Ovarian Classif

8/17/2019 Ovarian Classif

1/45

OVARIAN TUMORS

INTRODUCTION

Dr Anusha Rao P

PGY2(OBG)

CAIMS


2/45

NORMAL OVARIES

• Normal siz ! " # " #$m

• Varia%ion in &imnsions $an rsul%

'rom

– Endogenous hormonal ro&u$%ion(aris

*i%h a+ an& mns%rual $,$l) – Exogenous substances, in$lu&in+ OCs-

GnR. a+onis%s- or oula%ion/in&u$in+

m&i$a%ion- ma a0$% siz


3/45


4/45

MASSORGAN CYSTIC SOLID

OVARY 1un$%ional $,s%- Nolas%i$

$,s%- Bni+n- Mali+nan%-

n&om%riosis

Nolasm

Bni+n

Mali+nan%

FALLOPIAN

TUBES

Tu3o/oarian a3s$ss

.,&rosalin"

Paraoarian $,s%

Tu3o/oarian a3s$ss

$%oi$ r+nan$,

Nolasm

UTERUS In%rau%rin r+nan$, in a

3i$ornua% u%rus

P&un$ula%& or

in%li+amn%ous m,oma

BOWEL Si+moi& or $a$um &is%n&&

*i%h +as or '$s

Dir%i$uli%is- Ili%is-

An&i$i%is- Coloni$

$an$r

MISCELLANEOU

S

Dis%n&& 3la&&r- Pli$

4i&n,- Ura$hal $,s%

A3&ominal *all

hma%oma or a3s$ss-

r%rori%onal


5/45

Lifetime Risk of ov!i" "eo#$sm

• A *oman has !5678 li'%im ris4 o'

un&r+oin+ sur+r, 'or a sus$%&

oarian nolasm an&

• 6#5268 o' %hs *ill 3 'oun& %o 3

ha an oarian mali+nan$,


6/45

OVARIAN

MASSS

1UNCTIONA9IN19AMMATO

RYNOP9ASTIC OT.RS

1O99ICU9AR CYST

CORPUS 9UTUM

CYST

T.CA 9UTIN

TUBO OVARIAN ABSCSS BNIGN

BORDR9IN

MA9IGNANT

NDOMTRIOMA

N9ARGD PCO

PAROVARIAN CYST


7/45

COMMON OVARIAN TUMOURS

I"f"%& P!e#'(e!t$

A)o$es%e"t

Re#!o)'%tive

Pe!ime"o#'

s$

PostMe"o#'

s$

6 1un$%ional$,s%

1un$%ional$,s%

1un$%ional$,s%

1un$%ional$,s%

i%hlialoarian

%umor

Nolas%i$oarian

%umor

2: Grm $ll%umor

Grm $ll%umor

Grm $ll%umor

Drmoi& 1un$%ional$,s%

1un$%ional$,s%

#: i%hlial%umor

i%hlial%umor

M%s


8/45

1un$%ional oarian $,s%s

• 1olli$ular $,s%s

• Corus lu%um $,s%s

• Th$a lu%in $,s%s

• 9u%omas o' r+nan$,

B, 'ar %h mos% $ommon $lini$all, &%$%a3l

nlar+mn%s o' %h oar, in %h rro&u$%i

,ars:

All ar 3ni+n an& usuall, as,m%oma%i$:


9/45


10/45

W*O CLASSIFICATION


11/45

I: Common i%hlial Tumors;

•. Srous %umors

•. Mu$inous %umors

•. n&om%rioi& %umors

•. Clar $ll %umors

•. Brnnr %umors

•. Mi"& i%hlial %umors•. Un&i0rn%ia%& $a:

•. Un$lassi


12/45

II: S" $or& %umors;

• Granulosa/s%romal $ll %umors- %h$a$ll %umors

• An&ro3las%omas

• G,nan&ro3las%omas

•

Un$lassi


13/45

III: 9ii& $ll %umors

IV: Grm $ll %umors;

• D,s+rminoma

• n&o&rmal sinus %umor

• m3r,onal $a:

• Pol,m3r,oma

• Chorio$ar$inoma• Tra%oma

• Mi"&


14/45

V: Gona&o3las%omas;

• Pur

•

Mi"&VI: So'% %issu %umors (no% s$i


15/45

Sim#$e '$t!so'")+(se) !'$es fo! t,e

)i-"osis of ov!i" %"%e!.U$t!so'") O(stet G&"e%o$/001

RCOG /022


16/45


17/45

CLINICAL PRESENTATION•

As,m%oma%i$ 5 a$$i&n%all, &is$or& on USG

• Chroni$ a%%rn o' ain- in$rasin+ a3&ominal +ir%h or

mon%hs or *4s:

•

Asso$ia%& *i%h s$on&ar, s,m%oms o' anor"ia- nausa-

omi%in+- urinar, 'r>un$,:

• Coul& 3 asso$ia%& *i%h rimar, or s$on&ar,

amnorrha- mns%rual irr+ulari%is- iriliza%ion-

r$o$ious u3r%,

• B$om a$u%l, s,m%oma%i$ i' un&r+os %orsion- ru%ur

or hamorrha+:


18/45

COMPLICATIONS

• Torsion

• In%ra$,s%i$ hmorrha+

• In'$%ion

• Ru%ur

• Psu&om,"oma ri%oni

• Mali+nan$,


19/45

P*YSICAL EXAMINATION

• A3&ominal an& a+inal "amina%ionan& %h rsn$ or a3sn$ o' lo$all,mha&noa%h,

• Assss – 9a%rali%,

– C,s%i$ Vs soli&

–

Mo3il Vs


20/45

TVS•

Pa%%rn r$o+ni%ion is surior %o all o%hr s$ors:

• Su3?$%i alua%ion o' oarian masss 3as& on

a%%rn r$o+ni%ion $an a$hi snsi%ii%, o' @@8 %o6778 an& s$i


21/45

DOPPLER EVALUATION

• .,o"i$ %issu in %umors r$rui% lo*/rsis%an$- hi+h/o*

3loo& ssls

• Role in evaluating ovarian mass is controversial 5 as

%h ran+s o' alus o' RI-PI-MSV 3%*n 3ni+n an&

mali+nan% masss orla: PI324 RI30.5

• To or$om %his- as$ular samlin+ o' susi$ious aras

(aillar, ro?$%ions- soli& aras- %hi$4 s%a%ions) usin+

3o%h #D USG an& o*r &olr 3o%h has 3n alua%&

an& 'oun& 0$%i:

•

“Chaotic” vascular pattern in malignancy


22/45

OT*ER IMAGING MODALITIES

• CT- MRI- PT no% r$ommn&& in %h ini%ial alua%ion

• CT s$an; alua%in+

– 9N inolmn%-

– Omn%al m%s- ri%onal &osi%s- ha%i$ m%s-

– o3s%ru$%i uroa%h,

– or a ro3a3l alternate primary site *hn $an$r is

sus$%& 3as& uon TVS

• MRI ; &i0rn%ia%in+ non a&n"al li$ masss (li4

liom,oma%a)- "nsi an& in$onnin%:

• ACOG GUID9INS 277


23/45

TUMOR MARERS


24/45


25/45

SENSITIVITY SPECIFICITY PPV NPV

62+708 92+7:8 :;+728 69+708

CA+

2/;

Mos% us'ul *hn non/mu$inous i%hlial $an$rs ar rsn%

la%& in @78 o' a%in%s *i%h i%hlial oarian Ca 3u% onl, in

!78 o' a%in%s *i%h s%a+ I &isas

In$ras& snsi%ii%, in os% mnoausal *omn s: *hn

asso$ia%& *i%h rlan% $lini$al an& USG


26/45

*E5• . is a r$ursor %o %h i&i&,mal s$r%or, ro%in an& in normal

oarian %issu- %hr is minimal +n "rssion an& ro&u$%ion o' .:

• As a sin+l %umor mar4r- . ha& %h hi+hs% snsi%ii%, 'or &%$%in+

oarian $an$r- s$iall, S%a+ I &isas:

•

Combined CA125 and H! is a more accurate predictor ofmalignancy than either alone or to any other dual combination of

mar"ers

• . lls(H7 M) *r 'oun& %o 3 la%& in or hal' o' %h a%in%s

*i%h oarian $an$r *i%h normal srum CA62! lls (H#! UFml)

• . *hn s%u&i& in %h rmnoausal +rou o' a%in%s *as a3l %o

&is$rimina% 3ni+n %umors 'rom mali+nan$is

Moor % al: F G,n$olo+i$ On$olo+,- 277@


27/45

NEW SCORES

•ROMA; Ris4 o' Oarian Mali+nan$, Al+ori%hm

Th &ual mar4r al+ori%hm u%ilizin+ . an& CA62! %o $al$ula% a

ROMA alu

In a%in%s *i%h s%a+ I an& II &isas- ROMA a$hi& a snsi%ii%, o'

@!:#8 $omar& *i%h :8 'or RMI

MOOR T A9- AOG 2767

•OVA 6;

1DA aro&: Com3ina%ion o' ! immunoassa,s

CA 62!- %rans%h,r%%in- ao lioro%in A6- %rans'rrin- B2 mi$ro+lo3ulin

Snsi%ii%, ; #8- s$i


28/45

As,m%oma%i$ siml $,s%s

3;%ms Like$& #,&sio$o-i%$


29/45

Ov!i" mss i" !e#!o)'%tive -e -!o'#

3; %ms. @ ; %ms

USG USG

%&sti%

o(se!vtio"Com#$e4 so$i)4

s's#i%io

's

e!siste"%e o! #!o-!essio"

s'!-e!&

O i i ,i$), )


30/45

Ov!i" mss i" %,i$),oo)*isto!& ") #,&si%$ emi"tio"

A##!. Im-i"- st')ies

Sim#$e %&st+ O(se!ve ") !esse

So$i) o! so$i) %&sti%

MRI ") t'mo! m!ke!s

*i-, s's#i%io"of m$i-""%&

Lo> s's#i%io" of m$i-""%&

L#!otom& $#!os%o#&

F!oe" se%tio"M$i-""t oo#,o!e%tom& ")

st-i"-

Be"i-" + %&ste%tom&


31/45

Oarian $,s%s in os%mnoausal *omn;

• Pos% mnoausal +ona& a%rohis %o a

siz o' 6:! = 6 = 7:!$m on ara+

• Shoul&nJ% 3 ala3l on li$

"amina%ion:

•

Prsn$ o' ala3l oar, mus% alr% %hossi3ili%, o' an un&rl,in+ mali+nan$,:


32/45

• In$i&n$ in as,m%oma%i$ os% mnoausal

*omn 5

6:!8 3, li$ "amina%ion

#:#8 %o 6:!8 3, USG:

obstet gynecol survey, 2002

• Causs /678 'un$%ional

78 nolas%i$ (i%hr 3ni+n or

mali+nan%?


33/45

ASSSSMNT

• I% is r$ommn&& %ha% oarian $,s%s in

os%mnoausal *omn shoul& 3 assss& usin+

CA12 an& transvaginal grey scale sonogra!hy.

• Thr is no rou%in rol ,% 'or Dolr- MRI- CT or PT:

RC#$ 2%1%

SENSITIVITY SPECIFICITY

TVS @8 #8

CA 62! @68 !8


34/45


35/45


36/45

RCOG• Siml- unila%ral- unilo$ular oarian $,s%s- lss %han ! $m in &iam%r-

ha a lo* ris4 o' mali+nan$,: I% is r$ommn&& %ha%- in %h rsn$

o' a normal srum CA62! lls- %h, 3 mana+& $onsra%il,:

• Asira%ion is no% r$ommn&& 'or %h mana+mn% o' oarian $,s%s in

os%mnoausal *omn:

• I% is r$ommn&& %ha% a Lris4 o' mali+nan$, in&"J shoul& 3 us& %o

sl$% *omn 'or laaros$oi$ sur+r,- %o 3 un&r%a4n 3, a sui%a3l,

>uali


37/45

BORDR9IN OVARIAN TUMORS


38/45

Th, *r no% sara%l, $lassi


39/45

Tumour su3%,s

• 2 ma?or his%olo+i$al %umor su3%,s

– Srous(!78)

• (3ila%ral in #78)

•

Coul& 3 asso$ia%& *i%h "%raoarian lsion ; imlan%s(#!8)

– Mu$inous (8)

• Mu$inous %umors &o no% ha a $larl, &


40/45


41/45

*isto$o-& ") C&to$o-&•

A$$or&in+ %o Di%l an& .au%mann- %h his%olo+, o'3or&rlin %umors is $hara$%riz& 3, %h 'ollo*in+ 'a%urs;

– pithelial multi'layering of more than ! cell layers

– (ot more than ! mitoses per 1% high'po)er *eld +H,-.

– /ild nuclear atypia

– 0ncrease in nuclearcytoplasmic ratio

– light to comple3 branching of epithelial papillae and

pseudopapillae

– pithelial budding and cell detachment into the lumen

– (o destructive stromal invasion / A ma?or $omonn% in

&i0rn%ia%in+ mali+nan% 'rom 3or&rlin %umors


42/45

TUMOR STAGING

• Comrhnsi s%a+in+ ; o'

si+ni


43/45

In%rna%ional 1&ra%ion O' O3s%%ri$s

An& G,n$olo+, (1IGO) s%a+in+

FIGO st-e De"itio"

I Tumor $on


44/45

TREATMENT


45/45

No 'ur%hr $hmo%hra, (in all s%a+s:)

Documents

Ovarian Classif