Master the board step 3

Gynecology
Prepubertal or Postmenopausal Ovarian Mass
Any ovarian enlargement in prepubertal or postmenopausal women is always
suspicious for an ovarian neoplasm.
Risk Factors
• BRCA1 gene
• Positive family history
• High # of lifetime ovulations
• Infertility
Protective Factors
• Conditions that decrease # of
ovulations
- oral contraceptive pills (OCPs)
- chronic anovulation
- breastfeeding
- short reproductive life
Diagnosis
Which cancer should you suspect in the following cases? What tumor markers
will you order?
A 9-year-old girl presents with right adnexal pain and complex cystic mass on ultrasound.
Answer: Germ cell tumor: These are most common in young women and present in
early-stage disease. The most common malignant epithelial cell type is dysgerminoma.
Germ cells are the cells that give rise to the gametes. They undergo mitosis, meiosis,
and cellular differentiation to develop into mature gametes (sperm or eggs).
Tumor markers: LDH, ß-hCG, a-FP
A 67-year-old woman presents with progressive weight loss, distended abdomen,
and left adnexal mass.
Answer: Epithelial tumor: This is the most common ovarian cancer in postmenopausal
women. The most common malignant subtype is serous.
Tumor markers: CA-125, CEA
A 58-year-old woman presents with postmenopausal bleeding. Endometrial biopsy
shows endometrial hyperplasia. Pelvic ultrasound reveals a right ovarian mass.
Answer: Granulosa-theca (stromal tumor): This ovarian tumor secretes estrogen and
can cause endometrial hyperplasia.
Tumor markers: Estrogen
A 48-year-old woman complains of increased facial hair and deepening of her
voice. An adnexal mass is found on examination.
Answer: Sertoli-Leydig cell (stromal tumor): This ovarian tumor secretes testosterone.
Patients present with masculinization syndromes.
Tumor markers: Testosterone
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