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
Stein-Leventhal Syndrome
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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
Stein-Leventhal Syndrome
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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.
Downloaded from: Robbins & Cotran Pathologic Basis of Disease (on 28 April 2008 01:14 PM)
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.
Downloaded from: Robbins & Cotran Pathologic Basis of Disease (on 28 April 2008 01:14 PM)
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 ,
Surface Epithelium Origin
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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 ,
Surface Epithelium Origin
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Can have stromal component (Cystadenofibroma ,
Brenner tumor )
Ovarian Tumors
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Ovarian Tumors ,
Surface Epithelium Origin
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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).
Downloaded from: Robbins & Cotran Pathologic Basis of Disease (on 28 April 2008 01:14 PM)
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).
Downloaded from: Robbins & Cotran Pathologic Basis of Disease (on 28 April 2008 01:14 PM)
2007 Elsevier
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Figure 22-40 Papillary serous cystadenoma revealing stromal papillae with a columnar epithelium.
Downloaded from: Robbins & Cotran Pathologic Basis of Disease (on 28 April 2008 01:14 PM)
2007 Elsevier
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Figure 22-41 Borderline serous cystadenoma exhibiting increased architectural complexity and epithelial cell stratification.
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2007 Elsevier
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Figure 22-42 Papillary serous cystadenocarcinoma of the ovary with invasion of underlying stroma.
Downloaded from: Robbins & Cotran Pathologic Basis of Disease (on 28 April 2008 01:14 PM)
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.
Downloaded from: Robbins & Cotran Pathologic Basis of Disease (on 28 April 2008 01:14 PM)
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.)
Downloaded from: Robbins & Cotran Pathologic Basis of Disease (on 28 April 2008 01:14 PM)
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.
Downloaded from: Robbins & Cotran Pathologic Basis of Disease (on 28 April 2008 01:14 PM)
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).
Downloaded from: Robbins & Cotran Pathologic Basis of Disease (on 28 April 2008 01:14 PM)
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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