Ovarian Tumor 25

8/12/2019 Ovarian Tumor 25

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Ovaries

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The most important medical problems in ovaries arethe neoplasms

Death from ovarian cancers is more than that of

cervix and uterus together

Silent growth of ovarian tumors is the rule ,whichmake them so dangerous


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Ovarian

Cysts and Tumors

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Non neoplastic cysts are common but they are notserious problems

Primary inflammation of ovaries is rare

Salpingitis of fallopian tubes frequently causesperiovarian reaction (salpingo-Oophoritis)

Frequently ,the ovaries affected by endometriosis.


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Non-Neoplastic and Functional Cysts of

ovary

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Non Neoplastic Cyst are more common than theneoplastic ones

Follicular and Luteal cysts are most probably

physiologic

cystic follicles:Innocent lesions originate from

unruptured follicles or in follicles that have

ruptured and sealed. Usually they are small 1

1.5 cm ,and filled by clear fluid


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Follicular Cyst

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Is due to distention of unruptured graafian follicle It is sometimes associated with hyperestrinism and

endometrial hyperplasia.


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Corpus luteum cyst

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It results from hemorrhage into a persistent maturecorpus luteum.


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Theca lutein cyst

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Results from gonadotropin stimulation. Often multiple and bilateral.


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Chocolate cyst

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Is a blood containing cyst resulting from ovarianendometriosis with hemorrhage.

The ovary is the most common site for

endometriosis.


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Polycystic Ovaries

Stein-Leventhal Syndrome

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Young women ,and usually in girls after menarche.-Oligomenorrhea

-hirsutism

-infertility

-Obesity


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Polycystic Ovaries


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Secondary to excessive production of estrogens andandrogens, mainly androgens

The ovaries are usually twice normal in size ,gray-

white with smooth outer surface

Studded with sub cortical cysts 0.5 to 1.5 cm indiameter.

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Polycystic Ovaries


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Histologically ,thickened fibrosed outer tunica Multiple cysts lined by granulosa cells

Absence of corpora lutea

High level of LH and low FSH


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Figure 22-36 Polycystic ovarian disease and cortical stromal hyperplasia. A, The ovarian cortex reveals numerous clear cysts. B, Sectioning of the cortex reveals several

subcortical cystic follicles. C, Cystic follicles seen in a low-power microphotograph. D, Cortical stromal hyperplasia manifests as diffuse stromal proliferation with

symmetrical enlargement of the ovary.

Downloaded from: Robbins & Cotran Pathologic Basis of Disease (on 28 April 2008 01:14 PM)

2007 Elsevier


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Figure 22-36 Polycystic ovarian disease and cortical stromal hyperplasia. A, The ovarian cortex reveals numerous clear cysts. B, Sectioning of the cortex reveals several

subcortical cystic follicles. C, Cystic follicles seen in a low-power microphotograph. D, Cortical stromal hyperplasia manifests as diffuse stromal proliferation with

symmetrical enlargement of the ovary.


2007 Elsevier


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Ovarian Tumors

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Fifth most common cancer in the USA Fifth leading cause of cancer death in women

Diversity of pathologic entities because of the three

cell types make up the normal ovary


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Ovarian Tumors classification

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Three cell types : 1- the surface epithelium tumors

2- Germ cells tumors

3- Stromal /sex cord cells tumors


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Figure 22-37 Derivation of various ovarian neoplasms and some data on their frequency and age distribution.


2007 Elsevier

Cl ifi ti f O i T


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Classification of Ovarian Tumors,

Surface Epithelial Tumors

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:-Serous Tumors : Benign ,Borderline,And

malignant-Mucinous T. : Benign ,Borderline , and malignant-Endometrioid T. : Benign, Borderline, and

malignant-Transitional cell T. :Brenner tumors, Benign ,Borderline ,and malignant-Undifferentiated Carcinoma


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Classification of Ovarian Tumors,Sex Cord-Stromal tumors

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- -Granulosa Cell tuomr- -ThecomaFibroma

- -Sertoli-Leydig cell tumor

- -Gynandroblastoma

- -Unclassified


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Classification of Ovarian Tumors, Germ Cell

Tumors

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- -Dysgerminoma- -Yolk Sac Tumor

- -Embryonal Carcinoma

- -Choriocarcinoma

- -Teratoma : Mature, Immature

- -Polyembryoma


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O arian Tumors


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Ovarian Tumors

Surface Epithelium Origin

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Neoplasms of surface epithelium account for the

great majority of all primary ovarian tumors.

Ovarian Tumors


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Ovarian Tumors ,


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6570 % of overall tumors

90 % of malignant tumors

Age 20+

Traditionally divided into Benign ,Malignant ,and

Borderline in malignancy Can be strictly epithelial (serous ,Mucinous)

Ovarian Tumors


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Ovarian Tumors ,


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Can have stromal component (Cystadenofibroma ,

Brenner tumor )

Ovarian Tumors


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Ovarian Tumors ,


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The intermediate ,or the borderline tumors are

referred as tumors of low malignant potential

These appear to be low grade cancers with limited

invasive potential

They have better prognosis


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Serous Tumors

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The most frequent ovarian tumor

Age is 30 -40

May be solid ,usually cystic

Cystadenoma or Cystadenofibroma

65% benign ,15% low malignant potential , and 25%malignant

65 % of all ovarian cancers


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Serous Tumors

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Most are large ,spherical to ovoid ,cystic structures

510 cm and might be 30-40 cm

25% of benign tumors are bilateral

The surface of the benign is smooth and glistening

.In contrast to the malignant forms ,the surface isnodular and irregular


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Serous Tumors

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Cystic spaces are filled by serous fluide Papillary formation is very important and need to

be sampled well

Histologically the benign tumors are lined by a

single layer of tall columnar epithelium

Papillary formation can be seen in both the

benign and the malignant ones


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Serous Tumors

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Psammoma bodies could be seen

Between the clearly benign and the solid malignanttumors we can see the tumors of low malignantpotential

LMP tumors may seed the peritoneum, the implants

of tumors are non invasive. Sometimes may behaveas invasive peritoneal implants


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Serous Tumors

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The prognosis of LMP tumors is determined mainly

by the nature of the peritoneal implants

Prognosis of invasive Serous cystadenocarcinoma

after surgery ,chemotherapy ,and radiation is poor

and depend on stage 70% 5year survival for the tumors confined to the

ovary


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Serous Tumors

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5 year survival f0r LMP is 100% ,

Malignant Tumors with capsular invasion ,survival for

10 years is 13%

LMP with capsular invasion the 10 year survival is

80%.


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Figure 22-39 A, Borderline serous cystadenoma opened to display a cyst cavity lined by delicate papillary tumor growths. B, Cystadenocarcinoma. The cyst is opened to

reveal a large, bulky tumor mass. C, Another borderline tumor growing on the ovarian surface (lower).


2007 Elsevier


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Figure 22-39 A, Borderline serous cystadenoma opened to display a cyst cavity lined by delicate papillary tumor growths. B, Cystadenocarcinoma. The cyst is opened to

reveal a large, bulky tumor mass. C, Another borderline tumor growing on the ovarian surface (lower).


2007 Elsevier


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Figure 22-40 Papillary serous cystadenoma revealing stromal papillae with a columnar epithelium.


2007 Elsevier


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Figure 22-41 Borderline serous cystadenoma exhibiting increased architectural complexity and epithelial cell stratification.


2007 Elsevier


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Figure 22-42 Papillary serous cystadenocarcinoma of the ovary with invasion of underlying stroma.


2007 Elsevier


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Mucinous Tumors

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Epithelium is consists of mucin-producing cells

Less likely to be malignant

10% of ovarian cancers

80% of them benign

10% LMP

10% malignant


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Figure 22-44 A, A mucinous cystadenoma with its multicystic appearance and delicate septa. Note the presence of glistening mucin within the cysts. B, Columnar cell

lining of mucinous cystadenoma.


2007 Elsevier


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Brenner Tumor

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Transitional cell epithelium

Most are benign


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Figure 22-46 A, Brenner tumor (right) associated with a benign cystic teratoma (left). B, Histologic detail of characteristic epithelial nests within the ovarian stroma.

(Courtesy of Dr. M. Nucci, Brigham and Women's Hospital, Boston, MA.)


2007 Elsevier


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Sex Cord Tumors,


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Sex Cord Tumors,

Thecoma-Fibroma

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Any age

Unilateral

Solid gray to yellow

Rarely malignant


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Sex Cord Tumors


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Sertoli - Leydig

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All ages

Unilateral Gray to yellow

Produce androgens

Uncommonly malignant


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Germ Cell Tumors


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Dysgerminoma

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2ndand 3rddecades

Unilateral

Counterpart to Seminoma

Solid ,gray to yellow

All malignant PLAP positive


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Embryonal carcinoma

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2ndand 3rddecade

Solid

Aggressive

CD 30 positive.

Germ Cell Tumors


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Teratoma

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15-20 % of Ovarian tumors

Majority in the first 2 decades

The younger the patient ,the greater the likelihood ofmalignancy

Over 90% are benign cystic ,mature teratomas

Immature teratomas are malignant and are rare.


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Figure 22-48 Opened mature cystic teratoma (dermoid cyst) of the ovary. Hair (bottom) and a mixture of tissues are evident.


2007 Elsevier


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Figure 22-49 Benign cystic teratoma. Low-power view of skin (top), beneath which there is brain tissue (bottom).


2007 Elsevier


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Endodermal Sinus (Yolk Sac) Tumor

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the tumor is rich in -fetoprotein and 1-antitrypsin.

Its characteristic histologic feature is a glomerulus-likestructure composed of a central blood vessel envelopedby germ cells within a space lined by germ cells (Schiller-Duval body)

stained for -fetoprotein by immunoperoxidase

techniques Most patients are children or young women presenting

with abdominal pain and a rapidly developing pelvicmass. The tumors usually appear to involve a singleovary but grow rapidly and aggressively.


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Choriocarcinoma

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More commonly of placental origin, the choriocarcinoma,

similar to the Most ovarian choriocarcinomas exist in combination with

other germ cell tumors, and pure choriocarcinomas areextremely rare.

are aggressive tumors that generally have metastasized

widely through the bloodstream to the lungs, liver, bone,and other viscera by the time of diagnosis.

high levels of chorionic gonadotropins that aresometimes helpful in establishing the diagnosis ordetecting recurrences.

Ovarian Tumors


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Metastatic Carcinoma

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Older ages

Mostly Bilateral

Primaries are Breast ,lung, and G.I.T. (Krukenberg

Tumors)


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Ovarian Tumor 25