While working only alternate days, this is what I read today.
#PathQuiz on #CAPProtocol of ovary and fallopian tubes.
#pathology #GynPath

1. You receive a specimen of an already ruptured ovary. You should:
A. Call the surgeon
B. Gross it &describe it as “capsule ruptured”

Call the surgeon* & ask “where” did it rupture?
Intra-abdominal or extra-abdominal (in the container).
This makes a difference in the staging:
pT1c1: surgical spill
pT1c2: before surgery
pT1c3: peritoneal wash positive

(*Make a mention of your conversation in the report)

2. Which ovarian tumor is not graded?

Answer: Juvenile GCT

Serous carcinomas of the ENDOMETRIUM are NOT graded (considered high-grade)
Serous carcinomas of OVARY are graded (low / high)

Sertoli Leydig: G1-3 (tubules/lobules/sheets respectively)
Immature teratoma: G1-3 (immature neural tissue)

Other tumors which are not graded in ovary:

-Clear cell carcinomas
-Borderline epithelial tumors
-Carcinosarcomas
-All other malignant sex-cord stromal and germ cell tumors

3. Treatment effect (in case a patient has received prior chemotherapy) is assessed on

Chemotherapy response score (CRS) is given depending on the residual tumor in the OMENTUM

CRS1: No/minimal response
CRS2: Some response
CRS3: Complete response

4. A pT2 stage means the ovarian tumor:

Implants on fallopian tube / uterus / other pelvic tissues demand a pT2 stage

5. In an ovarian tumor, if you find tumor deposits in the para-aortic lymph nodes, you would stage the tumor as

pT3
Metastasis to the pelvic / para-aortic lymph nodes is a pT3 (yes “T” )

pN3....that doesn't even exist in the ovary staging!

6. In an ovarian carcinoma, pT3 stage would be assigned if tumor deposits are seen in all EXCEPT

Inguinal lymph node deposits = pM1

Capsule / surface involvement of liver, spleen, diaphragm = pT3

Tumor in parenchyma liver / spleen or diaphragm muscle = pM1

7. Serous tubal intraepithelial carcinoma (STIC) is NOT staged (since it’s intraepithelial / in-situ)

False
STIC involving the fallopian tube, is staged.

pT1a = one tube
pT1b= both tubes
pT1c3= malignant cells in ascitic fluid

8. The term “sentinel cancer” is used in hereditary nonpolyposis colorectal carcinoma / Lynch syndrome for early-onset tumors of which organ

Endometrial carcinoma is the most common extra-colonic carcinoma in Lynch syndrome and in more than half the patients, it presents as the “first” malignancy (yes, even before the colon) which then initiates the Lynch work-up

9. For patients with primary peritoneal high grade serous carcinoma, if the fallopian tube looks normal, how many sections should be submitted from it

ENTIRE tube should be submitted
as a microscopic focus of tumor may be present in the mucosa which maybe the probable primary site

10. If there is tumor in the ovary+fallopian tube+peritoneal deposits, which is TRUE:

A. This is primary peritoneal carcinoma
B. Largest mass is the primary
C. Intraepithelial carcinoma can cause this
D. Tumor site = “undesignated”

STIC (serous tubal intraepithelial carcinomas) can present with tumor deposits everywhere.

Don’t let the “intraepithelial” word fool you.

That’s also why you need to submit the whole fallopian tube.

11. For primary peritoneal high grade serous carcinoma (PPHGSC), which of the following is TRUE:

A. Ovaries and fallopian tubes should be normal
B. Diagnosis can be made after chemotherapy

PPHGSC exclusively involves the peritoneum and is usually a diagnosis of exclusion.
This diagnosis should never be made on a patient who has already received chemotherapy.

12. Hereditary breast and ovarian cancer syndrome is usually associated with which sub-type of ovarian carcinoma

Hereditary breast & ovarian cancer syndrome - BRCA 1/2 - serous carcinoma

Lynch Syndrome- MSI - Endometrioid & clear cell carcinomas

And that’s the end of this quiz! Hope y'all enjoyed it!