Dr.Ahmed Jasim gynecology
Ovarian NeoplasmsObjectives of this lecture
1.To learn the different type of ov. Tumor .2. to differentiate between benign& malignant ov.tumor .3.to know the clinical presentation ,staging &diagnosis of ov. Tumor.
4. 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 tumour4.Metastatic Tumors of Ovary.
Surface Epithelium
1.Mucinous TumorsIncidence 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-Psedomyxoma peritonei (jelly belly)
-May produce coarse calcifications in primary or metastases
Surface Epithelium
2.Serous TumorsIncidence 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
Surface Epithelium
3.Endometrial tumors
Incidence 20% of ovarian tumors
Morphology:
_Tumors containing solid and cystic areas
_Filled with hemorrhagic fluid
_Lined by glandular epithelium
Surface 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 oocytesIncidence: 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