Ovarian Tumors MCQs

Dysgerminoma: "The tumor is neutral and does not secrete either male or female sex hormones but secretes placental alkaline phosphatase, lactate dehydrogenase and beta hCG". Granulosa cell tumor : Secretes estrogen Theca cell tumor : Secretes estrogen Hilus cell tumor : Secretes androgens Reference: Shaw 15 th /ed p 378

Germ cell Tumors of ovary: In contrast to slow growing epithelial ovarian tumors, germ cell malignancies grow rapidly and are characterized by subacute pelvic pain. Most common germ cell Tumor – Mature teratoma or Dermoid cyst (Benign in nature). Most common malignant GCT – Dysgerminoma. Second most common malignant GCT –Immature cystic teratoma Reference: CGDT 10 th/ed p 875; Devita 7th/ed p 1391; Novak 14th/ed p 1506; 15th/ed p 1394; Williams Gynae 1st/ed p 741

Dermoid cyst: Dermoid cyst is a benign teratoma. It is most common benign tumour of ovary in reproductive age group. Most common benign neoplasm diagnosed during pregnancy. Most common Germ cell tumor. It is the commonest tumor to undergo torsion. Characteristically they are unilocular cyst containing hair and cheesy sebaceous material, teeth, bones, thyroid tissue and cartilage. If teeth or bone are seen in X-ray in adnexal mass, this finding is pathognomic for teratoma and thus X-ray is diagnostic. Malignant change in a dermoid cyst occurs in 0.5 – 2% cases in patients > 40 years. Most common malignancy which develops is, squamous cell carcinoma. Reference: Textbook of Gynaecology Sheila Balakrishnan 1 st /ed p 183 Reference: Shaw 15 th /ed p 376-7; Williams Gynae 1 st /ed p 214-5

The ovaries derive their nerve supply from Sympathetics via renal and aortic plexus and celiac and mesenteric ganglia (derived from T9 T10 spinal segment) which follow the course of the ovarian vessels. Ovaries are developed from genital ridge (abdominal organ) then descend to the pelvis at 33 week of gestation. Ovarian artery is a direct branch of the aorta, other pelvic organs are mainly supplied by the internal iliac artery. Reference: D C Dutta's textbook of gynecology, 7th edition, chapter 1

"Incidence of dermoid cyst increases two times in pregnancy and it becomes the most commonly diagnosed ovarian tumour during pregnancy." -Dutta Obs. 7/e, p 310 "A benign cystic teratoma is the most common neoplasm to undergo torsion." -Novak 14/e, p 510 Note: Benign cystic teratoma is another name for dermoid cyst. From the above two lines it is clear that dermoid cyst is the most common ovarian tumour to undergo torsion during pregnancy. For more details on dermoid cyst and other ovarian tumours kindly see" Self-Assessment and Review Gynaecology" by the same author. Reference : Novak 14/e, pg 510; Dutta Obs. 6/e, pg 310

Vaginal study gives a fair idea about the hormonal status and, in turn, about ovulation/ovarian cycle. For hormonal study, sample should be taken from: Lateral wall For cytological study (Papsmear), sample should be taken from: Posterior wall Squamous epithelium is resistant to gonococcal infection hence theoretically gonococcal vaginitis can occur in new born females Vagina does not have any mucus-secreting glands. Since vagina does not have any glands, vaginal discharge is not derived from vagina. The components of vaginal secretion are derived from: Endocervical glands Endometrial glands Bartholin’s glands Vagina does not have any serosal covering except for the area covered by cul de sac posteriorly. Apart from Doderlein’s bacilli, it contains many other pathogenic organisms including Cl. welchii. Reference: Self-assessment and review of gynecology, ch-1, page 10.

Krukenberg tumor: Krukenberg tumor by definition represents carcinoma of stomach metastasis to ovary . But the eponym is commonly used to denote any gastric cancer metastatic to ovary Tumor arises by retrograde lymphatic spread e. carcinoma cells pass from the stomach to the superior gastric lymph node which also receives lymphatics from the ovary. Characteristics of Krukenberg Tumour: Always bilateral Have smooth surface No tendency to form adhesions Freely mobile No infiltration through the capsule. Histologically the tumour has signet ring cells in the background of myxomatous stroma. They retain the shape of a normal ovary. Have waxy consistency. Reference : Shaw 15 th /ed pg 425-6; CGDT 10 th /ed pg 877

In breastfeeding females, prolactin levels are increased in response to the suckling stimulus of breastfeeding. These observations suggest that high concentrations of prolactin can work at both central level (by inhibiting pulsatile secretion of GnRH) and peripheral level i.e. ovarian sites (by inhibiting synthesis of progesterone and by changing testosterone/dihydrotestosterone ratio i.e. increasing local antiestrogen concentrations) to produce lactational amenorrhea and anovulation. The principle of GnRH suppression by prolactin is reinforced by the demonstration that treatment of amenorrheic, lactating women with pulsatile GnRH, fully restores pituitary secretion and normal ovarian cyclic activity. Reference : Leon Speroff 7 th /ed, pg no: 582