Thread: MCQs - Approach to Ovarian Neoplasm

A 58-year-old woman is noted to have bilateral adnexal masses on physical examination. Which of the following is most suggestive of these adnexal masses being malignant?

A. CT imaging revealing that they are primarily cystic
B. Elevation of the serum alkyline phosphatase level
C. Family history of lung cancer
D. The presence of ascites
E. The presence of low-grade fever

Answer / Explanation:

[HIDE]D. The presence of ascites and ovarian masses is strongly associated with ovarian cancer. Other features of malignancy include solid ovarian masses, bilaterality, and lymphadenopathy. [/HIDE]

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A 25-year-old woman is noted to have a solid and cystic right ovarian mass measuring 10 cm on ultrasound. Which of the following is the most likely histologic subtype?

A. Serous
B. Mucinous
C. Brenner
D. Teratoma
E. Fibroma

Answer / Explanation:

[HIDE]D. The benign cystic teratoma or dermoid cyst is the most common type of ovarian tumor in females younger than age 30 years. Dermoid cysts usually have solid and cystic components. [/HIDE]

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A 4-year-old girl is noted to have breast enlargement and vaginal bleeding. On physical examination, she is noted to have a 9-cm pelvic mass. Which of the following is the most likely etiology?

A. Cystic teratoma
B. Dysgerminoma
C. Endodermal sinus tumor
D. Granulosa cell tumor
E. Mucinous tumor

Answer / Explanation:

[HIDE]D. This young girl has signs of precocious puberty. Thus, the adnexal mass is likely to be an estrogen-secreting granulosa-theca cell tumor. These low-grade malignancies are slow-growing so-called stromal cell tumors. The androgen-secreting tumors are usually Sertoli-Leydig cell tumors and may cause virilism. [/HIDE]

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A 44-year-old woman undergoes an exploratory lapartomy for suspected ovarian cancer. Upon removal of the right ovary, a frozen section reveals “signet ring” cells. Which of the following is the most likely etiology?

A. Dysgerminoma
B. Metastatic
C. Mucinous
D. Serous
E. Teratoma

Answer / Explanation:

[HIDE]B. Signet ring cells suggest a Krukenberg tumor, usually metastatic from the gastrointestinal tract (stomach, colon) or breast. The mucin that fills the cell pushes the nucleus to the periphery of the cell, leading to the appearance of a signet ring. [/HIDE]

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Reference:

Approach to Ovarian Neoplasm

Definitions

Tuboovarian abscess:

An abscess formed within the adnexal space consisting of ovary, fallopian tube, and matted bowel caused by untreated or inadequately treated pelvic inflammatory disease.

Endometrioma:

A large (6- to 8-cm) loculated collection of endometrial tissue that can develop in the pelvis in females with endometriosis. As this tissue degenerates, it turns brownish in color and is known as a chocolate cyst.

Struma ovarii:

A benign teratoma in which functional thyroid tissue is the predominant histologic finding. Approximately 2 to 3 percent of teratomas are classified as struma ovarii. Thyrotoxicosis is clinically apparent in 5 percent of these cases.

Ovarian torsion:

A condition in which the ovary twists on its attachment to the infundibulopelvic ligament, thus interrupting

ovarian blood supply.

This usually is seen in conjunction with pathologic enlargement of the ovary and can be dynamic (intermittent) in nature or complete; the latter results in infarction and necrosis of the affected ovary.

Discussion

Although they may present in any decade of life, benign cystic teratomas are the most common ovarian neoplasm found in females under age 35 (excluding physiologic follicular and corpus luteum cysts) and are also the most common ovarian neoplasm found in pregnancy. Approximately 10 to 15 percent of all cases involve both ovaries.

PATHOLOGY PEARLS

• Benign cystic teratomas are the most common nonphysiologic ovarian tumor in females under age 35.
  
• Ten to 15 percent of all teratomas are bilateral.
• . Ovarian torsion occurs frequently with teratomas.
  
  
• The most common ovarian cancers are epithelial in origin and usually occur in postmenopausal women. Surgical excision followed by combination chemotherapy is the best treatment.
  
• Ovarian cancer is associated with ascites.
  
• Granulosa-theca cell tumors often secrete estrogen, and Sertoli- Leydig cell tumors often secrete androgens.
  
• Metastatic tumors to the ovary may have a “signet ring” appearance on microscopy and are called Krukenberg tumors.

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