Ovarian TumorsEpidemiology

-Ranks below only carcinoma of the cervix and the endometrium .

-Ovarian cancer accounts for 6% of all cancers in the female

- fifth most common form of cancer in women in the United States (excluding skin cancer) .

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Ovarian TumorsRisk Factors

1-Nulliparity:Higher frequency of carcinoma in unmarried women and in married women with low parity.

2-family history .5-10% of ovarian cancers are familial.

Two genes may be altered in susceptible families (i.e., ovarian cancer genes) .

mutations in both BRCA1 and BRCA2 increase susceptibility to ovarian cancer .

The estimated risk of ovarian cancer in women bearing BRCA1 or BRCA2 is 16% by the age of 70 years.Prolonged use of oral contraceptives reduce the risk of developing ovarian cancer

Ovarian TumorsClassification

Serous Tumor-These are the most common ovarian tumors.

They are usually cystic filled with clear serous fluid.Together the benign, borderline, and malignant types account for about 30% of all ovarian tumors .

About 75% are benign or of borderline malignancy, and 25% are malignant .

Serous cystadenocarcinomas account for approximately 40% of all cancers of the ovary and are the most common malignant ovarian tumors .

Benign and borderline tumors are most common between the ages of 20 and 50 years .Cystadenocarcinomas occur later in life on average.

Serous TumorGross

Serous TumorMicro

Benign tumors:The lining epithelium is composed of columnar epithelium with abundant cilia, microscopic papillae may be found .

Borderline tumors:There is increased complexity of the stromal papillae with stratification of the epithelium and nuclear atypia, but no destructive infiltrative growth into the stroma .

Serous TumorMicro

psammoma bodies

Serous TumorPrognosis

-The 5-year survival rate for borderline and malignant tumors confined within the ovarian mass is 100% and 70%.

-Whereas the 5-year survival rate for the same tumors involving the peritoneum is about 90% and 25%, respectively .

-Borderline tumors may recur after many years, and 5-year survival is not synonymous with cure .

Mucinous TumorsThese tumors closely resemble their serous counterparts .

They are less common, accounting for about 25% of all ovarian neoplasms .

They occur principally in middle adult life and are rare before puberty and after menopause .

80% are benign, 10 % borderline, and about 10% are malignant.

Mucinous cystadenocarcinomas are relatively uncommon and account for only 10% of all ovarian cancers.

Endometrioid TumorsThese neoplasms account for approximately 20% of all ovarian cancers.

Most endometrioid tumors are carcinomas.

They are distinguished from serous and mucinous tumors by the presence of tubular glands bearing a close resemblance to benign

or malignant endometrium.

Brenner TumorThese are uncommon ovarian tumors in which the epithelial component consists of nests of transitional cells resembling those lining the urinary bladder .

Less frequently, the nests contain microcysts or glandular spaces lined by columnar, mucin-secreting cells .

Clear cell carcinomaUncommon highly malignant ovarian tumor.

Germ Cell TumorsTeratomas These are divided into three categories :

1-Mature (benign)2-Immature (malignant)

3-Monodermal or highly specialized

Dysgerminoma.

Yolk Sac tumor (endodermal sinus tumors)Choriocarcinoma.

Mature Cystic TeratomaMicroscopic

Dysgerminoma