Quiz-summary
0 of 1 questions completed
Questions:
- 1
Information
Presented by Natalie Banet, M.D. and prepared by Nathan Cuka, M.D.
Case 1: A 22-year-old female with a 12 cm right ovarian mass.
You have already completed the quiz before. Hence you can not start it again.
Quiz is loading...
You must sign in or sign up to start the quiz.
You have to finish following quiz, to start this quiz:
Results
Time has elapsed
Categories
- Not categorized 0%
- 1
- Answered
- Review
-
Question 1 of 1
1. Question
Week 574: Case 1
A 22-year-old female with a 12 cm right ovarian mass.images/ncuka/20140106/1/1a.jpg
images/ncuka/20140106/1/1a1.jpg
images/ncuka/20140106/1/1b.jpg
images/ncuka/20140106/1/1c.jpgCorrect
Answer: Yolk sac tumor
Histology: This yolk sac tumor mostly displays the microcystic and endodermal sinus patterns. The cells are flat, pleomorphic, mesothelial-like cells with large hyperchromatic or vesicular nuclei. Increased mitotic figures are noted. The cysts vary in size. Characteristic Schiller-Duval bodies are present (perivascular pseudoglandular formations). Hyaline globules are noted. In general, staining of basement membrane material is PAS+. These tumors show the following traits by IHC: AFP+, CK7-, EMA-.
Discussion: Yolk sac tumors are the second most common malignant germ cell ovarian neoplasm (the first being dysgerminoma). They are most common before the age of 30, but have been described in post-menopausal women. They are almost always unilateral and are more common in the right ovary.
Grossly, they are usually large (most greater than 10 centimeters).The differential diagnosis of yolk sac tumor includes Clear cell carcinoma (lacks any microcystic areas, hobnail nuclei, CK7+, EMA+, AFP-), Endometrioid carcinoma with secretory differentiation (ER/PR+, CK7+, AFP-), and other germ cell neoplasms: Embryonal carcinoma: Very pleomorphic. Can have gland-like differentiation but usually arranged in sheets. Less common in ovary compared to testis. (pos: CD30, SALL4, PLAP, OCT4) Dysgerminoma (in ddx if you have solid YST): IHC+: SALL4, PLAP, c-kit, OCT-4, D2-40.
Yolk sac tumors are clinically aggressive (early spread to lymph nodes via lymphatics, intra-abdominal spread, and frequent recurrence). Chemotherapy has improved survival rates. Serum AFP is used to track clinical recurrence.
Reference(s):
– Blaustein’s Pathology of the Female Genital Tract, 6th ed. Chapter 16.Incorrect
Answer: Yolk sac tumor
Histology: This yolk sac tumor mostly displays the microcystic and endodermal sinus patterns. The cells are flat, pleomorphic, mesothelial-like cells with large hyperchromatic or vesicular nuclei. Increased mitotic figures are noted. The cysts vary in size. Characteristic Schiller-Duval bodies are present (perivascular pseudoglandular formations). Hyaline globules are noted. In general, staining of basement membrane material is PAS+. These tumors show the following traits by IHC: AFP+, CK7-, EMA-.
Discussion: Yolk sac tumors are the second most common malignant germ cell ovarian neoplasm (the first being dysgerminoma). They are most common before the age of 30, but have been described in post-menopausal women. They are almost always unilateral and are more common in the right ovary.
Grossly, they are usually large (most greater than 10 centimeters).The differential diagnosis of yolk sac tumor includes Clear cell carcinoma (lacks any microcystic areas, hobnail nuclei, CK7+, EMA+, AFP-), Endometrioid carcinoma with secretory differentiation (ER/PR+, CK7+, AFP-), and other germ cell neoplasms: Embryonal carcinoma: Very pleomorphic. Can have gland-like differentiation but usually arranged in sheets. Less common in ovary compared to testis. (pos: CD30, SALL4, PLAP, OCT4) Dysgerminoma (in ddx if you have solid YST): IHC+: SALL4, PLAP, c-kit, OCT-4, D2-40.
Yolk sac tumors are clinically aggressive (early spread to lymph nodes via lymphatics, intra-abdominal spread, and frequent recurrence). Chemotherapy has improved survival rates. Serum AFP is used to track clinical recurrence.
Reference(s):
– Blaustein’s Pathology of the Female Genital Tract, 6th ed. Chapter 16.
