OvaryOvaryDr. Amitabha Basu MDDr. Amitabha Basu MD

TopicTopic

Normal ovaryNormal ovary Polycystic ovaryPolycystic ovary Tumors of the ovaryTumors of the ovary

Normal ovary grossNormal ovary gross

MicroMicro

Th) Theca(MG) Membrana granulosa (CR) Corona radiata(ZP) Zona pellucida(CL) Corpus luteum

Polycystic ovarian diseasePolycystic ovarian disease

DefinitionDefinition MorphologyMorphology Clinical featuresClinical features

Def: Multiple cystic follicles in Def: Multiple cystic follicles in the ovary.the ovary.

Pathophysiology Pathophysiology

Excessive secretion of estrogen and Excessive secretion of estrogen and androgen.androgen.

High LHHigh LH Low FSHLow FSH LH/FSH Ratio: high

Clinical Clinical features/complicationsfeatures/complications

A.A. Oligomenorrhoea (Oligomenorrhoea (Polycystic Polycystic ovarian disease with ovarian disease with oligomenorrhea is known as oligomenorrhea is known as Stein-Stein-Leventhal syndromeLeventhal syndrome))

B.B. HirsuitismHirsuitism

C.C. InfertilityInfertility

D.D. Endometrial Hyperplasia. Endometrial Hyperplasia.

Tumors of the OvaryTumors of the Ovary

1.1. ClassificationClassification

2.2. SubtypesSubtypes

3.3. Age IncidenceAge Incidence

4.4. EtiopathogenesEtiopathogenesisis

A.A. Serous tumorsSerous tumors

B.B. Mucinous tumors Mucinous tumors

C.C. DysgerminomaDysgerminoma

D.D. TeratomaTeratoma

E.E. Granulosa-theca cell Granulosa-theca cell tumortumor

F.F. Sertoli Leydig cell Sertoli Leydig cell tumortumor

G.G. Metastasic tumorMetastasic tumor

ClassificationClassification

ClassificationClassification

A.A. Tumor arising form the surface Tumor arising form the surface epitheliumepithelium

B.B. Tumor arising form the germ cellsTumor arising form the germ cells

C.C. Tumor arising form Sex-cord stroma Tumor arising form Sex-cord stroma surface epitheliumsurface epithelium

D.D. Metastasic tumorMetastasic tumor

Tumor arising form the surface Tumor arising form the surface epitheliumepithelium

OriginOrigin Germ cellsGerm cells

FrequencyFrequency 15-20%15-20%

Proportion of Proportion of malignant malignant ovarian tumor.ovarian tumor.

3-5%3-5%

Age groupAge group 0-25+ years 0-25+ years

TypesTypes 1.1.TeratomaTeratoma

2.2.DysgerminomaDysgerminoma

3.3.Endodermal Endodermal sinus tumorsinus tumor

4.4.ChoriocarcinomaChoriocarcinoma

Tumor arising from sex cord Tumor arising from sex cord stromastroma

FrequencyFrequency 5-10%5-10%

Proportion of Proportion of malignant ovarian malignant ovarian tumor.tumor.

2-3%2-3%

Age groupAge group All ageAll age

TypesTypes 1.1. FibromaFibroma

2.2. Granulosa-Granulosa-theca cell theca cell tumortumor

3.3. Sertoli Leydig Sertoli Leydig cell tumorcell tumor

Metastasic tumorMetastasic tumor

FrequencyFrequency 5%5%

Proportion of Proportion of malignant ovarian malignant ovarian tumor.tumor.

5%5%

Age groupAge group All ageAll age

Example :Example : Krukenberg Krukenberg tumortumor

EtiopathogenesisEtiopathogenesis

MultipartyMultiparty Family Family

historyhistory

GenesGenes

1.1. BRCA 1 AND BRCA BRCA 1 AND BRCA 2 2

( IN HEREDITARY ( IN HEREDITARY OVARIAN CANCEROVARIAN CANCER))

1.1. ERB B2ERB B22.2. K-RASK-RAS3.3. TP53TP53

Serous tumor : TypesSerous tumor : Types

1.1. BenignBenign

2.2. Borderline Borderline

3.3. Malignant Malignant

Note: All surface epithelial tumors can be divided in these

three types

Features of Serous tumorFeatures of Serous tumor Common ovarian Common ovarian

tumor.tumor. Mostly benign.Mostly benign. Cysts are lined by Cysts are lined by

single Ciliated single Ciliated columnar columnar epithelium.epithelium.

Cyst contain serous Cyst contain serous fluid.fluid.

Bilateral (25%)Bilateral (25%) Usually Small. Usually Small.

Microscopy of serus tumor: Microscopy of serus tumor: Cysts are Cysts are lined by single Ciliated columnar lined by single Ciliated columnar

epitheliumepithelium

Borderline Serous TumorBorderline Serous Tumor

Between benign cyst adenomas and Between benign cyst adenomas and malignant cystadenocarcinomas lies malignant cystadenocarcinomas lies the grey zone of "borderline" lesions the grey zone of "borderline" lesions that are not clearly malignant, that are not clearly malignant, but are treated as though they but are treated as though they could be. could be.

Malignant serous Tumor : Malignant serous Tumor : Papillary Papillary serous cystadenocarcinomasserous cystadenocarcinomas : note : note

papillary areas.papillary areas.

Microscopy : Papillary process and Microscopy : Papillary process and cellular crowding and Psammoma body cellular crowding and Psammoma body

(not seen)(not seen)

Psammomma body in serous Psammomma body in serous tumors( malignant)tumors( malignant)

Spread of the tumorSpread of the tumor

These neoplasms characteristically These neoplasms characteristically spread by "seeding" along peritoneal spread by "seeding" along peritoneal surfaces.surfaces.

Marker for Surface epithelial tumors: Marker for Surface epithelial tumors: CA 125CA 125

Features of Mucinous tumorFeatures of Mucinous tumor Not common ( 10%), LargeNot common ( 10%), Large Cysts are lined by single layer Cysts are lined by single layer

Mucin secreting columnar Mucin secreting columnar epithelium.epithelium.

Cyst contain Mucinous Cyst contain Mucinous gelatinous fluid: if rupture gelatinous fluid: if rupture produce Pseudomyxoma produce Pseudomyxoma peritonei.peritonei.

Histology : Multilocular cysts lined by a single Histology : Multilocular cysts lined by a single layer of benign mucinous columnar layer of benign mucinous columnar

epithelium.epithelium.

Compare Serous and mucinous tumorsCompare Serous and mucinous tumors

TeratomaTeratoma

TypesTypes Dermoid cystDermoid cyst Immature malignant TeratomaImmature malignant Teratoma Struma Ovarii.Struma Ovarii.

TypesTypes

1.1. Benign Teratoma ( Mature: usually Benign Teratoma ( Mature: usually cystic)cystic)

2.2. Malignant Teratoma( Immature : Malignant Teratoma( Immature : usually solid)usually solid)

3.3. Monodermal Teratoma ( carcinoid Monodermal Teratoma ( carcinoid Tumor, struma ovarii)Tumor, struma ovarii)

Benign Teratoma ( Mature)Benign Teratoma ( Mature)of ovaryof ovary

It is also called Dermoid cyst. It is also called Dermoid cyst. ( because it contains dermal ( because it contains dermal appendages).appendages).

Dermoid cyst : Mature cystic Dermoid cyst : Mature cystic TeratomaTeratoma

Immature Malignant Immature Malignant TeratomaTeratoma

Mean age : 18 yearsMean age : 18 years Features : bulky, solidFeatures : bulky, solid Histology : Tissue containing Histology : Tissue containing

immature neural tissue with immature neural tissue with neuroepithelial differentiation.neuroepithelial differentiation.

DysgerminomaDysgerminoma

Etiopathogenesis : Etiopathogenesis : Occur with Occur with gonadal dygenesis.gonadal dygenesis.

Radiosensitive tumor : 80% cureRadiosensitive tumor : 80% cure UnilateralUnilateral

Grey white homogenousGrey white homogenous

Mimic Seminoma histology !Mimic Seminoma histology !

Granulosa-theca cell tumorGranulosa-theca cell tumor

Age : Post menopause but any ageAge : Post menopause but any age UnilateralUnilateral Diagnostic point : Presence of call Diagnostic point : Presence of call

Exner body in Histology.Exner body in Histology. Function: Secrete estrogen ; promote Function: Secrete estrogen ; promote

endometrial, breast carcinoma.endometrial, breast carcinoma.

Presence of call Exner bodyPresence of call Exner body

Sertoli Leydig cell tumorSertoli Leydig cell tumor

Age: all ageAge: all age UnilateralUnilateral Point for identification: Point for identification: Gross:Gross:

Yellow brown, solid. Yellow brown, solid. Micro:Micro: Pink Pink Sertoli Leydig cells.Sertoli Leydig cells.

Clinical effect: Masculinizing Clinical effect: Masculinizing ( defeminizing( defeminizing).).

Gross:Gross: Yellow brown, solid. Yellow brown, solid.

Struma ovariiStruma ovarii

In this tumor the Teratoma In this tumor the Teratoma contain contain predominantly predominantly thyroid tissue.thyroid tissue.

Struma ovarii : produce Struma ovarii : produce Hyperthyroidism Hyperthyroidism

Metastasic tumorMetastasic tumor

Age: older age Age: older age Primary Tumor: Breast, lung, GITPrimary Tumor: Breast, lung, GIT Big bilateral massBig bilateral mass Example : Example : Tumor nameTumor name : :

Krukenberg tumorKrukenberg tumor

Krukenberg tumorKrukenberg tumor

1.1. Primary tumor Primary tumor : Gastric : Gastric adenocarcinomaadenocarcinoma

2.2. Route of metastasisRoute of metastasis : Seeding : Seeding through body cavity.through body cavity.

3.3. Bilateral alwaysBilateral always..

4.4. Histology : contain “ signet Histology : contain “ signet ring” cells.ring” cells.

GrossGross

Nice to Know this Tumor: Nice to Know this Tumor: Thecoma-fibromaThecoma-fibroma

Any ageAny age UnilateralUnilateral Produce Meigs Produce Meigs

syndrome( ovarian tumor with syndrome( ovarian tumor with ascites and Hydrothorax)ascites and Hydrothorax)

Review Review

Endometriosis ( clinical features)Endometriosis ( clinical features) Endometrial Hyperplasia . Etiology Endometrial Hyperplasia . Etiology

with C/Fwith C/F Dermoid cyst Gross identification.Dermoid cyst Gross identification. Leiomyoma identification and c/fLeiomyoma identification and c/f Carcinoma in situCarcinoma in situ Granulosa theca cell tumor.Granulosa theca cell tumor.

ReviewReview

Metastasic tumorsMetastasic tumors Ectopic pregnancyEctopic pregnancy Genes for Ovarian cancers.Genes for Ovarian cancers. Clear cell carcinomaClear cell carcinoma Vaginitis Vaginitis Lichen sclerosusLichen sclerosus Polycystic ovaryPolycystic ovary Gonorrhea infection (PID)Gonorrhea infection (PID) Anovulatory cycle : and other Causes of Anovulatory cycle : and other Causes of

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