Department of pathology Prof:- Adiga

Student name :- Saeed Ayed saed Abdulrahman Awagi Alnami Muhannad Ali Asiri Faris Ali Nasser Ovarian Tumor

Introduction  Common neoplasms.  Ovarian cancer is second common malignancy of the female genital tract (after endometrial cancer).  80% are benign – young (20-45)  20% are Malignant - older (>40) o 50% deaths due to late detection o Majority of ovarian tumors are benign

Incidence Rates

Incidence of Ovarian tumors by histopathology  A-Surface epithelial 65-70%  B-Germ cell tumors15-20%  C-sex cord - stroma 5-10%  D-Metastatic tumors – 5%

A-Surface Epithelial tumors all types can be benign, borderline, or malignant, depending;  Benign ; - gross: mostly cystic - microscopic; fine papillae, single layer covering (no stratification), no nuclear atypia, no stromal invasion  Borderline ; - gross; cystic / solid foci - microscopic; papillary complexity, stratification, nuclear atypia, no stromal invasion  Malignant ; - gross; mostly solid & hemorrhage / necrosis - microscopic; papillary complexity, stratification, nuclear atypia, stromal invasion

Surface Epithelial tumors Divided into:  1-Serous (tubal)  2-Mucinous (endocx & intestinal)  3-Endometrioid  Transitional cell - Brenners.  Clear cell

1-Serous Tumors:  Frequently bilateral (30-66%).  75% benign and Borderline / 25% malignant. *Cysts are lined by tall columnar, ciliated epithelial cells (fallopian tube type) & filled with serous fluid. *Types: 1-Benign Serous Tumors (Cystadenomas): ( 60%) smooth lining & no solid areas 2- Borderline Serous Tumors : (15%) epithelial atypia, but no stromal invasion. 30% are bilateral. 3-Malignant Serous Tumors (Cystadenocarcinomas): (25%) multilayered epithelium with atypia&invading the stroma.

Serous Cystadenoma: single layer of columnar ciliated Fine papillae

2-Mucinous Tumors : Less common 25%, very large. Rare malignant - 15%. Multi loculated, many small cysts. Rarely bilateral – 5-20%. Tall columnar, apical mucin.

Mucinous cystadenoma Multilocular cyst lined by single layer of columnar cells with basally placed nuclei and apical mucin.

3-Endometrioid tumors  most are unilateral (40% are bilateral)  almost all are malignant  about 20% of all ovarian tumors  many are associated with endometrial cancer (30%)  patient may have concurrent endometriosis

Endometrioid tumors *Solid / cyst filled by hemorrhage & necrosis

B-Germ cell Tumors  1-Teratoma  2-Dysgerminoma  3-Yolk sac tumor (Endodermal sinus tumor )  4-Choricarcinoma  5-Mixed germ cell tumor

1-TERATOMA : Most common Germ Cell Tumor benign mature cystic teratomas (lined by skin & hairs, and filled with sebaceous secretion. there may be mature cartilage, bone, teeth & other structures. (10-15% are bilateral) *Immature teratoma –contain immature tissues. Grading is based on the amount of immature neuroepithelium. Uncommon * Specialized Teratomas: differentiate along the line of single tissue. Example:- Struma ovarii (mature thyroid tissue ). Rare

Cystic Teratoma Cyst with hair and cheesy material

2-Dysgerminoma  The ovarian counterpart of the testicular seminoma  2% of all ovarian malignancy  Most common malignant germ cell tumor  It is the most ovarian malignancy in pregnancy  An excellent prognosis. Highly radiosensitive.

Dysgerminoma Solid/ lobulated mass with foci of hemorrhage sheets of monotonous rounded cells with pale cytoplasm and central nuclei

3-Endodermal sinus tumor (Yolk sac carcinoma )  Tumor is a highly malignant and clinically aggressive neoplasm  Most frequently in children and young females  20% of malignant germ cell tumors.  Fatal within 2 years of diagnosis Schiller-Duval body

C- Sex Cord - Stromal Tumors  Granulosa-cell tumor  Thecoma  Fibroma  Sertoli-Leydig cell tumors

1-Granulosa Cell Tumor -Hormonally active tumor -The most common estrogenic ovarian neoplasm 2-Thecoma -Functional tumors producing estrogen

3- FIBROMA  These tumors for about 2-5% of all ovarian tumors.  These solid ovarian tumors may be associated with Meigs’ syndrome. Large firm fibrous mass Spindle shaped

D- Metastases to ovary  About 3% of malignant tumors in the ovary are metastatic  The primary tumors is from abdominal and breast tumors *Krukenberg tumor - It is applied to the uniform enlargement of the ovaries (usually bilaterally) due to diffuse infiltration of the ovarian stroma by metastatic signet-ring cell carcinoma. -The commonest primary site is the stomach followed by the colon.

Staging Stage I. growth limited to the pelvis 1- One ovary 2- both ovaries 3- 1 or 2 and ovarian surface tumor,rupture capsule, malignant ascites, peritoneal cytology positive. Stage II. Extension to the pelvis 1- extension to the uterus or fallopian tube 2- extension to the other pelvic tissues 3- 1 or 2 and ovarian surface tumor,rupture capsule, malignant ascites, peritoneal cytology positive. Stage III.Extension to abdominal cavity 1- abdominal peritoneal surfaces with microscopic metastases 2- tumor metastases <2cm in size 3- tumor metastases >2cm or metastatic disease in pelvic para aortic or inguinal lymph nodes Stage IV. Distant metastases Malignant pleural effusion Pulmonary parenchymal metastases Liver or splenic paranchyml metastases Metastases to thr supraclavicular lymph nodes or skin

prognosis Related to Response to chemotherapy Differentiation of tumor  * 5-year survival in ovarian epithelial carcinoma is low because of the tumor become strong of late- stage disease at diagnosis..  Stage I and II: %  Stage III: 15-20%  Stage IV: 5%  Patients under 50 in all stages have better 5-year survival than older patients (40% compared to 15%)  Dysgerminomas treated by surgery and radiation have an excellent cure rate in both early and late-stage disease  Endodermal sinus tumour has poor prognosis.  Germ cell better than epithelial

Information Radner's death from ovarian cancer in 1989 helped to raise awareness of early detection and the connection to familial epidemiology