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Department of pathology

Department of pathology. Prof:- Adiga. Ovarian Tumor. Student name :- Saeed Ayed saed -432800220 Abdulrahman Awagi Alnami -432800221 Muhannad Ali Asiri -432800225 Faris Ali Nasser- 432800229. Introduction. Common neoplasms .

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Department of pathology

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  1. Department of pathology Prof:- Adiga

  2. Ovarian Tumor Student name :- SaeedAyedsaed -432800220 AbdulrahmanAwagiAlnami -432800221 Muhannad Ali Asiri -432800225 Faris Ali Nasser- 432800229

  3. 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) • 50% deaths due to late detection • Majority of ovarian tumors are benign

  4. Incidence Rates

  5. Incidence of Ovarian tumors by histopathology • A-Surface epithelial 65-70% • B-Germ cell tumors15-20% • C-sex cord - stroma5-10% • D-Metastatic tumors – 5%

  6. 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 stromalinvasion • 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

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

  8. 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 .

  9. Serous Cystadenoma: • single layer of columnar ciliated • Fine papillae

  10. 2-Mucinous Tumors: • Less common 25% , very large. • Rare malignant - 15%. • Multi loculated , many small cysts. • Rarely bilateral – 5-20%. • Tall columnar, apical mucin.

  11. Mucinouscystadenoma • Multilocular cyst lined by single layer of columnar cells with basally placed nuclei and apical mucin.

  12. 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

  13. Endometrioid tumors *Solid / cyst filled by hemorrhage & necrosis

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

  15. 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

  16. Cystic Teratoma Cyst with hair and cheesy material

  17. 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 .

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

  19. 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

  20. C- Sex Cord - Stromal Tumors • Granulosa-cell tumor • Thecoma • Fibroma • Sertoli-Leydig cell tumors

  21. 1-Granulosa Cell Tumor -Hormonally active tumor -The most common estrogenic ovarian neoplasm 2-Thecoma -Functional tumors producing estrogen

  22. 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

  23. 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.

  24. 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 splenicparanchyml metastases • Metastases to thrsupraclavicular lymph nodes or skin

  25. 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: 80-100% • 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 tumourhas poor prognosis. • Germ cell better than epithelial

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

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