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OVARY 2 Neoplasms of the Ovary

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Presentation on theme: "OVARY 2 Neoplasms of the Ovary"— Presentation transcript:

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

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

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