Ovarian Tumor1

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Ovarian Cysts and Tumors112

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4Ovaries5The most important medical problems in ovaries are the neoplasmsDeath from ovarian cancers is more than that of cervix and uterus togetherSilent growth of ovarian tumors is the rule ,which make them so dangerous

5Ovarian Cysts and Tumors6Non neoplastic cysts are common but they are not serious problemsPrimary inflammation of ovaries is rareSalpingitis of fallopian tubes frequently causes periovarian reaction (salpingo-Oophoritis)Frequently ,the ovaries affected by endometriosis.

6Non-Neoplastic and Functional Cysts of ovary7Non Neoplastic Cyst are more common than the neoplastic onesFollicular 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 fluid7Follicular Cyst8Is due to distention of unruptured graafian follicleIt is sometimes associated with hyperestrinism and endometrial hyperplasia.Corpus luteum cyst9It results from hemorrhage into a persistent mature corpus luteum.

Theca lutein cyst10Results from gonadotropin stimulation.Often multiple and bilateral.

Chocolate cyst11Is a blood containing cyst resulting from ovarian endometriosis with hemorrhage.The ovary is the most common site for endometriosis.12

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14Polycystic OvariesStein-Leventhal Syndrome15Young women ,and usually in girls after menarche.-Oligomenorrhea-hirsutism-infertility-Obesity

15Polycystic OvariesStein-Leventhal Syndrome16Secondary to excessive production of estrogens and androgens, mainly androgensThe ovaries are usually twice normal in size ,gray-white with smooth outer surfaceStudded with sub cortical cysts 0.5 to 1.5 cm in diameter.16Polycystic OvariesStein-Leventhal Syndrome17Histologically ,thickened fibrosed outer tunica Multiple cysts lined by granulosa cells Absence of corpora luteaHigh level of LH and low FSH1718

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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 Tumors22Fifth most common cancer in the USAFifth leading cause of cancer death in womenDiversity of pathologic entities because of the three cell types make up the normal ovary22Ovarian Tumors classification23Three cell types : 1- the surface epithelium tumors2- Germ cells tumors3- Stromal /sex cord cells tumors2324

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

24Classification of Ovarian Tumors, Surface Epithelial Tumors 25:-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 Carcinoma25Classification of Ovarian Tumors, Sex Cord-Stromal tumors 26-Granulosa Cell tuomr-Thecoma Fibroma-Sertoli-Leydig cell tumor-Gynandroblastoma-Unclassified26Classification of Ovarian Tumors, Germ Cell Tumors 27- -Dysgerminoma-Yolk Sac Tumor-Embryonal Carcinoma-Choriocarcinoma-Teratoma : Mature, Immature-Polyembryoma27

Ovarian TumorsSurface Epithelium Origin29Neoplasms of surface epithelium account for the great majority of all primary ovarian tumors.29Ovarian Tumors ,Surface Epithelium Origin3065 70 % of overall tumors90 % of malignant tumorsAge 20+Traditionally divided into Benign ,Malignant ,and Borderline in malignancyCan be strictly epithelial (serous ,Mucinous)30Ovarian Tumors ,Surface Epithelium Origin31Can have stromal component (Cystadenofibroma , Brenner tumor )31Ovarian Tumors ,Surface Epithelium Origin32The intermediate ,or the borderline tumors are referred as tumors of low malignant potentialThese appear to be low grade cancers with limited invasive potentialThey have better prognosis 32Serous Tumors33The most frequent ovarian tumorAge is 30 -40May be solid ,usually cystic Cystadenoma or Cystadenofibroma65% benign ,15% low malignant potential , and 25% malignant 65 % of all ovarian cancers33Serous Tumors34Most are large ,spherical to ovoid ,cystic structures5 10 cm and might be 30-40 cm25% of benign tumors are bilateralThe surface of the benign is smooth and glistening .In contrast to the malignant forms ,the surface is nodular and irregular34Serous Tumors35Cystic spaces are filled by serous fluidePapillary formation is very important and need to be sampled wellHistologically the benign tumors are lined by a single layer of tall columnar epitheliumPapillary formation can be seen in both the benign and the malignant ones35Serous Tumors36Psammoma bodies could be seenBetween the clearly benign and the solid malignant tumors we can see the tumors of low malignant potentialLMP tumors may seed the peritoneum, the implants of tumors are non invasive. Sometimes may behave as invasive peritoneal implants

36Serous Tumors37The prognosis of LMP tumors is determined mainly by the nature of the peritoneal implantsPrognosis of invasive Serous cystadenocarcinoma after surgery ,chemotherapy ,and radiation is poor and depend on stage 70% 5 year survival for the tumors confined to the ovary37Serous Tumors385 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.Downloaded from: Robbins & Cotran Pathologic Basis of Disease (on 28 April 2008 01:14 PM) 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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55Mucinous Tumors56Epithelium is consists of mucin-producing cellsLess likely to be malignant10% of ovarian cancers80% of them benign10% LMP10% malignant5657

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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58Brenner Tumor59Transitional cell epitheliumMost are benign 5960

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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,Granulosa Cell Tumor64Most postmenopausal ,could be any ageUnilateralSolid and cystic Tiny to large in sizeProduce estrogenMalignant behaviour in 5-25%6465

65Sex Cord Tumors,Thecoma-Fibroma66Any ageUnilateralSolid gray to yellowRarely malignant6667

67Sex Cord TumorsSertoli - Leydig68All ages Unilateral Gray to yellowProduce androgensUncommonly malignant6869

69Germ Cell TumorsDysgerminoma702nd and 3rd decadesUnilateralCounterpart to SeminomaSolid ,gray to yellowAll malignantPLAP positive7071

71Embryonal carcinoma722nd and 3rd decadeSolidAggressiveCD 30 positive.Germ Cell TumorsTeratoma7315-20 % of Ovarian tumorsMajority in the first 2 decadesThe younger the patient ,the greater the likelihood of malignancyOver 90% are benign cystic ,mature teratomasImmature teratomas are malignant and are rare.

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