AssessmentsSurface epithelial-stromal tumor
Surface epithelial-stromal tumor
USMLE® Step 1 style questions USMLE
USMLE® Step 2 style questions USMLE
A 70-year-old woman comes to the clinic because of an unintentional 20lb weight loss and abdominal swelling over the past few months. She denies any recent change in her diet or activity level. Family history is significant for ovarian cancer in her sister and mother. Her temperature is 37.0°C (98.6°F), pulse is 77/min, respirations are 12/min, and blood pressure is 134/84 mm Hg. Physical examination shows a positive abdominal fluid wave suggestive of ascites. Abdominal computed tomography shows widespread metastasis throughout the peritoneal cavity with bilateral primary ovarian neoplasms. Surgical removal of the ovarian tumors shows complex cysts with a shaggy lining. Histology shows psammoma bodies. Which of the following is the most likely diagnosis?
Epithelial refers to the surface lining, and ovarian refers to ovary, of which women have two that sit along either side of the uterus so epithelial ovarian cancer, is a cancer that forms along the surface of an ovary.
Now, each ovary contains multiple follicles.
And, each follicle is made up of a germ cell, also known as an oocyte, which is the immature egg.
Between the follicles is the stromal or connective tissue cells, and lining the ovary is a layer of epithelial cells.
Now, if an epithelial cell starts to divide uncontrollably, it can either be a benign tumor which means that it does not invade nearby tissue or spread to other parts of the body, or it can be a malignant tumor which means that it might invade or spread to other tissues.
Compared with benign tumor cells, a distinguishing feature of malignant tumor cells have slightly less organized nuclei.
A third class of tumors are called borderline tumors because they have features that are intermediate between the other benign and malignant tumors.
Epithelial ovarian cancers can be subdivided into four types: serous, mucinous, endometrioid and transitional.
Serous and mucinous tumors arise from epithelial cells that line the outside of ovaries, whereas even though the tumors are found in the epithelium, the endometrioid and transitional cell tumors arise from other cell types.
Serous tumors have fluid-filled cysts, typically a single cyst, and can be benign, malignant, or borderline.
Benign serous tumors are called serous cystadenomas, and are the most common type, and often develop on both ovaries, and typically affect premenopausal women.
Mucinous tumors, on the other hand, have mucus-filled cysts that often involve large multiloculated cysts, but can also be benign, malignant, or borderline.
Benign mucinous tumors are called mucinous cystadenomas, and often develop on only one ovary.
The malignant type of serous tumors are called serous cystadenocarcinomas, and malignant mucinous tumors are called mucinous cystadenocarcinomas.
Both serous and malignant cystadenocarcinomas are cysts with an inflamed and swollen lining, and they commonly arise in postmenopausal women.
An interesting feature of serous cystadenocarcinomas is that they often contain psammoma bodies which are plaques with calcium and cellular debris.
Next are endometrioid tumors which come from endometrium-like cells which is ectopic, meaning they’re out of place, because those sorts of cells are usually found in the endometrium.
Benign endometrioid tumors often have cysts filled with dark blood, so although these are called endometriomas, they are sometimes referred to as chocolate cysts.
Finally there are transitional cell tumors which are also called Brenner tumors, named after the german pathologist, Fritz Brenner who first discovered them.