with clomiphene.
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Pathology - Ovarian Surface Epithelium Origin Tumors
Risk factors consist of a family history of breast or ovarian cancer, mutations in BRCA1 or BRCA2, and nulliparity.
Typically manifests in females over 20 years old.
Serous cystadenoma: Benign cysts with fallopian tube-like epithelium present bilaterally.
Papillary serous cystadenocarcinoma is characterized by malignant cysts bordered with stratified atypical epithelium, papillary growth, and psammoma structures.
Mucinous cystadenoma is characterized by the presence of several benign cysts with columnar cells packed with mucin.
Mucinous cystadenocarcinoma is a malignant tumor characterized by mucus-secreting atypical columnar epithelium, loss of gland architecture, and necrosis.
Brenner tumor is a benign tumor characterized by clusters of cells that resemble bladder transitional epithelium, found inside a fibrous stroma.
Endometrioid tumor: Cancerous tumor that resembles the endometrium.
Clear cell tumor: Rare, malignant tumor composed of sheets of clear cells.
Clinical Symptoms
Subtle abdominal discomfort; severe cases may show weakness, weight loss, and loss of appetite; pseudomyxoma peritonei (buildup of mucinous material in the abdominal cavity) is linked to mucinous cystadenocarcinoma.
Laboratory results: Increased levels of CA-125 in ovarian cancer.
Treatment involves tumor excision through procedures such as oophorectomy or hysterectomy, followed by chemotherapy.
75% of ovarian cancers are ovarian epithelial tumors.
Risk factors consist of a family history of breast or ovarian cancer, mutations in BRCA1 or BRCA2, and nulliparity.
Typically manifests in females over 20 years old.
Serous cystadenoma: Benign cysts with fallopian tube-like epithelium present bilaterally.
Papillary serous cystadenocarcinoma is characterized by malignant cysts bordered with stratified atypical epithelium, papillary growth, and psammoma structures.
Mucinous cystadenoma is characterized by the presence of several benign cysts with columnar cells packed with mucin.
Mucinous cystadenocarcinoma is a malignant tumor characterized by mucus-secreting atypical columnar epithelium, loss of gland architecture, and necrosis.
Brenner tumor is a benign tumor characterized by clusters of cells that resemble bladder transitional epithelium, found inside a fibrous stroma.
Endometrioid tumor: Cancerous tumor that resembles the endometrium.
Clear cell tumor: Rare, malignant tumor composed of sheets of clear cells.
Clinical Symptoms
Subtle abdominal discomfort; severe cases may show weakness, weight loss, and loss of appetite; pseudomyxoma peritonei (buildup of mucinous material in the abdominal cavity) is linked to mucinous cystadenocarcinoma.
Laboratory results: Increased levels of CA-125 in ovarian cancer.
Treatment involves tumor excision through procedures such as oophorectomy or hysterectomy, followed by chemotherapy.
75% of ovarian cancers are ovarian epithelial tumors.
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Pathology - Ovarian Germ Cell Tumors
Risk factors comprise nulliparity, positive family history of ovarian cancer, mutations in BRCA I and BRCA2 genes, and high expression of the HER2/neu oncogene.
Most frequently happens in children and young adults, with the exception of teratomas, which can develop at any age.
Dysgerminoma is a malignant tumor seen unilaterally, consisting of large vesicular cells with transparent cytoplasm and central nuclei, similar to male testicular seminoma.
Yolk sac tumor is a malignant tumor characterized by Schiller-Duval bodies, which are glomerulus-like structures consisting of a central blood artery surrounded by germ cells.
Choriocarcinoma is a highly aggressive and malignant tumor characterized by regions of cell death and bleeding, consisting of cancerous syncytiotrophoblasts and cytotrophoblasts.
Teratomas account for 90% of germ cell tumors. Mature teratomas, also known as dermoid cysts, are benign, but immature teratomas are malignant.
Histology involves examining structures derived from all germ layers.
Struma ovarii is a type of ovarian teratoma that consists of thyroid tissue and often affects only one ovary.
Subtle, vague stomach discomfort; struma ovarii can cause hyperthyroidism.
Laboratory results: Elevated AFP indicates yolk sac tumor, while high hCG levels suggest choriocarcinoma.
Therapy
Excision of tumor; surgical removal of ovaries or uterus; chemotherapy.
25% of ovarian cancers are germ cell tumors.
Risk factors comprise nulliparity, positive family history of ovarian cancer, mutations in BRCA I and BRCA2 genes, and high expression of the HER2/neu oncogene.
Most frequently happens in children and young adults, with the exception of teratomas, which can develop at any age.
Dysgerminoma is a malignant tumor seen unilaterally, consisting of large vesicular cells with transparent cytoplasm and central nuclei, similar to male testicular seminoma.
Yolk sac tumor is a malignant tumor characterized by Schiller-Duval bodies, which are glomerulus-like structures consisting of a central blood artery surrounded by germ cells.
Choriocarcinoma is a highly aggressive and malignant tumor characterized by regions of cell death and bleeding, consisting of cancerous syncytiotrophoblasts and cytotrophoblasts.
Teratomas account for 90% of germ cell tumors. Mature teratomas, also known as dermoid cysts, are benign, but immature teratomas are malignant.
Histology involves examining structures derived from all germ layers.
Struma ovarii is a type of ovarian teratoma that consists of thyroid tissue and often affects only one ovary.
Subtle, vague stomach discomfort; struma ovarii can cause hyperthyroidism.
Laboratory results: Elevated AFP indicates yolk sac tumor, while high hCG levels suggest choriocarcinoma.
Therapy
Excision of tumor; surgical removal of ovaries or uterus; chemotherapy.
25% of ovarian cancers are germ cell tumors.
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Pathology - Ovarian Tumors of Sex Cord–Stromal Origin
Risk factors comprise nulliparity, positive family history of ovarian cancer, mutations in BRCA1 and BRCA2 genes, and high expression of the HER2/neu oncogene.
Impacts individuals of all age brackets.
Ovarian fibroma-thecoma (OFT) is a tumor that secretes estrogen and is made up of spherical lipid-containing cells along with well-differentiated fibroblasts.
Granulosa cell tumor (GCT) secretes estrogen, leading to endometrial hyperplasia or cancer in adults. It is identified by Call-Exner bodies, which are tiny follicles with eosinophilic secretions, and small cuboidal granulosa cells grouped in interconnected cords.
Sertoli-Leydig cell tumor (SLCT) secretes androgens and is made up of Sertoli or Leydig cells mixed with stroma.
Slight, vague stomach ache.
Ovarian tumor, ascites, and hydrothorax characterize Meig syndrome.
GCT: Vaginal bleeding due to endometrial hyperplasia; early puberty; individuals have a higher risk of developing breast cystic disease and endometrial malignancy.
SLCT: Virilism.
Laboratory results: Elevated estrogen levels (OFT and GCT).
Excision of tumor; surgical removal of ovaries or uterus; administration of chemotherapy.
Ovarian sex cord-stromal tumors are uncommon.
Risk factors comprise nulliparity, positive family history of ovarian cancer, mutations in BRCA1 and BRCA2 genes, and high expression of the HER2/neu oncogene.
Impacts individuals of all age brackets.
Ovarian fibroma-thecoma (OFT) is a tumor that secretes estrogen and is made up of spherical lipid-containing cells along with well-differentiated fibroblasts.
Granulosa cell tumor (GCT) secretes estrogen, leading to endometrial hyperplasia or cancer in adults. It is identified by Call-Exner bodies, which are tiny follicles with eosinophilic secretions, and small cuboidal granulosa cells grouped in interconnected cords.
Sertoli-Leydig cell tumor (SLCT) secretes androgens and is made up of Sertoli or Leydig cells mixed with stroma.
Slight, vague stomach ache.
Ovarian tumor, ascites, and hydrothorax characterize Meig syndrome.
GCT: Vaginal bleeding due to endometrial hyperplasia; early puberty; individuals have a higher risk of developing breast cystic disease and endometrial malignancy.
SLCT: Virilism.
Laboratory results: Elevated estrogen levels (OFT and GCT).
Excision of tumor; surgical removal of ovaries or uterus; administration of chemotherapy.
Ovarian sex cord-stromal tumors are uncommon.
