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 >15 cm
Cystic and Solid
3% bilateral
Endometriosis

19. Clear Cell Carcinoma

20. Brenner Tumor

21. Transitional Cell LMP > 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
<5% 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,Polyembryoma)
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
< 20 yr
HCG

42. Teratomas Immature 18cm, solid immature tissue neuroectodermal
neuroepithelial rosettes

43. Immature Teratoma

44. Metastatic Tumors
Krukenberg Tumor