USMLE Step 2 CK Lecture Notes 2019: Obstetrics/Gynecology (Kaplan Test Prep)

GYN TRIAD

Sertoli-Leydig  Tumor

Classification of Ovarian Cancer

Type Percentage Age Group

Epithelial 80% Older

Postmenopausal  pelvic  mass

Masculinization

↑   testosterone    level

Epithelial  tumors  (80%)   (most   common  type    of  histologic  ovarian

carcinoma)  occur   predominantly   in  postmenopausal  women.  These   include

serous, mucinous,   Brenner,    endometrioid,   and clear   cell    tumors. The most

common  malignant   epithelial  cell    type    is  serous.

Germ cell   tumors  (15%)   occur   predominantly   in  teenagers.  These

include dysgerminoma,   endodermal  sinus   tumors, teratomas,  and

choriocarcinoma.    The most    common  malignant   germ    cell    type    is

dysgerminoma.   It  is  uniquely    x-ray   sensitive.

Stromal tumors  (5%)    are functionally    active. These   include granulosa-theca

cell    tumors  (which  secrete estrogen    and can cause   bleeding    from    endometrial

hyperplasia)    and Sertoli-Leydig  cell    tumors  (which  secrete testosterone    and

can produce masculinization syndromes). Patients    usually present with    early

stage   disease and are treated either  with    removal of  the involved    adnexa  (for

those   who desire  further fertility)  or  a   TAH and BSO (for    those   whose

families    have    been    completed). They    metastasize infrequently    and then

require chemotherapy    (vincristine,   actinomycin,    and Cytoxan).