Ovarian Classif

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    OVARIAN TUMORS

     INTRODUCTION

    Dr Anusha Rao P

      PGY2(OBG)

      CAIMS

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    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

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    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

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    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$,

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    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

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    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

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    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$:

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    W*O CLASSIFICATION

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    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

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    II: S" $or& %umors;

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

    • An&ro3las%omas

    • G,nan&ro3las%omas

    Un$lassi

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    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"&

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    V: Gona&o3las%omas;

    • Pur

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

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     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

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    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+:

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    COMPLICATIONS

    •  Torsion

    • In%ra$,s%i$ hmorrha+

    • In'$%ion

    • Ru%ur

    • Psu&om,"oma ri%oni

    • Mali+nan$,

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    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

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    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

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    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 

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    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

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     TUMOR MARERS

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    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

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    *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+,- [email protected]

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    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

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

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

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    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$), )

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    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&

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     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$,:

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    • 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%?

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    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

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    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

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    BORDR9IN OVARIAN TUMORS

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     Th, *r no% sara%l, $lassi

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     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, &

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    *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

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    TUMOR STAGING

    • Comrhnsi s%a+in+ ; o'

    si+ni

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    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

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    TREATMENT

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