Department of pathology

Prof:- Adiga

Student name-: Saeed Ayed saed -432800220Abdulrahman Awagi Alnami -

432800221Muhannad Ali Asiri -432800225

Faris Ali Nasser- 432800229

Ovarian Tumor

Introduction

Common neoplasms. Ovarian cancer is second common

malignancy of the female genital tract (after endometrial cancer).

80% are benign – young (20-45) 20% are Malignant - older (>40)o 50% deaths due to late detectiono Majority of ovarian tumors are benign

Incidence Rates

Incidence of Ovarian tumors by histopathology

A-Surface epithelial 65-70%

B-Germ cell tumors15-20%

C-sex cord - stroma 5-10%

D-Metastatic tumors – 5%

A-Surface Epithelial tumors

all types can be benign, borderline , or malignant, depending; Benign ; - gross: mostly cystic - microscopic; fine

papillae, single layer covering (no stratification), no nuclear atypia, no stromal invasion

Borderline ; - gross; cystic / solid foci - microscopic; papillary complexity, stratification, nuclear atypia, no stromal invasion

Malignant ; - gross; mostly solid & hemorrhage / necrosis

- microscopic; papillary complexity, stratification, nuclear atypia, stromal invasion

Surface Epithelial tumors

Divided into: 1-Serous (tubal) 2-Mucinous (endocx & intestinal) 3-Endometrioid Transitional cell - Brenners. Clear cell

1-Serous Tumors: Frequently bilateral (30-66%). 75% benign and Borderline / 25% malignant.*Cysts are lined by tall columnar, ciliated

epithelial cells (fallopian tube type) & filled with serous fluid.

*Types:1-Benign Serous Tumors (Cystadenomas): (60%)

smooth lining & no solid areas

2- Borderline Serous Tumors : (15%) epithelial atypia, but no stromal invasion. 30% are bilateral.

3-Malignant Serous Tumors (Cystadenocarcinomas): (25%) multilayered epithelium with atypia&invading the stroma .

Serous Cystadenoma:

• single layer of columnar ciliated

• Fine papillae

2-Mucinous Tumors:

Less common 25% , very large.Rare malignant - 15%.Multi loculated , many small cysts.

Rarely bilateral – 5-20%.Tall columnar, apical mucin.

Mucinous cystadenoma

•Multilocular cyst lined by single layer of columnar cells with basally placed nuclei and apical mucin.

3-Endometrioid tumors

most are unilateral (40% are bilateral)

almost all are malignant about 20% of all ovarian tumors many are associated with

endometrial cancer (30%) patient may have concurrent

endometriosis

Endometrioid tumors

*Solid / cyst filled by hemorrhage & necrosis

B-Germ cell Tumors

1-Teratoma 2-Dysgerminoma 3-Yolk sac tumor (Endodermal sinus

tumor ) 4-Choricarcinoma 5-Mixed germ cell tumor

1-TERATOMA:

Most common Germ Cell Tumor benign mature cystic teratomas (lined by skin & hairs, and filled with sebaceous secretion. there may be mature cartilage , bone , teeth & other

structures. (10-15% are bilateral)

*Immature teratoma –contain immature tissues. Grading is

based on the amount of immature neuroepithelium . Uncommon

*Specialized Teratomas: differentiate along the line of single

tissue. Example:- Struma ovarii (mature thyroid tissue). Rare

Cystic Teratoma

Cyst with hair and cheesy material

2-Dysgerminoma

The ovarian counterpart of the testicular seminoma

2% of all ovarian malignancy Most common malignant germ cell

tumor It is the most ovarian malignancy in

pregnancy An excellent prognosis. Highly

radiosensitive .

Dysgerminoma

•Solid/ lobulated mass with foci of hemorrhage

•sheets of monotonous rounded cells with pale cytoplasm and central nuclei

3-Endodermal sinus tumor(Yolk sac carcinoma )

Tumor is a highly malignant and clinically aggressive neoplasm

Most frequently in children and young females

20% of malignant germ cell tumors. Fatal within 2 years of diagnosis

• Schiller-Duval body

C- Sex Cord - Stromal Tumors

Granulosa-cell tumor Thecoma Fibroma Sertoli-Leydig cell tumors

1-Granulosa Cell Tumor-Hormonally active tumor-The most common estrogenic ovarian

neoplasm

2-Thecoma-Functional tumors producing estrogen

3-FIBROMA

These tumors for about 2-5% of all ovarian tumors.

These solid ovarian tumors may be associated with Meigs’ syndrome.

Large firm fibrous mass Spindle shaped

D- Metastases to ovary

About 3% of malignant tumors in the ovary are metastatic

The primary tumors is from abdominal and breast tumors

*Krukenberg tumor

- It is applied to the uniform enlargement of the ovaries (usually bilaterally) due to diffuse infiltration of the ovarian stroma by metastatic signet-ring cell carcinoma .

-The commonest primary site is the

stomach followed by the colon.

Staging Stage I. growth limited to the pelvis

1- One ovary 2- both ovaries 3- 1 or 2 and ovarian surface tumor ,rupture capsule, malignant

ascites, peritoneal cytology positive. Stage II. Extension to the pelvis

1- extension to the uterus or fallopian tube 2- extension to the other pelvic tissues 3- 1 or 2 and ovarian surface tumor ,rupture capsule, malignant

ascites, peritoneal cytology positive. Stage III.Extension to abdominal cavity

1- abdominal peritoneal surfaces with microscopic metastases 2- tumor metastases <2cm in size 3- tumor metastases >2cm or metastatic disease in pelvic para

aortic or inguinal lymph nodes Stage IV. Distant metastases

Malignant pleural effusion Pulmonary parenchymal metastases Liver or splenic paranchyml metastases Metastases to thr supraclavicular lymph nodes or skin

prognosis Related to

Response to chemotherapyDifferentiation of tumor

*5-year survival in ovarian epithelial carcinoma is low because of the tumor become strong of late-stage disease at diagnosis.. Stage I and II: 80-100% Stage III: 15-20% Stage IV: 5%

Patients under 50 in all stages have better 5-year survival than older patients (40% compared to 15%)

Dysgerminomas treated by surgery and radiation have an excellent cure rate in both early and late-stage disease

Endodermal sinus tumour has poor prognosis. Germ cell better than epithelial

Information

Radner's death from ovarian cancer in 1989 helped to raise awareness of early detection and the connection to familial epidemiology