OVARY 2

1
OVARY 2

• Neoplasms of the Ovary
• Epithelial, Sex Cord-Stromal, and Germ Cell

2
Common Ovarian Tumors

• Benign Cystic Teratoma 32
• Serous Cystadenoma 16
• Mucinous Cystadenoma 14
• Serous Carcinoma 9
• Fibroma-Thecoma 8
• Serous LMP 4
• Endometrioid Carcinoma 3

3
Pathologists examination

• Classification by Cell Type of Most
  Differentiated Areas
• Malignant Potential Determined by Least
  Differentiated Areas
• Gross exam Papillations, Nodular Thickening,
  Solid Areas, Hemorrhage, Necrosis
• 1 block per 1-2cm of maximum tumor size

4
Epithelial Tumors
General Consideration Peri and Postmenopausal
Women Mean age of Cancer Diagnosis approx. 52
years LMP 4-10 years younger
5

• Benign
• Borderline (Low Malignant Potential)
• Malignant

6
Serous Tumors

• LMP
• 9-15 of serous neoplasms
• cystic and papillary
• 14-40 bilateral
• 20-40 beyond ovaries at diagnosis
• excellent prognosis

7
Serous LMP
8
Serous Tumors

• Malignant
• Large 15cm or more
• Papillary, Cystic, Solid
• 35-50 bilateral
• poor prognosis

9
Serous Tumors
10
Variants

• Surface tumor
• Surface Serous Carcinoma of the Peritoneum
• Psammocarcinoma

11
Implants

• Invasive
• Noninvasive
• Epithelial
• Desmoplastic

12
Mucinous

• LMP
• less common than Serous LMP
• Intestinal Type
• Endocervical/ Muellerian Type
• Better prognosis than Serous

13
Mucinous

• Malignant
• 10 bilateral
• usually confined to ovary and (-) surface
• 66 5yr Stage I
• 59 10 yr
• Pseudomyxoma peritonei

14
Mucinous Tumors
15
Endometrioid

• LMP

16
Endometrioid

• Malignant
• 16-30 of Ovarian Ca
• Less Cystic
• 10-20 cm
• Well or Moderately Differentiated
• Assoc. EM Ca and Hyperplasia
• 40-55 5yr survival

17
Endometrioid Tumors
18
Clear Cell

• Nearly all are Ca
• 5-11 of Ovarian Ca
• 10 Hypercalcemia
• usually gt15 cm
• Cystic and Solid
• 3 bilateral
• Endometriosis

19
Clear Cell Carcinoma
20
Brenner Tumor
21
Transitional Cell

• LMP
• gt 8-10 cm
• Cystic or Semicystic
• Resemble LG Papillary TCC
• Usually Benign Clinical Course

22
Transitional Cell

• Malignant
• Malignant Brenner vs. TCC
• rare
• elderly women
• Unilateral and Cystic

23
Undifferentiated Carcinoma

• Poor Prognosis

24
Mixed Epithelial Tumors

• 2 or more cell types in 10 of tumor
• Each 10 or more of total area
• Mixed LMP Mucinous with Serous or Endometrioid
• Mixed Carcinoma Endometrioid with Clear, Serous,
  Mucinous

25
Misc.

• Small Cell Carcinoma of Hypercalcemic Type
• Small Cell Carcinoma Carcinoma of Pulmonary Type
• Squamous Cell Carcinoma

26
Sex Cord-Stromal Tumors

• Ovarian Differentiation
• Testicular Differentiation

27
Granulosa Cell Tumor

• Adult Type
• Juvenile Type
• lt5 before puberty

28
Adult Granulosa Cell Tumor

• 1/3 premenopausal
• 2/3 older
• assoc. with hyperestrogenic state
• vary in size
• characteristically yellow to white and cysts with
  blood

29
Juvenile Granulosa Cell Tumor

• Grossly similar to Adult Form
• Neoplastic Granulosa Cells scattered among which
  are varying numbers of follicles.

30
Granulosa Cell Tumor
31
Adult Granulosa Cell Tumor
32
Germ Cell Tumors

• 30 Ovarian Tumors
• 95 Dermoid Cysts
• 3 Ovarian Ca
• 2/3 of Ca in first 2 decades

33
3 Basic Types

• Immature Germ Cell (Children)
• Immature Germ Cells (Dysgerminoma)
• Early Embryonic Development (Embryonal,Polyembryom
  a)
• Extraembryonic Differentiation (Choriocarcinoma,
  Yolk Sac Tumor)
• Immature Somatic Tissue (Immature Teratoma)

34

• Mature Germ Cell Tumor (Reproductive Years)
• Most common
• Mature Somatic Tissue

35

• Benign Cystic Teratoma giving rise to malignancy
  (Postmenopausal)
• Squamous Cell Carcinoma
• Carcinoid
• Malignant Thyroid Cancer

36
Dysgerminoma

• Most Common Germ Cell Tumor
• 100 5yr survival St I
• Radio and Chemosensitive
• Solid, 15cm
• Primordial Germ Cells Fibrous Stroma w/
  Lymphocytes

37
Dysgerminoma
38
Yolk Sac (Endodermal Sinus) Tumor

• AFP
• Rapidly growing highly malignant
• Chemotx
• 80 5yr survival St I
• 25 rupture
• hemorrhage, necrosis
• Schiller-Duvall bodies

39
Yolk Sac Tumor
40
Embryonal

• Very Rare
• mean age 15
• HCG, AFP
• 15 cm
• Anaplastic large Cells

41
Choriocarcinoma

• Very rare
• lt 20 yr
• HCG

42
Teratomas

• Immature
• 18cm, solid
• immature tissue
• neuroectodermal
• neuroepithelial rosettes

43
Immature Teratoma
44
Metastatic Tumors

• Krukenberg Tumor