ovary

Fifth stage

Gynecology
Lec-

9/5/2017

Ovarian Neoplasms

Objectives of this lecture

To learn the different type of ov. Tumor .
To differentiate between benign& malignant ov.tumor .
To know the clinical presentation,staging &diagnosis of ov. Tumor.
To learn the managment of ov. Tumor .

1.Tumors of Surface Epithelium form 90% of ovarian tumors

2. Germ Cell Tumors
3. Sex cord-stromal tumour
4.Metastatic Tumors of Ovary.


Surface Epithelium
1.Mucinous Tumors
Incidence – 30% of ovarian neoplasms
Mucinous cyst adenoma
Commonest tumor
Age group: 30-50 yrs
Bilateral in 10%
Mucinous cystadenocarcinoma
Age group: 40-60 yrs
Bilateral in 10 %
Features
Large multilocular pedunculated cyst
Rare complication may occur with involvement of the peritoneum
Psedomyxomaperitonei (jelly belly)
May produce coarse calcifications in primary or metastases
2.Serous Tumors
Incidence – 50% of ovarian neoplasms
Serous cystadenoma:
Age group: 20 – 30 yrs
Bilateral in 15%
Malignant transformation in 20 – 30 %
Serous cystadenocarcinoma:
Age group: 40 – 60 yrs
Bilateral in 30%
5 year survival rate: 30 – 50 %
Features:
Contain fibrous walled cysts with papillary excrescences
Locules contain straw-colored fluid
Psammoma bodies=concentric calcification in papillary process
Usually fine sand-like calcification frequently difficult to see on plain radiographs
3.Endometrial tumors
Incidence – 20% of ovarian tumors
Morphology:
Tumors containing solid and cystic areas
Filled with hemorrhagic fluid
Lined by glandular epithelium
4.Clear Cell (mesonephroid tumor)
Incidence: uncommon
Age group: 50 – 60 yrs
Morphology:
Unilocular cysts with small cystic spaces
5.Brenner tumor:
Incidence: 1- 2%
Occur commonly in perimenopausal women


Germ Cell Tumors
Origin : cells derived form oocytes
Incidence: 15- 20% of all ovarian tumors, 5% malignant
Age: young age

1.Dysgerminoma

Incidence : very common
Age : 20 – 20 yrs
Bilateral : 10 – 15 %
Macroscopic features :
Solid tumors, elastic rubbery consistency having smooth, firm capsule
2.Teratoma
Derived from cells of all three germ layers
Types:
Mature or benign type (e.g. Dermoid cysts)
Immature or malignant type (e.g. Solid Teratoma)
Monodermal or highly specialized (e.g. Struma ovarii)
3.Choriocarcinoma and Embryonal Cell Carcinoma
Choriocarcinoma mostly of placental origin occurs in prepubertal girls. Highly malignant
Contains syncytiotrophoblasts and cytotrophoblasts
Secretes large quantities of the tumor marker - HCG
Embryonal cell carcinoma
Incidence : rare
Highly malignant
4.Ovarian Fibroma:
Meig’s syndrome
Ascites
Right sided effusion


Krukenberg tumor
Primary : 15% - small & large bowel , 20% - stomach, 6% - breast
Bilateral smooth surface
Histologically cellular or myxomatous stroma with scattered large signet ring cells

Routes of Peritoneal Spread

Right subphrenic space
The greater omentum
The Pouch of Douglas